Pleurisy: Pain Under Breast When Breathing Explained

Feeling pain under breast when breathing can be very uncomfortable especially if you engage in laborious activities and have to breathe really fast. What medical condition is this and how can it be explained?

Woman having a hard time breathing

Pleurisy is a medical condition that explains the feeling of pain under the breast while breathing. It describes chest pain characterized by a sharp jolt of pain in the chest cavity which worsens when you breathe. Pleurisy is caused by lung (pleura) lining inflammation, a condition referred to as pleuritis. There are two pleura layers, one that covers the lungs known as the visceral, and another that covers the inner chest wall lining called parietal pleura. Both layers are kept lubricated by the pleural fluid.

Pleurisy is often linked with extra fluid accumulation in the space between both pleural layers and the fluid is called pleural effusion. The fibers that carry pain sensation in the lungs can be found in this pleura, thus upon tissue inflammation, there will be a resulting sharp chest pain that worsens an s your breath. Other pleurisy symptoms include chest tenderness, cough, and short breath. As we go on we will be looking at other possible causes of this condition.

Pleurisy Facts

  • Fact 1: In pleurisy, the tissue layers lining your lungs get inflamed and also that of the inner wall of the chest.
  • Fact 2: Pleurisy is usually associated with fluid accumulation between both pleural layers of the lungs which is called pleural effusion.
  • Fact 3: Several conditions cause pleurisies such as congestive failure of the heart, tuberculosis, infections, pulmonary embolism, collagen vascular diseases, and cancer.
  • Fact 4: Pleurisy symptoms include chest pain aggravated during breathing, local tenderness, and taking short breaths. This pain may affect the cavity of your chest either at the back or front and may sometimes leave the patient with shoulder or back pain.
  • Fact 5: Pleurisy diagnosis is gotten by chest pain which is its main characteristic and also on physical chest examination. Imaging studies such as CT, ultrasound, and chest X-ray might sometimes reveal the fluid accumulation in the pleural chest cavity.
  • Fact 4: Pleural fluid can be aspirated and analyzed to determine what caused pleurisy.
  • Fact 5: The proper way of managing pleurisy is by treating underlying conditions.

Pleurisy: Causes of Pain Under Breast When Breathing 

The following listed conditions can cause pleurisy;

  • Infections: Bacterial infections like those responsible for tuberculosis may cause pleurisy. Also, viruses, parasites, or fungi infections may cause pleurisy.
  • Inhaled toxic or chemical substances: Exposure to harmful substances like ammonia may trigger pleurisy.
  • Collagen vascular conditions: Rheumatoid arthritis and lupus etc.
  • Cancers: The spread of breast or lung cancer, for example, may cause pleura
  • Pleura tumors: Sarcoma or mesothelioma.
  • Congestion: Heart failure
  • Pulmonary embolism: If your lung’s blood vessels have blood clots it may reduce oxygen and blood portions to the lung. Death may occur in pulmonary embolism and it can also cause pleurisy.
  • Lymph channels obstruction: This obstruction may happen due to lung tumors located centrally.
  • Trauma: Irritation in chest tubes that drains air-fluid in the pleural cavity or rib fractures can cause pleurisy.
  • Certain drugs: Certain drugs can lead to lupus syndrome. These drugs include hydralazine, a procan, procan-SR, phenytoin, prostanoid, and others.
  • Abdominal processes: These include liver cirrhosis, gallbladder disease, pancreatitis, and spleen damage.
  • Pneumothorax: When air accumulates in your pleural space either from trauma or spontaneously it can cause pleurisy.

How Pleura Works 

There are two thin tissue lining that makes up pleura. One layer covers the visceral pleura of the lungs while the other one is called the parietal pleura which covers the chest inner wall. They are both kept lubricated by the pleural fluid. There are normally ten to twenty millimeters of lubricant, a clear liquid between both layers.

The fluid will be replaced and absorbed continually through the pleura‘s outer lining. There is a negative pressure in the pleura and during inspiration, it becomes more negative. At exhalation, the negativity lessens.

Therefore the pressure of the two pleural layers is negative. With an introduction of positive pressure such as a stab wound, the lungs will collapse.

Pleurisy Symptoms

The symptoms that can be experienced during pleurisy include:

  • Chest pain that is worsened by breathing
  • Short breath
  • A stabbing feeling or sensation

Chest pain is a common pleurisy symptom. Although there are no pain nerves in the lungs the pleura has plenty of nerve endings. Accumulation of extra fluid in the pleural space the pain felt will be less severe. With large fluid accumulation, lung expansion will be limited worsening breath shortness.

The thoracic or chest cavity represents the back and the front portion of the body. During inflammation, the cavity moves to the back and may be referred to as back pain. The pain may also worsen when deep breaths are taken. Most of the other back pain causes do not have this description.


Splinting the wall of the chest externally and pain-relieving medications can relieve pain caused by pleurisy. There is usually an underlying cause of pleurisy and treating this condition will take care of pleurisy.

Removing fluid that accumulated in the chest cavity can relieve short breath and relieve pain. Sometimes removing fluid can worsen pleurisy temporarily because without the lubrication that the fluid provides the two pleural surfaces that are inflamed rub directly against each other when breathing.

If there are signs of infection in the pleural fluid, appropriate treatment will involve fluid drainage and the use of antibiotics. If pus begins to form inside the space it should be drained by inserting a chest tube. This procedure will require a tube being placed inside your chest under the effect of local anesthesia.


Some pleurisy cases can be avoided depending on its cause. For instance, if pneumonia is treated early it can prevent pleural fluid accumulation. In cases of lung, heart, and kidney disease, managing the underlying disease may prevent fluid from being collected.

Pain under the breast during breathing can be avoided and if it happens to occur then there are available treatments that can be used. 

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