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Dry (fibrinous) pleurisy - Information Overview
Last reviewed: 12.07.2025
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In most patients, dry (fibrinous) pleurisy begins acutely, less often - gradually. Complaints of patients are extremely typical: chest pain, increased body temperature, general weakness.
Chest pain is the most characteristic symptom of acute dry pleurisy. It is caused by irritation of the sensitive nerve endings of the parietal pleura and is localized in the corresponding half of the chest (on the affected side), most often in the anterior and lower lateral sections. The pain appears with a deep breath, and at the height of the breath, a dry cough may appear, which sharply intensifies when coughing (the patient reflexively puts his hand to the sore spot and tries to reduce the movement of the chest when inhaling, in order to reduce the pain). Also characteristic is an increase in pain when bending the body to the healthy side (Shepelman-Degio symptom), as well as when laughing and sneezing.
The most typical is acute chest pain, however, quite often the chest pain is insignificant (with gradual development of the disease). Depending on the different location of the inflammatory process, the pain can be localized not only in the typical anterior and lower lateral parts of the chest, but also in other areas.
Complaints of general weakness and increased body temperature (usually up to 38°C, sometimes higher) are also typical. In mild, non-spread dry pleurisy, body temperature may be normal, especially in the first days of the disease. Many patients are bothered by transient, low-intensity pain in muscles, joints, and headaches.
An objective examination of patients reveals a number of characteristic signs of dry pleurisy. The patient spares the affected side and therefore prefers to lie on the healthy side. However, some patients find significant relief (reduction of pain) in the position on the affected side, since in this case the chest is immobilized, irritation of the parietal pleura is reduced.
Rapid shallow breathing is also noted (with this type of breathing, pain is less pronounced), and there is a noticeable lag in the affected half of the chest due to pain.
When palpating the chest, in some cases it is possible to palpate the pleural friction noise at the site of localization of the inflammatory process (it is as if the crunch of snow is felt under the hand when breathing).
When percussing the lungs, the sound remains clear pulmonary if pleurisy is not caused by an inflammatory process in the lung parenchyma.
During auscultation of the lungs in the projection of the localization of pleural inflammation, the most important symptom of dry pleurisy is determined - pleural friction noise. It occurs due to friction against each other during breathing of the parietal and visceral pleural sheets, on which there are fibrin deposits and the surface of which becomes rough. Normally, the surface of the pleural sheets is smooth and the sliding of the visceral pleura along the parietal during breathing occurs silently.
Pleural friction noise is heard during inhalation and exhalation and resembles the crunch of snow underfoot, the creaking of new leather, or the rustling of paper or silk. Most often, pleural friction noise is quite loud, but in some cases it can be barely perceptible, and very careful auscultation in silence is necessary to detect it.
Due to the variety of timbre of pleural friction noise, it can be confused with crepitations or wheezing. Pleural friction noise differs from them by the following features:
- pleural friction noise is heard both during inhalation and exhalation, crepitation is heard only during inhalation;
- pleural friction noise is perceived as intermittent sounds of varying nature, following one after another, and dry wheezing is heard as a prolonged continuous sound;
- pleural friction noise does not change when coughing, wheezing after coughing may disappear, or intensify, or reappear;
- pleural friction rub can be heard from a distance;
- when pressing with a stethoscope or a finger on the intercostal space near the stethoscope, the pleural friction noise increases due to the closer contact of the pleural sheets; at the same time, this technique does not affect the volume of wheezing;
- pleural friction rub on auscultation seems to originate near the ear, while wheezing and crepitations are perceived more distantly;
- pleural friction noise can be felt by the patient himself.
In some cases, it is still very difficult to distinguish pleural friction rub from other additional respiratory sounds. In this situation, you can use the Egorov-Bilenkin-Muller method as modified by S. R. Tatevosov. The patient is asked to lie on the healthy side with his legs drawn up to his stomach, bent at the knees and hip joints. The hand corresponding to the diseased side is placed behind the head. The patient makes breathing movements, closing his nose and mouth, and then opening them for comparison. In both cases, the area of the chest is auscultated in the place where respiratory sounds are detected that require differential diagnosis. During breathing movements with the nose and mouth closed, only pleural friction rub continues to be heard, other respiratory sounds (wheezing, crepitation) disappear. During breathing movements with the mouth and nose open, both pleural friction rub and other respiratory sounds are heard.
Dry pleurisy can be localized near the heart, in which case an adhesive process can develop between the pleura and pericardium, in connection with which the friction of both pleural sheets occurs not only during breathing, but also with each contraction of the heart - pleuropericardial friction noise occurs. A characteristic feature of this noise is that it continues to be heard even when holding the breath.
It should be noted that in the area of the apexes of the lungs, pleural friction noise is rarely heard, which is explained by the poor respiratory mobility of the apexes.
In some patients, pleural friction rubs may continue to be heard for many years after pleurisy, which is due to uneven thickening of the pleural sheets.
Pleurisy - Causes and pathogenesis
[ Symptoms of dry (fibrinous) pleurisy
Parietal (costal) pleurisy is the most common form of fibrinous pleurisy, its symptoms are described above. The main signs of this variant of dry pleurisy are chest pain (in the projection of fibrinous deposits), which intensifies with breathing and coughing, and typical pleural friction noise.
The course of dry pleurisy is usually favorable. The disease lasts about 1-3 weeks and usually ends in recovery. A long recurrent course is typical for the tuberculous etiology of the disease.
Where does it hurt?
Diagnosis of dry (fibrinous) pleurisy
In fibrinous pleurisy, a high position of the diaphragm dome on the corresponding side, its lag during deep breathing, limited mobility of the lower pulmonary edge, and slight opacity of part of the pulmonary field can be determined. With significant fibrin deposits, it is sometimes possible to determine an unclear, indistinct shadow along the outer edge of the lung (a rare sign).
Ultrasound examination can reveal intense fibrin deposits on the parietal or visceral pleura. They look like thickening of the pleura with an uneven, wavy contour, increased echogenicity, and a homogeneous structure.
What tests are needed?
Who to contact?
Drugs