Pleuritis

Background

• Pleuritis (also known as pleurisy) is nonspecific inflammation of the parietal pleura
• Most often follows a viral illness

Clinical Features

• Pleuritic chest pain
  • Typically sharp in nature, worse with respiration, coughing, sneezing, etc
• May complain of shortness of breath as a result of pain

Differential Diagnosis

• Pulmonary embolism
• Pneumonia
• Pericarditis
• Myocardial infarction
• Pneumothorax
• Pleural effusion

Chest pain

Critical

• Acute coronary syndromes (ACS)
  • STEMI
  • Non-STEMI
  • Unstable angina
• Aortic dissection
• Cardiac tamponade
• Coronary artery dissection
• Esophageal perforation (Boerhhaave's syndrome)
• Pulmonary embolism
• Tension pneumothorax

Emergent

• Cholecystitis
• Cocaine-associated chest pain
• Mediastinitis
• Myocardial rupture
• Myocarditis
• Pancreatitis
• Pericarditis
• Pneumothorax

Nonemergent

• Aortic stenosis
• Arthritis
• Asthma exacerbation
• Biliary colic
• Costochondritis
• Esophageal spasm
• Gastroesophageal reflux disease
• Herpes zoster / Postherpetic Neuralgia
• Hypertrophic cardiomyopathy
• Hyperventilation
• Mitral valve prolapse
• Panic attack
• Peptic ulcer disease
• Pleuritis
• Pneumomediastinum
• Pneumonia
• Rib fracture
• Stable angina
• Thoracic outlet syndrome
• Valvular heart disease
• Muscle sprain
• Psychologic / Somatic Chest Pain
• Spinal Root Compression
• Tumor

Evaluation

Workup

Pleuritis is a diagnosis of exclusion

• EKG
• CXR
• Consider lab testing and/or more advanced imaging per history and physical exam

Diagnosis

• Typically made clinically after ruling out emergent causes of chest pain

Management

• NSAIDs
  • Indomethacin is recommended agent (most studied)

Disposition

• Discharge