Your doctor will find out if you have pleurisy or another pleural disorder by taking a detailed medical history and doing a physical exam and several tests. Your doctor will probably also want to know about any other symptoms that you may have, like shortness of breath, cough, or palpitations (a feeling that your heart has skipped a beat or is beating too hard).
Diagnosis often begins with a physical examination. Your doctor will listen to your breathing with a stethoscope to find out whether your lungs are making any strange sounds. Depending on the results of your physical exam, your doctor may recommend other diagnostic tests, such as the following:
Chest X-Ray. A chest x ray takes a picture of your heart and lungs. It may show air or fluid in the pleural space. It also may show what's causing the condition-for example, pneumonia, a fractured rib, or a lung tumor.
Computerized Tomography (CT) Scan. This test provides a computer-generated picture of your lungs that can show pockets of fluid. It also may show signs of pneumonia, a lung abscess, or a tumor.
Ultrasound. This test uses sound waves to create pictures of your lungs. It may show where fluid is located in your chest. It also can show some tumors.
Magnetic Resonance (MR) Scan. This test also is called nuclear magnetic resonance (NMR) scanning or magnetic resonance imaging (MRI). It uses powerful magnets and radio waves to show pleural effusions and tumors.
Blood Tests. Blood tests can show whether you have a bacterial or viral infection, pneumonia, rheumatic fever, a pulmonary embolism, or lupus.
Arterial Blood Gas Tests. In this test, a small amount of blood is taken from an artery in your wrist. It's then checked for oxygen and carbon dioxide levels. This test shows how well your lungs are taking in oxygen.
Thoracentesis. Once your doctor knows whether fluid has built up in the pleural space and where it is, he or she can remove a sample for testing. This test is called thoracentesis. The doctor inserts a small needle or a thin, hollow, plastic tube through the ribs in the back of your chest into your chest wall and draws fluid out of your chest.
Fluid Analysis. Doctors look at the fluid removed by thoracentesis under a microscope. They look at the chemicals in it and its color, texture, and clearness for signs of infection, cancer, or other conditions that may be causing the buildup of fluid or blood in the pleural space.
Biopsy. If your doctor thinks that tuberculosis or cancer may have caused the fluid buildup, he or she may want to look at a small piece of the pleura under a microscope.