Auscultatory pleural rub

Specialty: Respiratory.

• pleural rub
• rubbing noises of the pleura

Why it occurs

• Infectious dry pleuritis, usually of viral (Coxsackie, adenovirus) or incipient bacterial etiology (loss of smooth sliding of the pleural sheets due to fibrin deposition due to the inflammatory process)
• Peripheral pulmonary infarction due to pulmonary thromboembolism (ischemia of the subpleural lung tissue that generates a local inflammatory reaction in the visceral pleura)
• Autoimmune diseases with serosal involvement, mainly Systemic Lupus Erythematosus (SLE) or Rheumatoid Arthritis (lupus or rheumatoid pleuritis with fibrinous exudate)
• Primary pleural mesothelioma or pleural metastases from solid neoplasms (neoplastic infiltration alters the smooth surface of the pleura, generating auscultable friction before free effusion accumulates and separates the sheets)
• Blunt chest trauma with pulmonary contusion and localized reactive pleuritis

Initial workup

Real-time pleural ultrasound (allows you to observe absent or altered pleural sliding ("lung sliding") and detect free fibrin); Chest x-ray (rule out infiltrates, pneumothorax or subpelvic effusion); CT angiography of the chest (if pulmonary thromboembolism or pleural neoplasia is suspected); Analysis with immunological profile (ANA, anti-dsDNA, rheumatoid factor) if connective tissue disease is suspected.

Standard management

• Ibuprofen — 400-600 mg orally every 8 hours with food, as the anti-inflammatory of choice to reduce pleural inflammation and relieve frictional pain
• Indomethacin — 25-50 mg orally every 8 hours as a high-potency anti-inflammatory alternative in pleuritis
• Colchicine (0.5 mg orally every 12-24 hours, used as an adjuvant in recurrent pleuritis of autoimmune cause).