Clinical features

Pleurisy is characterized by sharp, localized pain in the chest, neck, or shoulder that is worsened by respiratory movements, coughing, or sneezing. A hallmark feature is a pleural friction rub caused by the inflamed parietal and visceral pleura rubbing together. The pleural friction rub is typically localized and may be palpable.

In some cases there may be apparently generalised abdominal tenderness.

Depending on the underlying cause, patients may also present with symptoms such as tachypnoea, tachycardia, wheezing, decreased breath sounds, fever, chest pain, or a productive cough.

Note

• pulsus paradoxus is a sign of pericardial effusion and tamponade
  • a pericardial friction rub is heard in pericarditis and unequal pulse and BP between arms is suggestive of aortic dissection. Decreased breath sounds with increased resonance on percussion suggests pneumothorax, whereas decreased breath sounds with dullness to percussion is suggestive of a pleural effusion.

Reference

1. Roberts ME, Rahman NM, Maskell NA, et al. British Thoracic Society guideline for pleural disease. Thorax. 2023 Jul;78(suppl 3):s1-42.
2. Reamy BV, Williams PM, Odom MR. Pleuritic Chest Pain: Sorting Through the Differential Diagnosis. Am Fam Physician. 2017 Sep 01;96(5):306-312.