Diagnosis

Your doctor will start by asking about your medical history and doing a physical exam, including examining your chest with a stethoscope.

To determine if you have pleurisy and identify the cause, your doctor might recommend:

• Blood tests. A blood test might tell your doctor if you have an infection. Other blood tests also might detect an autoimmune disorder, such as rheumatoid arthritis or lupus, in which the initial sign can be pleurisy.
• Chest X-ray. A chest X-ray can show if your lungs are fully inflating or if there is air or fluid between the lungs and ribs.
• Computerized tomography (CT) scan. A CT scan combines a series of X-ray images taken from different angles around your body and uses computer processing to create cross-sectional images that look like slices of your chest. These detailed images can show the condition of the pleura and if there are other causes of pain, such as a blood clot in the lung.
• Ultrasound. This imaging method uses high-frequency sound waves to produce precise images of structures within your body. Your doctor might use ultrasound to determine whether you have a pleural effusion.
• Electrocardiogram (ECG or EKG). Your doctor might recommend this heart-monitoring test to rule out certain heart problems as a cause for your chest pain.

Diagnostic procedures

In some cases, your doctor might remove fluid and tissue from the pleural space for testing. Procedures might include:

• Thoracentesis. In this procedure, your doctor injects a local anesthetic between your ribs to the area where fluid was seen on your imaging studies. Next your doctor inserts a needle through your chest wall between your ribs to remove fluid for lab analysis and to help you breathe better. Your doctor might insert the needle with the help of ultrasound guidance.
• Thoracoscopy. If TB or cancer is a suspected cause of your condition, your doctor might perform a thoracoscopy — also called a pleuroscopy — in which a tiny camera (thoracoscope) is inserted through a small incision in your chest wall. This procedure allows for a direct view inside your chest to look for any abnormalities or to get a tissue sample (biopsy).