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.

Treatment

Treatments used in pleurisy and pleural effusion focus primarily on the underlying cause. For example, if bacterial pneumonia is the cause, an antibiotic will control the infection. If the cause is viral, pleurisy will resolve on its own.

The outcome of pleurisy treatment depends on the seriousness of the underlying disease. If the condition that caused pleurisy is diagnosed and treated early, a full recovery is typical.

Lifestyle and home remedies

The following steps might help relieve symptoms related to pleurisy:

  • Take medication. Take medication such as ibuprofen (Advil, Motrin IB, others) as needed to relieve pain and inflammation.
  • Get plenty of rest. Find the position that causes you the least discomfort and try to stay in it. Even when you start to feel better, be careful not to overdo it.

Preparing for your appointment

You're likely to start by seeing your family doctor. However, when you call to set up your appointment, you might be urged to seek immediate medical care if you are experiencing severe, unexplained chest pain.

Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

  • Keep a record of any symptoms, including where your chest pain starts and how far it spreads. Also keep track of associated symptoms, such as fever, shortness of breath and weight loss.
  • Write down any key medical information, including recent hospitalizations, medications, vitamins or supplements you're taking, and any medical conditions you have. Also note whether any family members — especially children — or close friends have recently been ill.
  • Write down any key personal information, including recent travel abroad and major life changes. Your doctor might also be interested in your work history, including possible environmental exposure to asbestos.
  • Bring a family member or friend along, if possible, to help you remember questions to ask and what your doctor said.
  • Write down questions to ask your doctor.

Questions to ask your doctor

Questions to ask the doctor include:

  • What do you think is the underlying cause of my symptoms?
  • What kinds of diagnostic tests or procedures do I need, if any?
  • What treatment approach do you recommend, besides pain relievers?
  • How soon after I begin treatment can I expect to feel better?
  • Are there self-care steps I can take to improve my discomfort?
  • Do you recommend that I stay home from work or school? For how long?
  • Will it help if I stop smoking?
  • Am I at risk of long-term complications from this condition?
  • I have other health conditions. How can I best manage them together?

Don't hesitate to ask other questions.

What to expect from your doctor

Be ready to answer questions your doctor might ask:

  • How would you describe your symptoms?
  • What, if anything, seems to improve or worsen your symptoms?
  • Have you been diagnosed with or treated for any other health conditions?
  • Have you recently traveled?
  • Have you been involved in any work, projects or hobbies over the years that might have exposed you to asbestos?
  • Do or did you smoke? For how long?

What you can do in the meantime

While you wait for your appointment:

  • Take an over-the-counter pain reliever, such as ibuprofen (Advil, Motrin IB, others)
  • Try to find a comfortable position and stay in it
  • Apply a cold compress to your chest
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.