Diagnosis

The diagnosis of an inflammation of the pleura is performed in several steps. The first and most important step in the diagnosis of an inflammation of the pleura is a detailed discussion between doctor and patient (anamnesis). During this conversation, the affected patient should describe as precisely as possible which symptoms are present and when they were first noticed.

The quality of the pain (stabbing, dull, burning) can also provide a first indication of the underlying disease. This doctor-patient conversation is usually followed by a physical examination tailored to the symptoms. If there is a dry inflammation of the pleura, the attending physician can hear typical rubbing noises (so-called pleural rubbing) during this physical examination with the stethoscope.

This rubbing noise occurs when the pleura, which lines the ribcage from the inside, glides over the lung membrane surrounding the lung. Another important measure in the diagnosis of inflammation of the pleura is the taking of an x-ray of the ribcage (x-ray thorax). This image can be used to determine whether the inflammation of the pleura is caused by pneumonia.

In addition, the accumulation of fluid between the pleura and the lungs (pleural effusions), which is typical of a wet inflammation of the pleura, is also visible in the chest X-ray. In addition, an ultrasound examination can help determine whether fluid has accumulated in the thorax during the inflammation of the pleura. The extent of the inflammation at the pleura, or the exact extent of the inflammation, can be determined by means of a blood test.

Patients suffering from inflammation of the pleura typically have significantly elevated general inflammation levels in their blood. In addition to the white blood cells (leukocytes), the so-called C-reactive protein (CRP) also shows a significant increase. In addition, the blood sedimentation rate (BSG) is usually accelerated in the affected patients.Since an inflammation of the pleura is usually only the concomitant symptom of another disease, the treatment is primarily aimed at the causative underlying disease.

If the inflammation of the pleura is caused by pneumonia, antibiotic therapy may be necessary. Whether antibiotics are required depends on whether the pneumonia is caused by bacteria or a virus. Only pneumonia caused by bacteria responds to antibiotic treatment.

However, if the pneumonia is caused by a virus, only the symptoms can be relieved. For this reason, affected patients are usually given pain-relieving and anti-inflammatory medication. In some cases, direct treatment of the inflammation of the pleura may also be useful.

This is usually necessary especially in the case of dry inflammation of the pleura (pleuritis sicca). The therapy is carried out in the affected patients by means of special breathing training. In this way, it can be prevented that the different parts of the pleura grow together.

Since patients suffering from a wet inflammation of the pleura typically do not experience a painful flattening of the respiration, breathing training is not necessary in these cases. In addition to pain-relieving medication, cough-inhibiting drugs (antitussives) should also be prescribed. In addition, a so-called thoracic drainage may be necessary in cases of massive fluid accumulation.

In this procedure, the thorax is opened with a small incision and a thin plastic tube is inserted to transport the fluid out of the body. Patients suffering from a pronounced inflammation of the pleura should also note that bed rest must be maintained during the treatment phase. The inflammatory processes in the area of the ribcage place enormous demands on the body’s own defenses. The healing process can therefore be positively influenced by physical rest. If the treatment is initiated early in the presence of an inflammation of the pleura, the inflammatory processes usually heal without any problems.