Chest Pain (cont.)
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Daniel Lee Kulick, MD, FACC, FSCAI
Dr. Kulick received his undergraduate and medical degrees from the University of Southern California, School of Medicine. He performed his residency in internal medicine at the Harbor-University of California Los Angeles Medical Center and a fellowship in the section of cardiology at the Los Angeles County-University of Southern California Medical Center. He is board certified in Internal Medicine and Cardiology.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- Chest pain facts
- Chest pain introduction
- What are the sources of chest pain?
- What are the causes of chest pain?
- How is chest pain diagnosed?
- What is the philosophy of the approach to chest pain diagnosis?
- What is the diagnosis and treatment for chest pain?
- Broken or bruised ribs
- Pleuritis or pleurisy
- Pulmonary embolism
- Angina and heart attack (myocardial infarction)
- Aorta and aortic dissection
- Esophagus and reflux esophagitis
- Referred abdominal pain
- Find a local Doctor in your town
On occasion, the joints and cartilage where ribs attach to the sternum (breastbone) may become inflamed. The pain tends to hurt with a deep breath, and there is tenderness that can be felt when the sides of the sternum are palpated or touched. If there is swelling and inflammation associated with the tenderness, it is known as Tietze's syndrome.
The most frequent cause for costochondritis is idiopathic or unknown, meaning there is no explanation for the pain. Other causes include trauma to the area, infection (often viral), and fibromyalgia.
Though painful, the symptoms resolve with symptomatic care, including ice and/or warm compresses and anti-inflammatory medications (for example, ibuprofen). As with other chest wall pain, recovery may take weeks. Taking deep breaths to prevent the risk of pneumonia is very important.
For more, please read the Costochondritis and Tietze Syndrome article.
Pleuritis or pleurisy
The lung slides along the chest wall when a deep breath is taken. Both surfaces have a thin lining called the pleura to allow this sliding to occur. On occasion, viral infections can cause the pleura to become inflamed, and then instead of sliding smoothly, the two linings scrape against each other, causing pain. This pain hurts with a deep breath and is described as pleuritic.
Viral infections are a common cause of pleurisy, although there are many other infectious causes including tuberculosis. Other diseases that can inflame the pleura include:
- collagen vascular diseases like sarcoidosis and systemic lupus erythematosus,
- kidney failure,
- rheumatoid arthritis,
- complications of radiation therapy,
- complications of chemotherapy, and
- complications of surgery.
The physical exam may be relatively unremarkable, but a friction rub may be heard over the site of pleural inflammation. If a significant amount of fluid leaks from the inflammation, the space between the lung and the chest wall (the pleural space) can fill with fluid, known as an effusion. When listening with a stethoscope, there may be decreased air entry in the lung. As well, percussion, in which the health care professional taps on the chest wall like a drum, may reveal dullness of one side compared to the other.
Often a chest X-ray is done to assess the lung tissue and the presence or absence of fluid in the pleural cavity.
Pleurisy is usually treated with an anti-inflammatory medication. This will often treat an effusion as well. If the effusion is large and is causing shortness of breath, thoracentesis (thora=chest + centesis=withdrawing fluid) may be done. For thoracentesis, a needle is placed in the pleural space and the fluid withdrawn. Aside from making the patient feel better, the fluid may be sent for laboratory analysis to help with diagnosis. For more, please read the Pleurisy article.
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