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Diagnosis of pleurisy
Last reviewed: 06.07.2025
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The accumulation of exudate in the pleural cavity occurs in many diseases of the lungs, pleura and other organs, which complicates etiological diagnostics. In adolescents, pleurisy is more often tuberculous (75%). Among pleurisy of non-tuberculous etiology, it is necessary to note exudation in pneumonia of various origins, rheumatism, collagenoses, circulatory failure, tumors, trauma, etc.
In differential diagnostics of pleurisy, anamnesis data indicate the tuberculous nature of pleurisy: contact with a patient with tuberculosis, hyperergic reaction to the Mantoux test or a turn in the tuberculin test. If exudative pleurisy has developed against the background of a turn, most likely this is pleurisy of tuberculous etiology, and the child needs urgent chemotherapy.
Parapneumonic and metapneumonic pleurisy develops in the acute period or a short time after pneumonia. The disease is often preceded by lesions of the upper respiratory tract, colds. In the blood test of patients with tuberculous pleurisy, an increase in ESR, moderate leukocytosis, a band shift in the leukocyte formula, lymphopenia, and monocytosis are noted. In pleurisy complicating pneumonia, a higher leukocytosis and a shift in the leukocyte formula to the left, sometimes anemia, are determined, and in lupus pleurisy, lupus cells are detected.
In rheumatic pleurisy, indications of repeated exacerbation of rheumatism, indicators of rheumatic activity, and simultaneous damage to the pleura and heart (rheumatic carditis) are of decisive importance.
Hydrothorax is a consequence of circulatory failure and is detected in cardiac pathologies (for example, myocarditis, heart defects).
Oncological pleurisy is characterized by a malignant course, anemia, weight loss, and decreased sensitivity to tuberculin.
Traumatic pleurisy is associated with chest contusion, rib fracture, or artificial pneumothorax.
In differential diagnostics, the study of the effusion is mandatory. The fluid can be both an exudate and a transudate, for example, in hydrothorax. In specific pleurisy, the fluid is often serous, lymphocytic in nature, mycobacteria and anti-tuberculosis antibodies can be found in it in high titers. If the exudate does not suppurate, then its sowing is sterile. The volume of pleural fluid in non-specific pleurisy rarely exceeds 300 ml, when sowing, the growth of non-specific microflora is determined, and in cytological examination - neutrophilic granulocytes. In the case of lupus pleurisy, lupus cells are sometimes found in the exudate. In oncological pleurisy, the exudate is immediately hemorrhagic or transforms from serous, characterized by persistent accumulation ("inexhaustible"), atypical cells and erythrocytes can be detected in large quantities cytologically. X-ray and tomography performed before and after fluid evacuation make it possible to distinguish free fluid from encapsulated fluid in the pleural cavity and to identify changes in the lungs, mediastinum, and pleura.
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