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Tests and diagnosis
By Mayo Clinic staffYour doctor may make a diagnosis based on your signs and symptoms. When examining you and listening to your chest, your doctor may hear a "friction rub" that may sound like the crunching sound of walking on very dry snow.
Your doctor might also use the following procedures to determine the underlying cause of pleurisy:
- Imaging. A chest X-ray may show an area of inflammation in your lungs that indicates pneumonia. Your doctor will want to investigate an unexplained abnormality seen on an X-ray with additional imaging, usually beginning with a computerized tomography (CT) scan. In a CT procedure, a computer translates information from X-rays into images of thin sections (slices) of your chest. CT scans produce more-detailed images of your internal organs than do conventional X-ray studies. Sometimes doctors want a special type of chest X-ray in which you lie on your side where the pleurisy is to see if there's any fluid that doesn't appear on a standard chest X-ray. This type of X-ray is called a decubitus chest X-ray. Your doctor may also use ultrasound to determine whether you have a pleural effusion.
- Blood test. A blood test may tell your doctor if you have an infection and, if so, what type of infection you have. Other blood tests also may detect an autoimmune disorder, such as rheumatoid arthritis or lupus, in which the initial sign is pleurisy.
- Thoracentesis. To remove fluid for laboratory analysis, your doctor may suggest a procedure called thoracentesis. In this procedure, your doctor first injects a local anesthetic, then inserts a needle through your chest wall between your ribs to remove fluid. In addition, a sample of tissue (pleural biopsy) for microscopic analysis may be obtained if your doctor is concerned that the fluid collection may be caused by tuberculosis or cancer. If only a small amount of fluid is present, your doctor may insert the needle with the help of ultrasound guidance over the site of the fluid.
- Thoracoscopy. This procedure allows a surgeon to see inside your chest and obtain a sample of pleural tissue. First, the surgeon makes one or more small incisions between your ribs. A tube with a tiny video camera is then inserted into your chest cavity — a procedure sometimes called video-assisted thoracoscopic surgery (VATS). Special surgical tools allow your surgeon to cut away tissue for testing.
References
- What are pleurisy and other disorders of the pleura? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/pleurisy/pleurisy_whatare.html. Accessed Dec. 15, 2008.
- Pleurisy fact sheet. American Lung Association. http://www.lungusa.org/site/apps/nlnet/content3.aspx?c=dvLUK9O0E&b=2060321&content_id=%7B653829A9-6104-4561-BFC5-528F5419BEC2%7D¬oc=1. Accessed Dec. 15, 2008.
- Kass SM, et al. Pleurisy. American Family Physician. 2007;75:1357.
- Pleural effusion. The Merck Manuals Online Medical Library: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec05/ch060/ch060d.html#sec05-ch060-ch060d-1244. Accessed Dec. 15, 2008.
- Celli BR. Diseases of the diaphragm, chest wall, pleura and the mediastinum. In: Goldman L, et al., eds. Goldman: Cecil Medicine. 23rd ed. Philadelphia, Pa.: Saunders Elsevier; 2007:697.
- Chest pain, acute. American Academy of Family Physicians. http://familydoctor.org/online/famdocen/home/tools/symptom/523.html. Accessed Dec. 15, 2008.
- Rosenow EC (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 23, 2008.
