Post-pleurisy chest X-ray presentation

Written by Li Hu Chen
Imaging Center
Updated on September 23, 2024
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Patients with pleurisy, after their recovery, often exhibit certain signs on chest X-rays, such as thickening and adhesion of the pleura, and blunting of the costophrenic angle. These conditions commonly arise because diseases like pleurisy might have a somewhat extended duration or are not detected timely, lacking prompt medical treatment. Hence, pleural thickening is prone to occur, visible on X-rays at the lung margins, where localized soft tissue density appears slightly thicker. Normally, the edge of the lung at the costophrenic angle would be quite sharp, but after pleural thickening, this angle becomes blunted or even rounded. In some cases, encapsulated effusions might be seen on a chest X-ray as a spindle-shaped high-density shadow near the chest wall, which appears as a notably bright shadow.

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Written by Liu Jing Jing
Pulmonology
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Is pleurisy ascites easy to treat?

Whether pleurisy with effusion is easy to treat depends on identifying the cause of the pleurisy, which commonly includes tuberculosis, infection, and tumors. Tuberculous pleurisy can usually be cured about six months to a year after standard anti-tuberculosis treatment; infectious pleurisy generally has a good prognosis if it is sensitive to anti-infective drugs; however, pleurisy caused by tumors often indicates metastasis to the pleura, and at this stage, surgical options are no longer viable, leading to a poor prognosis. Therefore, if pleurisy is present, it is necessary to go to the hospital to complete thoracic puncture and clarify the nature of the pleural effusion, and treat according to the cause.

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Written by An Yong Peng
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What are the symptoms of pleurisy?

Pleurisy often presents with symptoms of chest pain, which tends to worsen with deep breathing. Patients with pleurisy may also experience a feeling of tightness in the chest, possibly caused by a significant accumulation of fluid in the chest cavity due to the pleurisy. Sometimes, this tightness could also be due to severe chest pain that makes the patient reluctant to inhale deeply. Patients with pleurisy are likely to exhibit symptoms of fever. It is important to note that pleurisy caused by different factors may have distinct clinical features. For example, purulent pleurisy often presents with high fever, while tuberculous pleurisy may show symptoms of tuberculosis intoxication like low-grade fever in the afternoon and night sweats. However, some cases of tuberculous pleurisy might present with high fever, and others may not have noticeable fever at all. Additionally, viral pleurisy usually features prominently painful symptoms in the chest.

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Written by Wang Chun Mei
Pulmonology
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Is it normal to have pain in the later stages of pleurisy?

Pleurisy is very common in clinical settings, caused by various pathogens invading the pleural cavity, leading to an inflammatory response. Most pleurisy patients are mainly afflicted due to infections by the tuberculosis bacillus, thus pleurisy typically comes with varying degrees of effusion, leading to different degrees of adhesion in the pleural cavity. Therefore, even during the acute phase of pleurisy, patients may suffer from symptoms such as coughing, fever, chest pain, breathlessness, and difficulty breathing. Even after effective medicinal treatment of pleurisy and full recovery, patients may still experience varying degrees of chest pain later on, primarily due to various degrees of pleural adhesion. During physical exertion or coughing, this can lead to varying degrees of chest pain, a very common occurrence.

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Written by Wang Chun Mei
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Is pleurisy serious in young people?

Pleurisy, when it occurs in young people, is also relatively common in clinical settings. It is primarily caused by an invasion of the pleura by Mycobacterium tuberculosis, resulting in an inflammatory lesion. The symptoms manifested by these patients mainly include coughing, shortness of breath, chest tightness, chest pain, and in severe cases, respiratory difficulties. Tuberculous pleurisy is mostly seen in adolescents and children. If young people are diagnosed with pleurisy and receive timely and accurate diagnosis, along with systematic and effective treatment with anti-tuberculosis drugs, their condition can generally be effectively controlled. However, it is important to note that although young people have better resistance, they must strictly adhere to the treatment duration for anti-tuberculosis medication, which usually spans six to nine months to completely cure pleurisy.

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What should I do about pleurisy calcification?

Pleural calcification, mainly results from long-term unresolved pleuritis or inadequate timely treatment, causing adherence between the two pleural layers. Following this adhesion, calcium salts may deposit, leading to calcification. Usually, the primary consideration is whether the patient's lung function has been impacted. If so, a thoracotomy and pleural decortication might be performed to restore the pleural structure. If the patient only shows pleural calcification on imaging without significant discomfort, it may be observed without immediate intervention, and regular monitoring of the calcification is recommended to see if it enlarges. If the condition remains stable over time, it might not require treatment since this represents a tendency towards healing, or the residual scarring may not necessitate special management.