Pleurisy can be indicative of a broad spectrum of disorders, ranging from mild to life-threatening. The clinician must first consider and perform diagnostic tests to exclude critical diagnoses such as pulmonary embolism, myocardial infarction, or pneumothorax. Pneumothorax, pneumonia, and pleural effusions are easily identifiable by chest x-ray or CT scan. Findings and characteristics that can be identified by chest x-ray include infiltrations (i.e., pneumonia), effusions (i.e., pulmonary embolism, malignancy), and/or the lack of identifiable lung markings (i.e., pneumothorax).
A CT scan can provide many findings similar to those of a chest x-ray, but with a more definitive diagnosis. ECG assessment is suggested if a patient demonstrates signs and symptoms indicative of myocardial infarction, pulmonary embolism, or pericarditis. Laboratory analyses such as CBC, D-dimer, arterial blood gas, and cultures enable the clinician to order further testing for suspected diagnoses. In many cases, the cause of pleurisy can be differentiated by the symptom onset: acute (minutes to hours), subacute (hours to days), chronic (days to weeks), or recurrent. Identifying when symptom onset occurred may aid in differentiating the diagnosis.
US Pharmacist © 2012 Jobson Publishing