Pleurisy or pleuritis describes the chest pain syndrome characterized by a sharp chest cavity pain that worsens with breathing. Pleurisy is caused by inflammation of the linings around the lungs (the pleura), a condition also known as pleuritis.

There are two layers of pleura: one covering the lung (termed the visceral pleura) and the other covering the inner wall of the chest (the parietal pleura). These two layers are lubricated by plural fluid.

Pleurisy is frequently associated with the accumulation of extra fluid in the space between the two layers of plural. This fluid is referred to as a pleural effusion.

The pain fibers of the lung are located in the pleura. When this tissue becomes inflamed, it results in a sharp pain in the chest that is worse with breathing. Other symptoms of pleurisy can include cough, chest tenderness, and shortness of breath.

Pleurisy involves inflammation of the tissue layers (pleura) lining the lungs and inner chest wall.

Pleurisy is often associated with the accumulation of fluid between the two layers of pleura, known as pleural effusion.

Pleurisy is caused by a variety of conditions, such as: –

• Infections,
• Tuberculosis (TB),
• Congestive heart failure,
• Cancer,
• Pulmonary embolism,
• Collagen vascular diseases: Ankylosing spondylitis. Dermatomyositis. Polyarteritis nodosa. Polymyositis. Psoriatic arthritis. Rheumatoid arthritis. Scleroderma. Systemic lupus erythematosus.

Symptoms

Symptoms of pleurisy include pain in the chest, which is aggravated by breathing in, shortness of breath, and local tenderness. This pain can affect the chest cavity in either the front or back of the cavity and sometimes patients have back or shoulder pain.

Diagnosis

The diagnosis of pleurisy is made by the characteristic chest pain and physical findings on examination of the chest. The sometimes-associated pleural accumulation of fluid (pleural effusion) can be seen by imaging studies (chest X-ray, ultrasound, or CT).

Analysis of pleural fluid aspirated from the chest can help determine the cause of pleurisy.

Allopathic treatment for Pleurisy

Treatment of the underlying conditions is key to the proper management of pleurisy.

Thoracentesis Procedure

The pleura is composed of two layers of thin lining tissue. The layer covering the lung (visceral pleura) and the parietal pleura that covers the inner wall of the chest are lubricated by pleural fluid. Normally, there are about 10-20 ml of a clear liquid that acts as a lubricant between these layers. The fluid is continually absorbed and replaced, mainly through the outer lining of the pleura.

The pressure inside the pleura is negative (as in sucking) and becomes even more negative during inspiration. The pressure becomes less negative during exhalation. Therefore, the space between the two layers of pleura always has negative pressure. The introduction of air (positive pressure) into the space (such as an open wound) will result in a collapse of the lung.

When is thoracentesis performed?

Thoracentesis is performed when the pleural fluid gets collected in the chest (pleural effusion) and the doctor should determine the reason for it besides reducing symptoms due to the effusion. Common conditions for which thoracentesis may be performed are as follows:

• Pleural effusion associated with congestive heart failure.
• Empyema (pus in the pleural space).
• Pulmonary embolism.
• Congestive heart failure.
• Cancer.
• Pulmonary hypertension.
• Pneumonia.
• Liver failure.
• Tuberculosis

Causes of pleurisy

Pleurisy can be caused by any of the following conditions:

• Infections: bacterial (including those that cause tuberculosis), fungi, parasites, or viruses.
• Inhaled chemicals or toxic substances: exposure to some chemical agents like ammonia, drug factories, chemical and paint factories, agricultural sprays etc.
• Collagen vascular diseases: lupus, rheumatoid arthritis.
• Cancers: for example, the spread of lung cancer or breast cancer to the pleura.
• Tumors of the pleura: mesothelioma or sarcoma.
• Congestion: heart failure.
• Pulmonary embolism: blood clot inside the blood vessels to the lungs. These clots sometimes severely reduce blood and oxygen to portions of the lung and can result in death to that portion of lung tissue (lung infarction). This, too, can cause pleurisy.
• Inflammatory bowel disease.
• Sickle cell disease.
• Certain allopathic medications for example hydralazine, isoniazid, procainamide, paracetamol etc.
• Obstruction of lymph channels: as a result of centrally located lung tumors.
• Trauma: rib fractures or irritation from chest tubes used to drain air or fluid from the pleural cavity in the chest.
• Certain allopathic drugs: allopathic drugs that can cause lupus-like syndromes (such as hydralazine, Procan, phenytoin, paracetamol etc.).
• Abdominal processes: such as pancreatitis, cirrhosis of the liver, gallbladder disease, and damage to the spleen.
• Pneumothorax: air in the pleural space, occurring spontaneously or from trauma.

Symptoms of pleurisy include:

1. pain in the chest that is aggravated by breathing,
2. shortness of breath, and/or
3. a “stabbing” sensation.

The most common symptom of pleurisy is pain that is generally aggravated by inspiration. Although the lungs themselves do not contain any pain nerves, the pleura contains abundant nerve endings. When extra fluid accumulates in the space between the layers of pleura, the pain usually is a less severe form of pleurisy. With very large amounts of fluid accumulation, the expansion of the lungs can be limited, and shortness of breath can worsen.

The thoracic cavity represents both the front and back of the upper portion of the body. If the inflammation is more toward the back, then the pain may be described as back pain. Of importance is that with pleurisy; the pain will worsen with deep breaths. Most other causes of back pain don’t have this quality, however, for some people, back pain will worsen with cough. (As can be seen in spinal disc disease.)

Diagnosis Pleurisy

The pain of pleurisy is very distinctive. The pain is in the chest and is usually sharp and aggravated by breathing. However, the pain can be confused with the pain of inflammation around the heart (pericarditis), or heart attack.

To make the diagnosis of pleurisy, a doctor examines the chest in the area of pain and can often hear (with a stethoscope) the friction that is generated by the rubbing of the two inflamed layers of pleura with each breath. The noise generated by this sound is termed a pleural friction rub. (In contrast, the friction of the rubbing that is heard with pericarditis occurs synchronous with the heartbeat and does not vary with respiration.).

With large amounts of pleural fluid accumulation, there can be decreased breath sounds (less audible respiratory sounds heard through a stethoscope) and the chest is dull sounding when the doctor drums on it (dullness upon percussion).

A chest X-ray is taken in the upright position and while lying on the side is a tool for diagnosing fluid in the pleural space. It is possible to estimate the amount of fluid collection by findings on the X-ray. Occasionally, as much as 4-5 liters of fluid can accumulate inside the pleural space.

Ultrasonography is a method of detecting the presence of pleural fluid.

A CT scan can be very helpful in detecting very small amounts of fluid and trapped pockets of pleural fluid, as well as in determining the nature of the tissues surrounding the area.

Removal of pleural fluid with a needle and syringe (aspiration) is essential in diagnosing the cause of pleurisy. The fluid’s color, consistency, and clarity are analyzed in the laboratory. The fluid analysis is defined as either an “exudate” (high in protein, low in sugar, high in LDH enzyme, and high white cell count; characteristic of an inflammatory process) or a “transudate” (containing normal levels of these body chemicals).

Causes of exudative fluid include infections (such as pneumonia), cancer, tuberculosis, and collagen diseases (such as rheumatoid arthritis and lupus).

Causes of transudative fluid are congestive heart failure and liver and kidney diseases. Pulmonary emboli can cause either transudates or exudates in the pleural space.

The fluid can also be tested for the presence of infectious organisms and cancer cells. In some cases, biopsy can be done for microscopic study if there is suspicion of tuberculosis (TB) or cancer.

Thoracoscopy; A small, lighted tube with a camera to look inside the lungs and find any problems.

Allopathic treatments for pleurisy

Thoracentesis

External splinting of the chest wall and pain medication (non-steroidal anti-inflammatory drugs or NSAIDs and Corticosteroids) can reduce the pain of pleurisy.

Treatment of the underlying disease, of course, ultimately relieves pleurisy. For example, if a heart, lung, or kidney condition is present, it is treated. Removal of fluid from the chest cavity (thoracentesis) can relieve the pain and shortness of breath. Sometimes fluid removal can make pleurisy temporarily worse because, without the lubrication of the fluid, the two inflamed pleural surfaces can rub directly on each other with each breath.

If the pleural fluid shows signs of infection, appropriate treatment involves antibiotics and drainage of the fluid. If there is pus inside the pleural space, a chest drainage tube should be inserted. This procedure involves placing a tube inside the chest under local anesthesia. The tube is then connected to a sealed chamber that is connected to a suction device in order to create a negative pressure environment. In severe cases, in which there are large amounts of pus and scar tissue (adhesions), there is a need for “decortication.” This procedure involves examining the pleural space under general anesthesia with a thoracoscope. Through this pipelike instrument, the scar tissue, pus, and debris can be removed. Sometimes, an open surgical procedure (thoracotomy) is required for more complicated cases.

In cases of pleural effusion that result from cancer, the fluid often reaccumulates. In this setting, a procedure called pleurodesis is used. This procedure entails instilling an irritant, such as bleomycin, tetracycline, or talc powder {I Dr Qaisar Ahmed) strictly not recommend talcum powder as it contains “aluminum oxide” which in near future could cause cancer in absolutely healthy patient}, inside the space between the pleural layers in order to create inflammation. This inflammation, in turn, will adhere or tack the two layers of pleura together as scarring develops. This procedure thereby obliterates the space between the pleura and prevents the re-accumulation of fluid.

Homeopathic treatment for Pleurisy

Homeopathy is one of the most popular holistic systems of medicine throughout the world now a days. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach. The aim of homeopathy is not only to treat the diseases but to address its underlying cause and individual susceptibility. As far as therapeutic medication is concerned, many medicines are available to treat pleurisy, here are very few of them:

Aconit Lycoctonum

Difficult respiration. Slight cough with watery expectoration. Difficult respiration. Slight cough with watery expectoration. After a slight chill, cough leaving a taste of, blood in the mouth.

Bryonia Alba

Asthma. Bilious attack. Bronchitis. Consumption (TB). Coryza. Cough. Influenza. Pleurisy. Pleurodynia. Pneumonia. Whooping-cough. Stitches in chest, and expectoration of rust-colored sputa. Frequent desire to take a long breath. Difficult, quick respiration; worse every movement; caused by stitches in chest. Croupous and pleuro-pneumonia. Tough mucus in trachea. Heaviness beneath the sternum extending towards the shoulder. Cough worse in warm. Stitches in cardiac region. Angina pectoris (use tincture). Pleurodynia (ness in neck. Stitches and stiffness in small of back.

Cantharis Vasicatoria

Pleurisy, as soon as effusion has taken place. Intense dyspnea; palpitation; frequent, dry cough. Tendency to syncope. Short, hacking cough, blood-streaked tenacious mucus. Burning pains.

Ranunculus Bulbosus

Various kinds of pains and soreness, as if bruised in sternum, ribs, intercostal spaces, and both hypochondria. Inter-costal rheumatism. Chilliness in chest when walking in open air. Stitches in chest, between shoulder-blades; worse, inspiring, moving. Rheumatic pain in chest, as from subcutaneous ulceration. Tenderness of abdomen to pressure. Muscular pain along lower margin of the shoulder-blade; burning in small spots from sedentary employment.

Kali Carbonicum

Asthma.  Bronchitis. Catarrh (excess of mucus). Consumption (TB). Hydrothorax (water/pus in lungs). Pleurisy (inflammation of lungs covering layer). Pleurodynia. Whooping-cough. Violent cough. Pulmonary oedema. Laryngeal oedema. Awakes choking. Expectoration like soap-suds, greenish. Pneumonia, when hepatization commences. Pneumococci meningitis. Stitching pains through lungs to back. Asthma. Dyspnea on ascending, with pain in heart. Hydrothorax (Merc sulph). Pleuritic effusion.

Kali Iodatum

Violent morning cough. Pulmonary oedema. Laryngeal oedema. Awakes choking. Expectoration like soapsuds, greenish. Pneumonia, when hepatization commences. Pneumococci meningitis. Stitching pains through lungs to back. Asthma. Dyspnea on ascending, with pain in heart. Hydrothorax. Pleuritic effusion. Cold radiates downward to chest.

Senega

Hoarseness. Hurts to talk. Bursting pain in back on coughing. Catarrh of larynx. Loss of voice. Hacking cough. Thorax feels too narrow. Cough often ends in a sneeze. Rattling in chest. Chest oppressed on ascending. Bronchial catarrh, with sore chest walls; much mucus; sensation of oppression and weight of chest. Difficult raising of tough, profuse mucus, in the aged. Asthenic bronchitis of old people with chronic interstitial nephritis or chronic emphysema. Old asthmatics with congestive attacks. Exudations in Pleura. Hydrothorax. Pressure on chest as though lungs were forced back to spine. Voice unsteadies, vocal cords partially paralyzed.

Sulphur

Oppression and burning sensation in chest. Difficult respiration; wants windows open. Aphonia. Heat, throughout chest. Red, brown spots all over chest. Loose cough; worse talking, morning, greenish, purulent, sweetish expectoration. Much rattling of mucus. Chest feels heavy; stitches, with heart feeling too large and palpitating pleuritic exudations. Stitching pains shooting through to the back, worse lying on back or breathing deeply. Flushes of heat in chest rising to head. Oppression, as of a load on chest. Dyspnea in middle of night, relieved by sitting up. Pulse rapid in morning than in evening. Drawing pain between shoulders. Stiffness of nape. Sensation as if vertebrae glided over each other.

Pyrogenium

Wheezing. Cough; with large masses of phlegm. Stitching pain in back. Pain in lung and shoulder. Neglected pneumonia. Night-sweats, frequent pulse, abscess had burst discharging much pus of mattery taste. Severe contracting pain within lower sternum, sometimes extending to rib-joints and up to throat, as if esophagus being cramped. Ecchymoses on pleura.

Tuberculinum

Hard, dry cough during sleep. Expectoration thick, easy; profuse bronchorrhea. Shortness of breath, extreme rapidity of respirations without dyspnea. Sensation of suffocation. Bronchopneumonia. Hard, hacking cough, profuse sweating and loss of weight, rales all over chest. Deposits begin in apex of lung. Palpitation and pains in back with cough. Sensation of pressure in chest. Heat in chest. Sticking pain in chest. Sensation of contraction in the precordial region. Pains in both sides of chest going to back. Palpitation, caused by deep inspirations, aching in back with pains under ribs. Development of fresh tubercles: small tubercles giving rise to new ulcers have suddenly appeared, especially in pleura, pericardium, and peritoneum. Metastasis. Abscesses in the lungs. Perforating abscesses in respiratory organs.

Lobelia Cardinalis

Breathing oppressed; through day, with sticking pains on taking a deep breath; with dull, distressing pain in lower part of sternum, with same feeling on each side, forming a circle, > by beating the part gently with the hand.

Lobelia Inflata

Respiration anxious, difficult, sobbing, with sensation of obstruction in chest; short, imperfect, with sensation of fulness in chest; during inspiration, tickling in inferior region of sternum. Pain in chest, with breathing.

Merc Solebulis

Soreness from fauces to sternum. Cannot lie on side. Cough, with yellow muco-purulent expectoration. Paroxysms of two; worse, night, and from warm. Catarrh, with chilliness; dread of air. Stitches from lower lobe of right lung to back. Whooping-cough with nosebleed.

Carbo Animalis

Cough. Pleurisy. Pleurisy of typhoid character, and remaining stitch. Ulceration of lung, with feeling of coldness of chest. Cough, with discharge of greenish pus.

Squilla Maritima

Dyspnea and stitches in chest, and painful contraction of abdominal muscles. Violent, furious, exhausting cough, with much mucus; profuse, salty, slimy expectoration, and with involuntary spurting of urine and sneezing. Child rubs face with fist during cough. Cough provoked by taking a deep breath or cold drinks, from exertion, change from warm to cold air. Cough of measles. Frequent calls to urinate at night, passing large quantities.

Causticum

Hoarseness with pain in chest; aphonia. Larynx sore. Cough, with raw soreness of chest. Expectoration scanty; must be swallowed. Cough with pain in hip, especially left worse in evening; better, drinking cold water; worse, warmth of bed. Sore streak down trachea. Mucus under sternum. Pain in chest, with palpitation. Cannot lie down. Voice re-echoes. Own voice roars in ears and distresses.

Cardus Marianus

Bronchitis. Hemoptysis. Influenza. Pleurisy. Stitching pains in lower right ribs and front; worse, moving, walking, etc. Asthmatic respiration. Pain in chest, going to shoulders, back, loins and abdomen, with urging to urinate.

Arsenic Album

Unable to lie down, fears suffocation. Air-passages constricted. Asthma worse midnight. Burning in chest. Suffocative catarrh. Cough worse after midnight; worse lying on back. Expectoration scanty, frothy. Darting pain through upper third of right lung. Wheezing respiration. Hemoptysis with pain between shoulders; burning heat all over. Cough dry.

Ammonium Carbonicum

Hoarseness. Cough. Emphysema. Asthenic pneumonia. Pulmonary edema. Heart: Audible palpitation with fear, cold sweats and lachrymation. Heart weak with difficult breathing and palpitation.

Aconite nepalus

Bronchitis. Catalepsy. Catheter fever. Chest, affections of. Chickenpox. Cholera. Cholera infant. Cold. Coldness. Consumption. Convulsions. Cough. Croup. Cystitis. Pleurisy. Whooping-cough. Influenza. Pneumonia. Pleurodynia. Smell disorders. Yawning.

Amylenum Nitrosum

Dyspnea and asthmatic feelings. Great oppression and fullness of chest; spasmodic, suffocation cough. precordial anxiety. Tumultuous action of heart. Pain and constriction around heart. Fluttering at slightest excitement.

Argentum Nitricum

Dyspnoea. Chest feels as if a bar were around it. Palpitation, pulse irregular and intermittent; worse lying on right side. Painful spots in chest. Angina pectoris, nightly aggravation. Many people in a room seem to take away his breath.

Arnica Montana

Pleurodynia (chest/pleura pains). Chest, affections of. Bronchitis. Whooping-cough. Yawning. Exhaustion. Voice affections.

Antimuonium Arsenicicum

Emphysema (shortness of breath). Phthisis. Pleurisy. Pneumonia, Catarrhal pneumonia.

Apis Mellifica

Asthma. Pleurisy. Typhus. dyspnea, breathing hurried and difficult. Edema of larynx. Feels as if he could not draw another breath. Suffocation; short, dry cough, suprasternal. Hydrothorax.

Hepar Sulphuricum

Asthma. Bronchitis. Cough. Croup. Emphysema (breath shortness due to alveolars damage). Hemoptysis (bloody cough. Blood from lungs). Laryngitis. Lung’s affections. Pleurisy (water/pus in the lungs). Pneumonia. Whooping-cough.

Zizia Aurea

Severe pains in pleurae. Bruised feeling in muscles of chest. Pressure = pain in intercostal muscles. On and around xiphoid cartilage pain and tenderness to touch. Dull, aching pain under r. scapula. Severe shooting from front of thorax to scapula. Sharp pains from sides and chest to both scapulae. Severe stitching pains accompanied by feverish symptoms. Pleuritic stitching pain.

Guaiacum

Bronchitis. Cough. Pleurisy (lungs covering layer infection). Pleurodynia (pain in chest and/or abdomen when breathing).

Phosphorus

Sweetish taste while coughing. Hard, dry, tight, racking cough. Congestion of lungs. Burning pains, heat and oppression of chest. Tightness across chest; great weight on chest. Sharp stitches in chest; respiration quickened, oppressed. Pneumonia, with oppression. Violent palpitation with anxiety.

P. S: This article is only for doctors having good knowledge about Homeopathy and allopathy, for learning purpose(s).

For proper consultation and treatment, please visit our clinic.

None of above-mentioned medicine(s) is/are the full/complete treatment, but just hints for treatment; every patient has his/her own constitutional medicine.

To order medicine by courier, please send your details at WhatsApp– +923119884588

Dr. Sayyad Qaisar Ahmed (MD {Ukraine}, DHMS), Abdominal Surgeries, Oncological surgeries, Gastroenterologist, Specialist Homeopathic Medicines.

  Senior research officer at Dnepropetrovsk state medical academy Ukraine.

Location:  Al-Haytham clinic, Umer Farooq Chowk Risalpur Sadder (0923631023, 03119884588), K.P.K, Pakistan.

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