Chest Pain (cont.)
Costochondritis
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 is 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:
The physical exam may be relatively unremarkable, revealing only a friction
rub 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.
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withdrawn. For more, please read the
Pleurisy article.
Next: Pneumothorax »
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