Chest Pain (cont.)
Pneumothorax
The lung is held against the chest wall by negative pressure in the pleura.
If this seal is broken the lung can shrink down or collapse (known as
pneumothorax). This may be associated with a rib injury or it may occur
spontaneously. Though commonly seen in those who are tall and thin, other risk
factors for a collapsed lung include
emphysema or asthma. Small blebs or weak
spots in the lung can break and cause the air leak that breaks the negative
pressure.
The common presentation is the acute onset of sharp chest pain associated
with shortness of breath, with no preceding illness or warning. Physical
examination reveals decreased air entry on the affected side. Chest x-ray
confirms the diagnosis.
Treatment is dependent upon what percentage of the lung is collapsed. If it
is a small amount and vital signs are stable with a normal O2 sat, the
pneumothorax may be allowed to expand on its own with close monitoring. If there
is a larger collapse, a chest tube may have to be placed into the pleural space
through the chest wall to suck the air out and re-establish the negative
pressure. On occasion, thoracoscopy (thoraco=chest +scopy=see with a camera) may
be considered to identify the bleb and to staple it shut. For more, please read
the Pneumothorax article.
Shingles
The rash of shingles is caused by the varicella zoster virus, the same one
that causes chickenpox. Once the virus enters the body, it hibernates in the
nerve roots of the spinal column, only to emerge sometime in the future. The
rash is diagnostic as it follows the nerve root as it leaves the back, and
circles to the front of the chest, but not crossing the midline.
Once the rash appears, the diagnosis is relatively easy for the healthcare
provider. Unfortunately, the pain of shingles may begin a few days before the
rash emerges and can be confusing to both patient and healthcare provider,
since the pain and burning may seem out of proportion to the findings on
physical examination.
The treatment for shingles includes antiviral medications like acyclovir
(Zovirax)
along with pain control medication. Since it is the nerve that has become
inflamed, the pain can be quite severe. Some patients may develop postherpetic
neuralgia, or chronic pain from the inflamed nerve, which may persist long after
the infection has cleared. A variety of pain control strategies are available
from medication to pain stimulators to surgery. For more, please read the
Shingles article.
Next: Pneumonia »
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