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Tests and diagnosis
By Mayo Clinic staffTests to diagnose the underlying cause of your symptoms may include:
- Medical history and physical exam. Your doctor will ask detailed questions about your medical history, including other health problems, medications and your recent signs and symptoms. Your doctor may want to examine your chest with a stethoscope. If he or she hears a "snow crunching" sound over the area of your pain, that may be enough to diagnose pleurisy. You may even be able to feel the crunching with your hand. This sign isn't always present with pleurisy, however.
- Blood tests. 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.
Your doctor may also order imaging tests or diagnostic procedures.
Imaging tests
Imaging tests to diagnose the underlying cause of pleurisy may include:
- Chest X-ray. A chest X-ray may show an area of inflammation in your lungs that indicates pneumonia. 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.
- Computerized tomography (CT) scan. Your doctor will want to investigate any unexplained abnormality seen on chest X-rays with additional imaging, usually beginning with a 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.
- Ultrasound. This imaging method uses high-frequency sound waves to produce precise images of structures within your body. Your doctor may use ultrasound to determine whether you have a pleural effusion.
Diagnostic procedures
In some cases, your doctor may remove fluid and tissue from the pleural space for testing. Procedures may include:
- 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 between your ribs to the area where fluid was seen on your imaging studies. Next your doctor then inserts a needle through your chest wall between your ribs to remove fluid for laboratory analysis. 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.
- Pleural biopsy. If tuberculosis or lung cancer is a suspected cause of your condition, your doctor may perform thoracentesis with pleural biopsy — removal of a sample of tissue 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 may use ultrasound guidance for this procedure as well.
- 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. 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). Tools designed for this type of surgery 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. 30, 2010.
- Poznak MV. Pleurisy. In: Ferri FF. Ferri's Clinical Advisor 2011: Instant Diagnosis and Treatment. Philadelphia, Pa.: Mosby Elsevier; 2011. http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-0-323-05610-6..00025-1--sc30630&isbn=978-0-323-05610-6&sid=1096727073&type=bookPage§ionEid=4-u1.0-B978-0-323-05610-6..00025-1--sc30630&uniqId=230257626-6#4-u1.0-B978-0-323-05610-6..00025-1--sc30630. Accessed Dec. 30, 2010.
- Pleuropulmonary disorders. In: Mason RJ, et al. Murray & Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa.: Saunders Elsevier; 2010. http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-1-4160-4710-0..00030-4--s0050&isbn=978-1-4160-4710-0&sid=1096727073&type=bookPage§ionEid=4-u1.0-B978-1-4160-4710-0..00030-4--s0055&uniqId=230257626-6#4-u1.0-B978-1-4160-4710-0..00030-4--s0055. Accessed Dec. 30, 2010.
- Rosenow EC (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 3, 2011.
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