Your doctor will ask about your medical history, including your history of smoking. He or she also may ask whether you have been anywhere where you may have been exposed to tuberculosis.. To confirm the diagnosis, he or she will examine you, paying special attention to your lungs. Your doctor will check for signs of pleural effusion by gently tapping your chest wall. He or she also will listen with a stethoscope to check for a pleural friction rub, the rough, scratchy sound of the inflamed layers of pleura sliding past each other during breathing. Depending on the results of your physical examination and the suspected cause of your pleurisy, the doctor then may recommend:
A chest X-ray — This can show areas of pneumonia, pulmonary tuberculosis, pulmonary embolism, pleural effusion or a cancerous nodule.
Blood tests — Specific blood tests can be used to help diagnose pneumonia, rheumatic fever, pulmonary embolism and lupus.
Ultrasound or chest computed tomography (CT) — If your doctor suspects a pleural effusion, an ultrasound or CT scan of the chest can confirm that there is an abnormal pocket of fluid in the lungs.
Depending on the results of these preliminary tests, additional tests may be necessary to confirm the diagnosis. For example, in patients with suspected pulmonary embolism, a lung scan or CT scan of the lungs may be used to confirm the diagnosis. A patient with confirmed pleural effusion may require a procedure called thoracentesis, in which some chest fluid is removed and sent to a laboratory to be tested.