Is it normal to have pain in the later stages of pleurisy?

Written by Wang Chun Mei
Pulmonology
Updated on September 04, 2024
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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 Shen Jiang Chao
Radiology
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Can pleurisy be seen on a chest X-ray?

Pleurisy can also be detected in chest radiographs, but it depends on the type. There are two types of pleurisy: dry and wet. Dry pleurisy cannot be clearly identified, while wet pleurisy, which is mostly caused by tuberculosis, can show more typical characteristics. Tuberculous pleurisy primarily manifests as pleural effusion. A small amount of pleural effusion on an X-ray appears as blunting of the costophrenic angle on the same side and blurring of the diaphragm. A moderate amount of pleural effusion is shown on the chest radiograph as a uniformly consistent high-density shadow on the same side, which appears higher on the outside and lower on the inside, with an arc-shaped shadow. The muscle costophrenic angle and diaphragm are obscured. A large amount of pleural effusion presents as a high-density shadow in the pleural cavity on the same side, with the mediastinal cardiac silhouette clearly shifting to the interlateral side.

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Written by Wang Chun Mei
Pulmonology
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The dangers of secondary recurrence of pleurisy

Pleurisy is very common in clinical settings, with most cases caused by the invasion of Mycobacterium tuberculosis into the pleural cavity, leading to inflammatory lesions. Patients generally experience pleurisy symptoms, and if their immune function is weak, some may relapse if not careful. Therefore, for patients recovering from pleurisy, it is essential to strengthen their immune system and pay attention to balancing work and rest, avoiding spicy and irritating foods, which can greatly reduce the possibility of pleurisy recurrence. If pleurisy recurs, the clinical symptoms may worsen compared to the initial infection or may present similarly to the initial symptoms. Generally, if pleurisy recurs, there might be severe complications due to adhesions in the pleural cavity, possibly leading to persistent chest pain symptoms.

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Written by Xu Jun Hui
General Surgery
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The difference between pleurisy and peritonitis

Peritonitis generally refers to a severe disease caused by bacterial infection, chemical irritation, or injury, most of which are secondary peritonitis originating from infections and necrosis of abdominal organs, perforations, trauma, etc. The main symptoms include abdominal pain, tense abdominal muscles, tenderness, and board-like abdomen. Pleurisy generally refers to the inflammation of the pleura caused by pathogenic microorganisms, also known as pleuritis, which can be accompanied by pleural effusion. Pleurisy is commonly caused by tuberculosis. Generally, the symptoms of peritonitis are more severe than those of pleurisy. Both pleurisy and peritonitis require active, timely, and regular treatment.

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Written by Yuan Qing
Pulmonology
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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.

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Written by Yuan Qing
Pulmonology
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Sequelae of pleurisy with pulmonary effusion

The main sequelae of pleurisy with pleural effusion are pleural adhesions, which can affect respiratory function. Pleurisy is mostly caused by infectious diseases, although a portion is also due to non-infectious diseases. In the case of pleural effusion caused by infectious diseases, it contains a large amount of fibrinogen, which has the function of adhering to our pleura, thereby causing the pleura to thicken. At this time, the pleura will compress our lungs, significantly reducing the respiratory volume of our lungs, which greatly affects our respiratory function. Patients mainly exhibit symptoms such as shortness of breath, chest tightness, and rapid breathing even with slight activity or while lying in bed. Therefore, if pleurisy is detected, it is crucial to drain the fluid from the patient as soon as possible to avoid delaying treatment and the subsequent development of severe sequelae.