Pleurisy can result from pneumonia, tuberculosis, viruses, systemic lupus erythematosus, rheumatoid arthritis, uremia, Dressler’s syndrome, cancer, pulmonary infarction, and chest trauma.

Extensively inflamed pleural membranes may result in permanent adhesions that can restrict lung expansion. The inflammation can also stimulate excessive production and hinder reabsorption of pleural fluid, leading to pleural effusion.

The patient may report a sudden, sharp, stabbing pain that worsens on inspiration, the result of inflammation or irritation of sensory nerve endings in the parietal pleura that rub against one another during respiration. He may tell you that the pain is so severe that it limits his movement on the affected side during breathing. He may also have dyspnea. Other symptoms vary, depending on the underlying pathologic process.

When you auscultate the chest, you may hear a characteristic pleural friction rub—a coarse, creaky sound heard during late inspiration and early expiration—directly over the area of pleural inflammation. Palpation over the affected area may reveal coarse vibration.

Although diagnosis generally rests on the patient’s history and your respiratory assessment, diagnostic tests help rule out other causes and pinpoint the underlying disorder. Electrocardiography rules out coronary artery disease as the source of the patient’s pain, and chest X-rays can identify pneumonia.