Pleuritis is defined as inflammation of the pleura. The pleural space, a thin fluid-filled space between the lung and the thoracic cavity, enables the smooth frictionless movement of the lung during respiration. It is lined by 2 layers of pleura: the visceral (covering the lung) and the parietal (covering the thoracic cage). Pain receptors are present on the parietal pleura. Irritation and inflammation of the pleura presents with symptoms of sharp lancing, fleeting pain in the chest that is exacerbated by deep breathing, coughing, sneezing, and Valsalva (forced expiration against a closed airway) or Mueller maneuvers (reverse of Valsalva maneuver).
It is important to exclude potentially life-threatening conditions such as pulmonary embolism, acute coronary syndrome, aortic dissection, and pneumothorax during evaluation. Pneumonia must also be considered. Though not causes of pleuritis per se, conditions such as pericarditis, perforated viscus, and costochondritis should be considered in the differential diagnosis when patients present with chest pain that is pleuritic in nature.
