The diagnosis and treatment of pleurisy in general practice

Pleurisy is most commonly viral in aetiology. Pleurisy may be caused by a number of conditions, such as pericarditis, pneumonia, myocardial infarction, and pneumothorax.¹ During 2011-12, there were approximately 2000 hospital admissions due to pleurisy. It is likely that the prevalence may be higher than this, as many people do not seek further treatment.

Pleuritic chest pain

Pleuritic chest pain is a symptom of pleurisy and is caused by the parietal pleura becoming inflamed. The parietal pleura is innervated by somatic nerves, whereas the visceral pleura does not have pain receptions or nociceptors.¹

The parietal pleura of the outer rib cage and lateral aspect of each hemidiaphragm is innervated by intercostal nerves. The phrenic nerve innervates the central part of the diaphragm. If impulses are transmitted through the phrenic nerve, pain may be referred to the shoulder.