Clinical characteristics of the patient with nonspecific pleuritis.

To determine if patients with nonspecific pleuritis could be clinically distinguished from those with malignant or granulomatous pleural disease, the medical records and chest roentgenograms of all patients who had a closed needle biopsy of the pleura during a five-year period from January 1979 to December 1983 were reviewed. A total of 119 patients were categorized based upon their ultimate diagnosis as having malignant (n = 41), granulomatous (n = 25), or nonspecific pleuritis (n = 53). Weight loss, fever greater than 38 degrees, a positive PPD, a pleural fluid lymphocytosis of greater than 95 percent, and an effusion which occupied more than half a hemithorax were significantly more common in the patients with malignant or granulomatous disease. Based on these results, a conservative approach is recommended for the patient with an initial biopsy which reveals only nonspecific pleuritis who has none of the criteria, but an aggressive diagnostic work-up in the individual with two or more criteria is advocated.