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.
In some cases, your doctor might remove fluid and tissue from the pleural space for testing. Procedures might include:
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- 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.
- Pleural biopsy. If tuberculosis or cancer is a suspected cause of your condition, your doctor might perform thoracentesis with pleural biopsy — removal of a sample of tissue of the outer pleura to be examined in a pathology laboratory. The biopsy needle has a small hook on the end that lifts away a small piece of tissue. Your doctor might use ultrasound guidance for this procedure.
- Thoracoscopy. This procedure, performed while you're under a general anesthetic, allows a surgeon to see inside your chest and obtain a sample of pleural tissue.
- What are pleurisy and other pleural disorders? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/pleurisy/pleurisy_whatare.html. Accessed Oct. 2, 2013.
- Ferri FF. Ferri's Clinical Advisor 2014: 5 Books in 1. Philadelphia, Pa.: Mosby Elsevier; 2014. https://www.clinicalkey.com. Accessed Oct. 2, 2013.
- Mason RJ, et al. Murray and Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa.: Saunders Elsevier; 2010. http://www.clinicalkey.com. Accessed Oct. 2, 2013.
- Kliegman RM, et al. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa.: Saunders Elsevier; 2011. http://www.clinicalkey.com. Accessed Oct. 2, 2013.
- Patient information: Pleuritic chest pain. http://www.uptodate.com/home. Accessed Oct. 4, 2013.
- Lee YCG. Diagnostic evaluation of pleural effusion in adults: Additional tests for undetermined etiology. http://www.uptodate.com/home. Accessed Oct. 4, 2013.
- Rosenow EC (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 7, 2013.