Dry pleurisy, whatever its cause, is
a painful condition characterized by knife-like pain related to the respiratory
excursion, which it tends to inhibit locally. The pain is not of critically
sudden onset, and careful interrogation will generally distinguish it from
intercostal neuralgia, fibrositis and pre-eruptive herpes. Friction is the
cardinal sign and must always be sought. The friction has a rubbing, grating or
scratching quality and, if coarse, can be palpated with the flat of the hand.
Pressure with the hand will often cause the pain to disappear, and pressure
with the chest-piece of the stethoscope may diminish, or even abolish, the
friction sound while pressure is maintained. Friction in a peculiar way sou
nds
very " near to the ear ". It is often useful to posture the patient
so as to stretch the side of the thorax on which the rub is being sought, and
to listen exactly over the site of the pain as indicated by the patient. With pleural friction, as with other physical signs
in the chest, its absence in a given case by no means excludes the possibility
of pleurisy.
Radiographic evidence
of dry pleurisy is not constant and fluoroscopy only sometimes affords evidence
in the form of abnormalities of diaphragmatic function and behaviour. X-ray
examination, however, will eliminate such conditions as spontaneous pneumothorax,
and will help to establish the presence of any intra-pulmonary condition of
which pleurisy is symptomatic.
