Background Chronic pleurisy can occur in systemic inflammatory diseases, pleural infections and intra-abdominal diseases as a result of asbestos exposure, chronic uremia or side effects of drug treatment (e.g. checkpoint inhibitors) and vaccinations. Furthermore, chronic cardiac effusion can also be associated with chronic (lymphocytic) pleural inflammation, if the pleural effusion persists for a long time. A chronic nonspecific pleurisy is present if no underlying disease is diagnosed. This complex disease represents a differential diagnostic and diagnostic challenge. Objective This article provides an overview of the current status regarding the diagnosis and potential differential diagnostic considerations in the presence of chronic pleurisy as well as the necessary diagnostic steps. Furthermore, existing problems concerning the diagnostic reliability are highlighted. Material and methods This article is based on comprehensive literature searches and own experiences. Cytological and thoracoscopic images and video recordings from own examinations contribute to a better understanding of this complex disease and the multiple differential-diagnostic considerations. Results and conclusion In addition to a thorough medical history, the clinical examination and the investigation of blood parameters, imaging diagnostics (ultrasound, thoracic and computed tomography) also play an important role. Analysis of pleural effusion fluid and, in particular, cytological diagnostics, can provide groundbreaking results. Cytological results are particularly valuable in cases of pleural tuberculosis, lupus erythematosus or rheumatic pleurisy. Thoracoscopy with local anesthesia is a gentle and minimally invasive highly effective procedure that is indicated when the origin of the effusion cannot be determined using conventional methods. Chronic pleurisy is a mirror of numerous internal diseases and fundamentally requires a holistic approach. If a clear diagnosis cannot be made despite knowledge of all clinical details even with thoracoscopy, a chronic nonspecific pleurisy is present. In this case a follow-up control is necessary because underlying diseases can be revealed during the course. There is no consensus among experts concerning the necessary duration of the follow-up period.

Chronische Pleuritis

期刊论文
发表日期：

2025年12月27日

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Ralf Heine

摘要

Background

Chronic pleurisy can occur in systemic inflammatory diseases, pleural infections and intra-abdominal diseases as a result of asbestos exposure, chronic uremia or side effects of drug treatment (e.g. checkpoint inhibitors) and vaccinations. Furthermore, chronic cardiac effusion can also be associated with chronic (lymphocytic) pleural inflammation, if the pleural effusion persists for a long time. A chronic nonspecific pleurisy is present if no underlying disease is diagnosed. This complex disease represents a differential diagnostic and diagnostic challenge.

Objective

This article provides an overview of the current status regarding the diagnosis and potential differential diagnostic considerations in the presence of chronic pleurisy as well as the necessary diagnostic steps. Furthermore, existing problems concerning the diagnostic reliability are highlighted.

Material and methods

This article is based on comprehensive literature searches and own experiences. Cytological and thoracoscopic images and video recordings from own examinations contribute to a better understanding of this complex disease and the multiple differential-diagnostic considerations.

Results and conclusion

In addition to a thorough medical history, the clinical examination and the investigation of blood parameters, imaging diagnostics (ultrasound, thoracic and computed tomography) also play an important role. Analysis of pleural effusion fluid and, in particular, cytological diagnostics, can provide groundbreaking results. Cytological results are particularly valuable in cases of pleural tuberculosis, lupus erythematosus or rheumatic pleurisy. Thoracoscopy with local anesthesia is a gentle and minimally invasive highly effective procedure that is indicated when the origin of the effusion cannot be determined using conventional methods. Chronic pleurisy is a mirror of numerous internal diseases and fundamentally requires a holistic approach. If a clear diagnosis cannot be made despite knowledge of all clinical details even with thoracoscopy, a chronic nonspecific pleurisy is present. In this case a follow-up control is necessary because underlying diseases can be revealed during the course. There is no consensus among experts concerning the necessary duration of the follow-up period.