Diagnosis		History	Physical examination	Selected diagnostic test results
Connective tissue disorders		Prior diagnosis of systemic lupus erythematosus, rheumatoid arthritis, or other connective tissue disorder should raise suspicion, but pleuritic chest pain may be initial presentation Fever; arthritis or arthralgias	Decreased breath sounds	Chest radiography: small to moderate unilateral or bilateral effusion PFA: exudative effusion (rheumatoid arthritis characterized by low glucose level [< 40 mg per dL (2.2 mmol per L)], elevated lactic dehydrogenase level [> 700 U per L], and low pH [< 7.2]) Abnormal disease-specific serologic markers
Drug-induced pleuritis		Use of drug known to cause drug-induced pleural disease or drug-induced lupus pleuritis*	Possible decreased breath sounds, pleural friction rub	Chest radiography: may be normal or demonstrate infiltrate, pleural effusion, or pleural thickening PFA: exudative effusion
Familial Mediterranean fever		Recurrent episodes of fever (one to four days) associated with abdominal, chest, or joint pain or erysipelas-like skin disease Mediterranean descent Family history of familial Mediterranean fever	Normal between episodes During episodes: temperature of 100 to 104° F (38 to 40° C) and signs of serositis (e.g., peritoneal irritation, pleural and/or pericardial friction rub) Other possible findings: joint swelling, unilateral erythema over extensor surface of leg, ankle, or foot	Increased acute phase reactants (ESR, CRP, WBC, fibrinogen) Positive mutation analysis for MEFV gene
Post–cardiac injury syndrome†		Recent myocardial infarction, cardiac procedure, or chest trauma Fever, dyspnea, pleuropericardial pain	Pleural and/or pericardial friction rub; decreased breath sounds	Chest radiography: may reveal pleural effusion PFA: exudative effusion Elevated ESR, leukocytosis Electrocardiographic abnormalities similar to pericarditis (see Table 3)
Tuberculous pleuritis		Exposure to environment with high risk of Mycobacterium tuberculosis Cough, low-grade fever, weight loss, fatigue Human immunodeficiency virus infection	Unilaterally decreased breath sounds	Chest radiography: small to moderate unilateral pleural effusion, often without associated infiltrate PFA: exudative effusion with elevated adenosine deaminase levels (> 40 to 60 U per L [670 to 1,000 nkat per L]) Caseous granulomas on pleural biopsy Culture positive for M. tuberculosis on induced sputum, pleural fluid culture, or pleural biopsy Negative PPD result does not exclude diagnosis
Viral pleurisy		Recent respiratory illness or undifferentiated febrile illness	Rapid, shallow respirations; pleural friction rub	Chest radiography: normal