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- What are the sources of chest pain?
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- 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
Quick GuideHeart Disease: Symptoms, Signs, and Causes
On occasion, the joints and cartilage where ribs attach to the sternum (breastbone) may become inflamed. The pain tends to occur 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.
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.