What is pleuritic chest pain? — Pleuritic chest pain is a type of sharp, stabbing pain that gets worse when you breathe in and even worse when you take a deep breath. It is often caused by problems with the thin layers of tissue that surround the lungs (called the "pleura"). Pain from the ribs or muscles lying over the ribs can cause a similar chest pain.
What causes pleuritic chest pain? — Pleuritic chest pain can be caused by the following lung problems:
Pneumothorax – A pneumothorax is when air gets trapped between the lung and the rib cage (figure 1). This air presses on the lung and causes it to deflate or collapse. Causes of pneumothorax include injuries to the chest, cigarette smoking, and certain lung infections.
Pleural effusion – Pleural effusion is when fluid builds up in the space between the lung and the rib cage. Causes of pleural effusion include tumors, pneumonia (an infection in the lungs), and blood clots in the lungs.
Pleuritis – Pleuritis is the medical term for inflammation of the pleura. This can also be called "pleurisy." The most common cause of pleuritis is infection, but it can also be caused by lupus, rheumatoid arthritis, and certain medicines.
Empyema – Empyema is the medical term for an infection in the fluid between the lung and the rib cage.
Pericarditis – Pericarditis is a term for inflammation of the tissues around the heart. Sometimes the pain from pericarditis is similar to pleuritic chest pain.
Should I see a doctor or nurse? — Yes, if you have stabbing chest pain that gets worse when you breathe in and lasts more than a few minutes, see a doctor or nurse right away.
Are there tests I should have? — Your doctor or nurse will decide which tests you should have based on your age, other symptoms, and individual situation.
Here are the most common tests doctors use to find the cause of pleuritic chest pain:
Blood tests – Blood tests can show whether you are fighting an infection, whether there is an infection in your blood, and whether your blood has certain proteins that get released into the blood during a heart attack.
Pulse oximetry – This test uses a small device that goes on your finger. It checks the amount of oxygen in your blood.
Chest X-ray – A chest X-ray can show if the lungs are inflating all the way. It can also show if there is air or fluid between the lungs and the ribcage.
CT scan – A chest CT scan can show if there is a blood clot in the lung, and find other causes of pleuritic pain.
Thoracentesis – During this procedure, doctors use a needle to take some fluid from around the lungs. Then they can test the fluid for infection and find out what kind of cells it has in it. (This test is only for people who have fluid around the lungs.)
Heart tests – Because heart problems can cause chest pain, some people with pleuritic chest pain have heart tests. These tests could include an electrocardiogram (ECG), which measures the electrical activity of the heart, or an echocardiogram, which uses sound waves to create pictures of the heart as it beats.
How is pleuritic chest pain treated? — That depends on what kind of problem is causing the pain.
Pneumothorax – Sometimes a pneumothorax will heal on its own. If a pneumothorax is too big to heal on its own, doctors can drain the air in the pneumothorax using a tube (called a chest tube).
Pneumonia with empyema caused by bacteria – If the pain is caused by a bacterial infection in the fluid around the lung, doctors can treat the infection with antibiotics. Often they also use a chest tube to help drain the infection.
Blood clot – If the pain is caused by a blood clot, doctors give medicine that dissolves clots or keeps them from getting bigger.
Medicines – If a medicine is causing pleuritis, doctors might stop or switch the medicine.
Viral infection – If the pain is not caused by any of the problems listed above, it is probably caused by a viral infection. Viral infections usually go away on their own after a few days or a couple of weeks. To help with pain in the meantime, doctors often suggest pain-relieving medicines, such as ibuprofen (sample brand names: Advil, Motrin) or naproxen (sample brand name: Aleve).
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This topic retrieved from UpToDate on: Mar 30, 2020.
Topic 17108 Version 6.0
Release: 28.2.2 - C28.105
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