How Is Pleurisy Diagnosed?

Pleurisy is the inflammation of the two-layered membranes lining your lungs. Your doctor can diagnose pleurisy after taking a careful history, complete physical exam, and investigations.

During the diagnosis, your doctor will exclude all the other possible causes that have a similar presentation and find the underlying cause for pleurisy, so that it can be treated accordingly.

Taking a medical history

Initially, when you first meet with your doctor, he/she will take a detailed medical history. The doctor will ask you questions regarding the pain you are experiencing such as:

• The type of pain you are experiencing: a sharp pain or a blunt pain.
• The location of pain.
• If the pain radiates elsewhere like to the arms, shoulders, or neck.
• How it first began? Was it of sudden onset or a gradual pain?
• The factors that aggravate and relieve the pain.
• How severe the pain is on a scale of 1 to 10.

You doctor will continue to further question you regarding any other symptoms you feel along with the pain such as shortness of breath, coughing, fever, or palpitations. He/she will then take a detailed history regarding your past medical conditions such as heart disease or tuberculosis.

Other aspects like smoking, travel history, exposure to tuberculosis, exposure to asbestos, and your current medications will also be asked.

The physical examination

After taking a detailed medical history from you, your doctor will move on to do a physical exam. Your doctor will listen to your lung sounds using a stethoscope. If you have pleurisy, a rough sound will be heard known as the pleural friction rub. If your doctor hears this sound, then he/she will know that you have pleurisy. Sometimes, if pleurisy is complicated with a pleural effusion (fluid accumulation between the two pleural membranes), then a friction rub will not be heard. This can also be noticed by your doctor if you have a large pleural effusion by tapping on your chest. On tapping, a dull sound will be produced if there is a large pleural effusion. 

Tests to confirm the diagnosis

A diagnosis of pleurisy can be made alone with a physical exam, but tests are usually done to confirm a diagnosis that will exclude other possible causes giving the same results. The tests will be ordered depending on the results of your physical exam.

• Blood tests – This is the simplest test that is used to find out the underlying cause of your pleurisy such as pneumonia, bacterial, or viral infections.

• Chest X-ray – is a painless screening procedure that uses radiation to make an image of your chest and its organs. It will help find out the underlying cause of pleurisy such as a fractured rib, pneumonia, or a lung cancer. If you have a pleural effusion, this will also be shown by a chest X-ray.

• Ultrasound scan – is also a painless procedure that uses sound waves to create an image of your internal organs. If there is fluid in your chest, an ultrasound scan will be able to detect it.

• Chest CT or MRI scans – these scans also use radiation and is used to find the underlying cause if the above tests failed. CT or MRI scans can detect fluid and abscesses in your lungs.

• Thoracentesis and fluid analysis – if your doctor detects that you have fluid in your lungs then the excess fluid will be removed for further analysis by a procedure known as thoracentesis. During this procedure, a thin needle is inserted into your chest cavity, and the excess fluid is removed, which will be sent for analysis. This fluid will be examined under a microscope to look for an infection, cancer cells, or any other signs of other conditions that may cause fluid to build in your lungs.