Grade 2 to 3: hold immunotherapy, initiate corticosteroids
Drainage and procedural considerations
Thoracentesis
Therapeutic drainage relieves dyspnea
Maximum single-session drainage 1.5 L to reduce re-expansion pulmonary edema
ACEP Level B recommendation for ultrasound guidance
Indwelling pleural catheter
Malignant pleural effusion management
Allows outpatient drainage
Reduces hospital admissions for recurrent malignant effusions
Patient Discharge Instructions
copy discharge instructions
What is pleurisy
Inflammation of the lining around your lungs causing sharp chest pain
Pain is worse with breathing, coughing, or movement
The most common cause is a viral infection and usually resolves in 1 to 2 weeks
Medications at home
Take ibuprofen or naproxen as directed with food
Do not exceed the prescribed dose
Take acetaminophen if anti-inflammatory medications are not tolerated
Finish all antibiotics if prescribed
Return to emergency department immediately if
Chest pain suddenly becomes much worse
Difficulty breathing at rest or blue lips or fingertips
Coughing up blood
Fainting or near-fainting episode
One leg becomes swollen, red, or painful
Fever above 38.5 degrees Celsius that is not improving
Confusion or inability to speak clearly
New rash, joint swelling, or worsening systemic symptoms
At home care
Rest and avoid strenuous activity until pain improves
Breathing exercises: take slow deep breaths several times per hour to prevent complications
Stay well hydrated
Sleep in a position of comfort, often slightly elevated
Avoid smoking and second-hand smoke exposure
Follow-up instructions
See your family doctor within 2 to 5 days
Return for repeat imaging as recommended if an effusion was seen
Notify your doctor if symptoms are not improving within 1 week
Blood test results may require follow-up for autoimmune or TB testing
References
Guidelines and key sources
Guideline sources
ACEP Clinical Policy on evaluation of chest pain in the emergency department
ESC guidelines on pericarditis management 2015
CHEST guidelines on diagnosis and management of pleural diseases 2023
BTS guidelines on investigation of unilateral pleural effusion in adults 2023
AHA/ESC pulmonary embolism guidelines
Key clinical evidence
MIST-2 trial: intrapleural alteplase plus DNase for pleural infection
Mortality and surgical rate outcomes
Dual enzyme therapy superiority demonstrated
COPE trial and EFFECT trial: colchicine for acute and recurrent pericarditis
Colchicine reduces recurrence from 37% to 17%
Foundation for Class I recommendation
Studies supporting age-adjusted D-dimer threshold
Increases specificity without loss of sensitivity
ACEP Level B recommendation for PE workup
Coding standards
ICD-10 R09.1 pleurisy
ICD-10 J90 pleural effusion not elsewhere classified
ICD-10 I26.9 pulmonary embolism without mention of acute cor pulmonale
ICD-10 I30.9 acute pericarditis unspecified
SNOMED CT pleurisy disorder concept
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.