Diagnosis

Your doctor will start by asking about your medical history and doing a physical exam, including examining your chest with a stethoscope.

To determine if you have pleurisy, your doctor might recommend:

  • Blood tests. A blood test might tell your doctor if you have an infection. Other blood tests also might detect an autoimmune disorder, such as rheumatoid arthritis or lupus, in which the initial sign is pleurisy.
  • Chest X-ray. A chest X-ray can show if your lungs are fully inflating or if there is air or fluid between the lungs and ribs. Your doctor might recommend a special type of chest X-ray in which you lie on your side (decubitus chest X-ray).
  • Computerized tomography (CT) scan. In a CT scan, a computer translates information from X-rays into images of thin sections (slices) of your chest, producing more-detailed images. A chest CT scan can show if there is a blood clot in the lung or find other causes of pleuritic pain.
  • Ultrasound. This imaging method uses high-frequency sound waves to produce precise images of structures within your body. Your doctor might use ultrasound to determine whether you have a pleural effusion.
  • Electrocardiogram (ECG or EKG). Your doctor might recommend this heart-monitoring test to rule out certain heart problems as a cause for your chest pain.

Diagnostic procedures

In some cases, your doctor might remove fluid and tissue from the pleural space for testing. Procedures might include:

  • Thoracentesis. To remove fluid for laboratory analysis, your doctor might suggest thoracentesis. In this procedure, your doctor injects a local anesthetic between your ribs to the area where fluid was seen on your imaging studies. Next your doctor inserts a needle through your chest wall between your ribs to remove fluid for laboratory analysis. Your doctor might insert the needle with the help of ultrasound guidance.
  • Thoracoscopy or pleuroscopy. If tuberculosis or cancer is a suspected cause of your condition, your doctor might perform a procedure that allows for direct visualization inside your chest to look for any abnormalities or to obtain a tissue sample (biopsy) if needed.
Nov. 12, 2016
References
  1. What are pleurisy and other pleural disorders? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/pleurisy/. Accessed Sept. 12, 2016.
  2. Ferri FF. Pleurisy. In: Ferri's Clinical Advisor 2017. Philadelphia, Pa.: Elsevier; 2017. https://www.clinicalkey.com. Accessed Sept. 12, 2016.
  3. Mason RJ, et al. Pleural effusion. In: Murray and Nadel's Textbook of Respiratory Medicine. 6th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. http://www.clinicalkey.com. Accessed Sept. 12, 2016.
  4. Kliegman RM, et al. Pleurisy, pleural effusions, and empyema. In: Nelson Textbook of Pediatrics. 20th ed. Philadelphia, Pa.: Elsevier; 2016. http://www.clinicalkey.com. Accessed Sept. 12, 2016.
  5. Patient information: Pleuritic chest pain. http://www.uptodate.com/home. Accessed Sept. 12, 2016.
  6. Lee YCG. Diagnostic evaluation of pleural effusion in adults: Additional tests for undetermined etiology. http://www.uptodate.com/home. Accessed Sept. 12, 2016.
  7. Sheski FD. An overview of medical thoracoscopy. http://www.uptodate.com/home. Accessed Sept. 19, 2016.