Pleurisy – Diagnosis and Treatment
Diagnosis
When a person may have pleurisy, the doctor usually asks about the person’s health background and any symptoms, like chest pain, fever, or difficulty breathing.
Next, the doctor performs a physical exam to check for signs like a friction rub, which can be heard with a stethoscope.
Doctors often look for related conditions such as pneumonia, tuberculosis, heart failure, or autoimmune diseases like lupus and rheumatoid arthritis, which could cause or worsen pleural inflammation.
Several tests help confirm pleurisy and rule out other possible reasons for pleuritic pain.
Some of the most common tests for this condition are listed in the table below:
| Test Name | What It Checks | Why Itโs Important |
|---|---|---|
| Blood Tests | Signs of infection or autoimmune disease | Helps spot viral or bacterial infection, lupus, or rheumatoid arthritis |
| Chest X-Ray | Air or fluid in the lungs or pleural space | Can show pneumonia, pleural effusion, lung cancer, or collapsed lung |
| CT Scan | Detailed lung and pleural images | Finds blood clots, tumors, or other causes not seen on an X-ray |
| Ultrasound | Fluid in pleural space | Helps find and measure pleural effusions |
| Electrocardiogram (ECG/EKG) | Heart function | Can rule out pericarditis or heart attack |
Doctors may use a clinical decision rule to narrow down the causes based on a personโs symptoms and test results.
If needed, they might check for other viruses like influenza, coxsackievirus, RSV, Epstein-Barr, and adenovirus.
They may also explore conditions like pericarditis, pancreatitis, trauma to the chest, and joint pain linked to autoimmune diseases.
Ways to Take a Closer Look
If extra testing is needed, doctors may use certain procedures to collect fluid or tissue from the pleural space.
Fluid Removal (Thoracentesis): The doctor uses ultrasound to guide a needle between the ribs to draw out pleural fluid. After numbing the area, the doctor collects the fluid and sends it to a lab to check for infection, cancer, or diseases like tuberculosis. Removing the fluid can also help with shortness of breath and swelling.
Viewing Inside the Chest (Thoracoscopy/Pleuroscopy): If the doctor suspects a tumor or tuberculosis, a small camera on a tube is used to look directly inside the chest. The camera enters through a small cut in the chest. If the doctor sees anything unusual, a piece of tissue can be taken for a biopsy. This helps diagnose lung cancer, infections, or autoimmune causes.
Ways to Manage and Treat Pleurisy
Treating pleurisy depends on the underlying condition. If bacteria cause the problem, doctors prescribe antibiotics.
For viral causes, rest and time are often enough. Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, help reduce pain and swelling.
Sometimes, doctors give corticosteroids for stronger inflammation control.
| Symptom or Cause | Possible Treatment |
|---|---|
| Bacterial infection | Antibiotics |
| Inflammation | NSAIDs, corticosteroids |
| Severe fluid buildup | Thoracentesis, pleurodesis |
| Blood clots | Anticoagulants |
Thoracentesis can drain excess fluid for relief and may require a biopsy if cancer or infection is suspected. Pleurodesis is sometimes used to prevent fluid from coming back.
Pain management helps keep patients comfortable during recovery.
Everyday Actions and Helpful Home Tips
Taking nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help reduce pain and swelling.
Over-the-counter options are usually enough for mild discomfort. Getting plenty of rest gives the body time to heal.
Avoiding smoking helps protect the lungs from extra irritation. If quitting is hard, a healthcare provider can give support and advice. These steps can make symptoms easier to handle at home.
Getting Ready for Your Visit
Steps You Can Take Before Your Visit
Being prepared helps make the appointment more useful and less stressful.
Here are steps to take:
Write Down Your Symptoms: Note where the chest pain starts, if it spreads, how severe it feels, and when it happens. Include any other issues such as fever, shortness of breath, or weight changes.
List Your Medical Background: Bring details about past hospital stays and any medical problems you have. Include information about whether anyone in your home or someone close to you has been sick recently.
Record Your Medications: List all prescription and over-the-counter medicines, vitamins, herbal products, and supplements, along with their dosages.
Mention Important Personal Details: This can include recent trips, sudden life changes, or your work history. Share if you might have been exposed to substances like asbestos.
Prepare Questions: Think about what you want to ask. Having these written down helps you remember during the visit.
Example questions:
| Question Topics | Example Questions |
|---|---|
| Possible causes | What could be causing my symptoms? |
| Diagnostic steps | Will I need tests or procedures? |
| Treatment plans | What are my options for treatment? |
| Recovery time | When will I feel better after treatment? |
| At-home care | What can I do on my own to ease symptoms? |
| Work/school | Should I stay home from work or school? For how long? |
| Lifestyle | Should I stop smoking? |
| Risks | Are there any long-term problems to know about? |
| Managing other conditions | How do I handle my other health issues together? |
It may help to bring someone along to listen, take notes, and ask questions you might forget.
What Your Provider May Ask or Do
Healthcare providers need a wide range of information to make a diagnosis.
To make the most of your visit, prepare for questions about:
Details of Your Symptoms: When did they start? How do they feel?
- Factors That Make It Better or Worse: Have you noticed anything that changes your symptoms?
Other Health Problems: Do you have other medical conditions? Have you ever been treated for anything similar before?
Recent Travels: Sometimes infections or exposures happen during travel, so be ready to discuss this.
Job History and Exposures: Your provider might ask about jobs, activities, or hobbies that could have exposed you to health risks, such as asbestos.
Smoking History: Your provider will likely ask if you have ever smoked, how much, and for how long.
Joint Pain or Rashes: Be ready to discuss any recent swelling, soreness, or skin rashes.
The provider may change their questions based on your answers. Bring clear and complete information to help your provider diagnose and treat you more accurately.
