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Understanding Pleurisy -- Diagnosis & Treatment

How Is Pleurisy Diagnosed?

Oftentimes, pleurisy's distinctive pain when inhaling is an important clue to your doctor. In addition, your doctor will listen to your chest with a stethoscope as you breathe. This exam may reveal a pleural friction rub -- the abrasive sound of the pleura's two layers sliding against each other.

Pleural friction rub produces a scraping, raspy sound that occurs at the end of your inhalation and the beginning of your exhalation. It comes from the area directly over the pleural inflammation. A decrease in breath sounds and a change in their quality may allow your doctor to diagnose a pleural effusion.

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Your doctor may also take X-rays of your chest. These X-rays will be normal if you have only pleurisy without fluid but may show fluid if you have a pleural effusion. They can also show if pneumonia is the cause of the pleurisy. CT scans and ultrasound scans may also be used to better visualize the pleural space.

If there is a large amount of fluid present, your doctor may draw a sample of pleural fluid for analysis. Your doctor will determine the exact location of the fluid. Then, after injecting your back or chest with a local anesthetic, your doctor will use a syringe to extract the fluid in a procedure called thoracentesis. This may be done with guidance from an ultrasound test. The doctor will run tests on the sample to determine the underlying cause of the fluid buildup.

Occasionally, your doctor may request a biopsy of the pleura to better analyze the tissue and determine the cause of the pleurisy. A sample of pleural tissue can be obtained several ways:

  • With a biopsy needle
  • By making a small incision in the chest wall
  • By using a thoracoscope (a video-assisted instrument for viewing the chest cavity and collecting samples)

 

What Are the Treatments for Pleurisy?

Once the underlying cause of your pleurisy is identified, your doctor will take steps to treat it. Your doctor may give you antibiotics for an infection. In addition to this, your doctor may prescribe anti-inflammatory drugs or other pain medicines to remedy the inflammation. Sometimes, a codeine-based cough syrup will be prescribed to control a  cough that can exacerbate pain.

In the case of pleural effusion, your doctor will direct treatment towards the underlying cause of the fluid. Sometimes, if the pleural fluid is infected or the amount is excessive, the doctor may drain it through a tube inserted in your chest, a procedure that requires hospitalization.

How Can I Prevent Pleurisy?

While pleurisy probably can't be prevented, it could indicate a larger underlying problem like infection, a blood clot (pulmonary embolism), or lupus that needs immediate attention.

WebMD Medical Reference

Reviewed by Lisa B. Bernstein, MD on March 18, 2015

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