This is not a situation for watchful waiting. An aggressive approach is needed. You should have a biopsy by thoracoscopy done by a specialist with great experience with the procedure.
Video-assisted thoracoscopic lung biopsy (VATS) is a less invasive surgical procedure. It allows several different pieces of lung tissue to be taken for testing through two small incisions. A scope with a video camera at one end is placed through one of these incisions. Recovery is generally fast and uneventful.
There are a lot of potential causes of your problem. Many of them are treatable. Chest x-ray, CT scan, blood tests or examination of the fluid may not find these problems.
this is quit common senario in respirology. the fluid in the pleural space is called pleural effusion and it is divided in to 2 typres based on thoracocentesis result; exudative which is increase in pleura permeability secondary to various conditions like infectious, inflammatory, cancerous, the other typr is transudative which is secondary to change in driving pressures to accomulate fluid in the pleural space and this form is related to cardiac, liver, types of kidney diseases. the general approach and probability of etiology is guided by patient history, then thoracocentesis performed in attempt to categorize into transudate or exudate type. TB testings done always and if no answer yet then CT Chest done to look for abnormal lung tissue abnormalities, hidden cancers, asbestos related findings, rheumatoid arthritis lung findings, lupus lung findings, pulmonary embolism (clot), and pleural tissue abnormalities and many other causes like metastesis to the pleura. if still no answer then thoracoscopy done by thoracic surgeon with biopsy taken will give more detail about the histology. the blood work that is done is CBC, kidney function, liver function, RF (RHEUMATOID FACTOR), ANA (ANTINEUCLEOR ANTIBODY), anti-dsDNA (ANTI-DOUBLE STRANDED DNA)if ana is positive, lipase is pancreatitis was probable. radiological tests would include CT chest as i said, abdominal imaging would be required if abdominal malignancy is suspected especially ovaries in a female. the presence of pleurisy is indicating an ongoing inflammatory process and the yield of a biopsy will likely be positive.
this a detailed approach that i hope it will help you understanding the idea of your disease.
I still don't understand why every test, CT Chest, VQ Scan, TB test, Cardiac test, blood work, EVERYTHING is coming back with NOTHING. Would I really move forward and have a biopsy done?
I've heard that pleurisy can go away on its own.
these tests are important when no direct answer available. as i mentioned the possibilities for the etiology for pleural effusion really wide. if these tests negative then biopsy is mandatory either by pulmonologist or thoracic surgeon via thoracoscopy.
IT's been three months now and I'm not much better. I now have fluid in my left lung also. I went to NY City to specialists and they don't believe that it's anything serious. Blood work shows up great, so it's not Lupus or ??? I was told to wait another 6 weeks, and if the fluid doesn't go away, then we can do a biopsy. Does that sound right to you also?