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Pleurisy Center

Pleurisy Diagnosis

If you suspect that you are experiencing pleurisy, you're likely to start by first seeing your family doctor. However, when you call to set up your appointment, you may be urged to seek immediate medical care if you are experiencing severe, lasting chest pain or difficulty breathing. Other medical professionals who can help diagnose or treat pleurisy include:

  • General Practitioner
  • Internist
  • Pulmonologist

Medical history
Doctors start a pleurisy or pleural disorder diagnosis by taking a detailed medical history. The purpose is to rule out other possible causes of symptoms so that they can be treated. During a detailed medical history, your doctor will likely to ask you questions about chest pain such as:

  • Can you sense pain in the arms, jaw, or shoulder?
  • Does chest pain away and then come back?
  • What does the pain feels like
  • What makes pain better or worse?
  • When did chest pain begin?
  • Where is the pain located exactly?

Your doctor will also want to know about other symptoms, medications and personal history. This is because exposure to certain substances or medications can trigger pleurisy. Other things your doctor is likely to ask about include whether you've ever:

  • Do or did you smoke? For how long?
  • Do symptoms include other types of pain, such as a sore throat or joint pain?
  • Do you experience difficulty breathing?
  • Do you experience fever or night sweats?
  • Have you been diagnosed with or treated for any other health conditions?
  • Have you been diagnosed with heart disease?
  • Have you ever been exposed you to asbestos?
  • Have you lost weight without trying?
  • How does your current energy level compare to what's normal for you?
  • Have you recently had any medical procedures?
  • Have you recently travelled to another country? Did anyone who travelled with you get sick?
  • What medications are you currently taking?

Medical exams
After a medical history, your doctor will perform a physical exam. During a physical, doctors place a stethoscope to the chest and are listening for abnormal sounds such as a "friction rub" as you breathe. Depending on the results of the physical exam, your doctor may recommend other diagnostic tests, in order to identify the illness that caused the pleurisy. Tests may include:

Arterial blood gas tests - During this test, doctors take a small amount of blood from an artery in the wrist to check for oxygen and carbon dioxide levels. This test indicates how well your lungs are taking in oxygen.

Blood tests - Blood tests can show whether bacterial or viral infections, pneumonia, rheumatic fever, pulmonary embolism, or lupus are present.

Biopsy - During a biopsy, doctors take a small tissue sample of the outer layer of the pleura, especially when they think that tuberculosis or cancer may have caused the fluid build-up. Doctors either insert a needle through the skin on the chest (needle biopsy) or insert a small tube with a light on the end (endoscope) into tiny cuts in the chest wall during an open pleural biopsy.

Chest x ray - Doctors use x rays to take a picture of the heart and lungs to look for air or fluid in the pleural space. X rays can also identify what's causing the condition (ex. pneumonia, fractured rib, or a lung tumor). Sometimes an x ray is taken while you lie on the side where the pain is. This may show fluid that didn't appear on the standard x ray taken while you were standing.

Computerized tomography (CT) scan - CT scans provide a computer-generated picture of the lungs that can show pockets of fluid or indicate signs of pneumonia, a lung abscess, or tumor(s).

Fluid analysis - Doctors look at the fluid removed by thoracentesis (see below) under a microscope for chemicals, color, texture, and clearness for signs of infection, cancer, or other conditions. Laboratories may examine the pleural fluid and/or use a special centrifuge (cytocentrifuge) to concentrate the fluid’s cells on a slide. The slide is treated with a special stain and evaluated for the different kinds of cells that may be present. Additionally, doctors order bacterial culture and susceptibility testing to detect any microorganisms that may be present in the pleural fluid. Tests on pleural fluid include:  

  • cytology
  • total cell counts
  • white blood cell (WBC) differential

Laboratory tests - Additional tests may be performed during pleurisy diagnosis, including many blood tests. Other tests for infectious diseases that are less commonly ordered may include tests for viruses, mycobacteria (AFB smear and culture), and parasites. Common lab tests include:

  • amylase blood tests
  • blood glucose
  • lactate levels
  • triglyceride levels
  • tumor markers

Magnetic resonance imaging (MRI) scan - An MRI uses powerful magnets and radio waves to create images of pleural effusions and tumors.

Physical exam - During a physical, your doctor listens to breathing with a stethoscope to find out whether your lungs are making any strange sounds.

Ultrasound - Ultrasound tests use sound waves to create pictures of the lungs to identify possible locations of fluid in the chest. Ultrasounds can also show evidence of some tumors.

Thoracentesis - During a thoracentesis, doctors remove a sample pleural tissue for testing. During the procedure, a doctor inserts a small needle or a thin, hollow, plastic tube through the ribs in the back of the chest into the chest wall and draws fluid out of your chest. Many doctors use ultrasound to guide the needle to the fluid around the lungs. Most complications of this procedure are minor and are easily treated.

Recovery from pleurisy depends on the treatment of the cause. Pleurisy and other disorders of the pleura can be serious, but if diagnosed and treated early, you usually can expect a full recovery. To learn more about treatment options for pleural disorders, continue reading the next section on treatment for pleurisy here.

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