Sharp chest pain that catches when you breathe in. The pain is the easy part; finding the cause is the point.
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Pleurisy is inflammation of the pleura — the two thin layers of tissue that line the lung and the inside of the chest wall. Normally they slide over each other silently with every breath. When they are inflamed they catch, and each breath in produces a sharp, stabbing pain.
The single most important thing to understand is that pleurisy is not really a diagnosis. It is a sign, and the whole question is what is causing it.
The cause that has to be excluded first is a clot on the lung. Pulmonary embolism is one of the commonest causes of pleuritic chest pain, it can be fatal, and it is entirely treatable if it is found. That is the reason this page tells you to be assessed today rather than to see how it goes.
Most pleurisy turns out to be viral and settles within days to a couple of weeks. But "most" is not good enough when one of the alternatives kills people who were sent home. Getting it checked is the point.
The accompanying symptoms are what point to the cause:
That combination can mean fluid has built up between the layers, separating them. The pain settles because the surfaces are no longer rubbing — but the situation has not improved. Do not treat it as recovery.
Assessment starts with the probability of pulmonary embolism, using a structured score such as the Wells score alongside the history and examination.
A pleural rub — a creaking sound in time with breathing, often compared to walking on fresh snow — is characteristic when it is present, though it is frequently absent. None of this can be assessed over video.
Costochondritis is the commonest alternative — tender when you press on the chest wall, which pleurisy usually is not. Also shingles before the rash appears, a rib fracture, reflux, pericarditis (pain typically better sitting forward), and muscular strain.
None of those should be settled on until a clot has been excluded.
We will not manage new pleuritic chest pain remotely. Working it out requires listening to the chest, measuring oxygen levels and breathing rate, and — critically — the ability to arrange a D-dimer, a chest X-ray or a CT scan of the lung arteries the same day.
If you have sharp chest pain on breathing in, particularly with any breathlessness, you need face-to-face assessment today. If a consultation with us starts that way, we will say so within the first minute and tell you where to go, rather than working through a history that ends in the same place.
Do not drive yourself, and do not wait to see whether it settles. A clot on the lung and a collapsed lung both present exactly like this and both can deteriorate quickly.
The pain settles but breathlessness increases — fluid may be accumulating. Or the pain keeps returning over weeks, which needs a cause found rather than more painkillers.
The advice below applies after assessment, not instead of it.
Flu, COVID and pneumococcal vaccination where you are eligible, all free on the NHS.
We say this plainly because pleuritic chest pain is a presentation where hesitating to "bother anyone" causes real harm.
This page follows NICE guideline NG158 on venous thromboembolic diseases, NICE guideline NG12 on suspected cancer, British Thoracic Society pleural disease guidelines, and NICE Clinical Knowledge Summaries on chest pain.
Guidance emphasises that pleuritic pain should not be attributed to a musculoskeletal or viral cause until pulmonary embolism has been appropriately excluded, since PE frequently presents with pleuritic pain in people who otherwise appear well.
Reviewed against NICE NG158, NG12, British Thoracic Society pleural guidelines and NICE CKS current at the date shown above.
The inflammation itself usually is not. What causes it may be.
Pleurisy is a sign, not a diagnosis — and one of the possible causes, a clot on the lung, can be fatal and is very treatable once found.
Because pulmonary embolism is one of the commonest causes of pleuritic chest pain, and people who look and feel reasonably well can have one.
It has to be excluded before anything else is assumed, which is why this needs same-day assessment.
No, and we will not try. It needs a chest listened to, oxygen levels measured, and same-day access to a D-dimer or CT scan.
We will tell you that immediately rather than taking a fee for a consultation that ends by sending you to A&E anyway.
Sharp and catching, clearly worse when you breathe in, and usually on one side. Coughing, sneezing and moving make it worse; holding your breath eases it.
Many people can point to exactly where it hurts.
No — that combination needs urgent assessment. Fluid building up between the layers separates them, so the rubbing stops and the pain eases.
The pain improving is not the same as the problem improving.
Viral pleurisy usually settles over several days to a couple of weeks.
Anything else lasts as long as its cause takes to treat, which is another reason the cause matters more than the pain.
Anti-inflammatories — ibuprofen or naproxen — work better than paracetamol alone for this particular pain.
Holding a pillow against your chest when you cough helps, and so does lying on the painful side. Do keep taking some deep breaths despite the discomfort.
Pericarditis causes similar pain, though it is typically better sitting forward and worse lying flat.
Crushing central pain with sweating, nausea, or pain into the arm or jaw is different again — that is 999 immediately.
Recurrent pleurisy warrants looking for an underlying autoimmune condition, particularly lupus or rheumatoid arthritis.
In lupus, pleurisy can be the presenting feature, and the diagnosis is often delayed by years.
Pleurisy itself is not, but the viruses that cause it are.
Pneumonia and tuberculosis, which can also cause it, spread between people — another reason the cause needs establishing rather than assuming.
August 30, 2026
Ongoing
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Your NHS record in the room
Written treatment plan
Told when a test isn’t needed
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Same day, usually
20 minutes
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£40 for 20 minutes
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Typically 10 minutes
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Usually
Free
Same day
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Same-day access is usually available, from 6am to 10pm, seven days a week. You choose a time that suits you rather than waiting on hold at 8am.
Yes. Care is led personally by Dr Mohammad Khan, so you are not passed between clinicians. Continuity is the point of a small practice: someone who knows your history and is listening attentively rather than working through a checklist.
Yes, with your consent. We can access your Summary Care Record during the consultation, so your current medications, allergies and significant history are in the room. That means fewer questions you have already answered elsewhere, and safer prescribing.
No. We are not here to replace GPs, only to support them. Your NHS practice remains responsible for your ongoing care, and with your consent we write to them after the consultation. We are useful when you need to be seen sooner, or want more time than a standard appointment allows.
Twenty unhurried minutes and a comprehensive assessment. A written treatment plan is included, along with any prescription, sick note or referral letter arising from the consultation, at no extra charge.
£40 for 20 minutes, self-pay. Membership is optional and never required. Priced for fairness, because we are not here to charge extortionate amounts for access to a doctor.
It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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