II. Definitions
- Pleuritic Chest Pain (Symptom)
- Chest Pain exacerbated by forceful breathing
- Pleurisy
- Inflammation of parietal pleura
- One of many conditions resulting in Pleuritic Pain
III. Pathophysiology
- Parietal pleura (not visceral) has Sensory Nerves
- Irritated by inflammation or Trauma
- Nerve distribution
IV. Causes: Serious and life-threatening
- Pulmonary Embolism (represents 5-20% of Pleurisy in ER)
- Pneumothorax or spontaneous Pneumomediastinum
- Pneumonia
- Pericarditis
- Myocarditis
- Myocardial Infarction (Pleuritic Pain is atypical)
- Aortic Dissection
V. Causes: Infection
-
Bacteria
- Bacterial Pneumonia
- Tuberculosis and Tuberculous pleuritis
- Rickettsia (Mediterranean Spotted Fever, Rocky Mountain Spotted Fever)
-
Virus (common)
- Adenovirus
- Coxsachievirus
- Cytomegalovirus (CMV)
- Epstein-Barr Virus (EBV)
- Influenza
- Parainfluenza
- Respiratory Syncytial Virus
- Mumps
-
Parasite
- Amebiasis
- Paragnomiasis
VI. Causes: Other
- Musculoskeletal Causes
- Cardiopulmonary Causes
- Post-Myocardial Infarction, Cardiac injury, surgery
- Asbestosis
- Hematologic and oncologic conditions
- Malignancy (esp. malignant Pleural Effusion)
- Familial Mediterranean Fever (recurrent episodes)
- Sickle Cell Anemia (acute Sickle Cell Crisis)
- Inflammatory Conditions
- Reactive Eosinophilic pleuritis
- Rheumatologic pleuritis (Systemic Lupus, Rheumatoid Arthritis)
- Sjogren Syndrome
- Ankylosing Spodylitis
- Gastrointestinal and Genitourinary Conditions
VII. Symptoms
- Sudden and intense, sharp, stabbing or burning Chest Pain on forceful breathing
- Perceived Dyspnea (due to suppressed respirations)
- Provocative factors
- Movement
- Forceful breathing
- Deep breathing
- Coughing
- Sneezing
- Laughing
- Radiation
- May radiate to neck or Shoulder (via phrenic nerve) when diaphragm is involved
- Radiation to arms (especially both arms or right arm) is more suggestive of Acute Coronary Syndrome
- Radiation to intrathoracic back (severe intensity) may be seen with Aortic Dissection, Pancreatitis
VIII. Symptoms: Red flags for serious or atypical causes
- Sudden, acute onset within minutes (consider life-threatening causes listed above)
- Significant Dyspnea (Pulmonary Embolism, Pneumothorax, Pneumonia)
- Night Sweats
- Significant weight loss
- Joint Pain
- Syncope
- Productive cough
IX. Signs: Red Flags on cardiopulmonary exam
- Hypotension
- Tachycardia
- Tachypnea
- Pericardial Friction Rub
- Rales, asymmetric or absent lung sounds
X. Labs
- Consider D-Dimer
- Consider cardiac enzymes
XI. Diagnostic Tests
-
Chest XRay (obtain in all patients)
- Widened mediastinum (Aortic Dissection)
- Pneumothorax
- Pleural Effusion
- Pneumonia
-
Electrocardiogram
-
Acute Coronary Syndrome
- See Electrocardiogram in Myocardial Infarction
- ST Segment changes
- New Q Waves or new onset Left Bundle Branch Block
- T Wave Inversion
-
Pulmonary Embolism
- See Electrocardiogram in Pulmonary Embolism
- Electrocardiogram shows nonspecific changes in 80% of cases
- Classic Findings (Right heart strain): S1 Q3 T3 (seen in under 20% of cases)
- T Wave Inversion especially in anteroseptal (v1-v4) and possibly inferior (II, III, aVF) leads
-
Pericarditis
- See Electrocardiogram in Pericarditis
- Abnormal EKG changes in 90% of Pericarditis cases
- PR Segment Depression (without T Wave Inversion)
- Diffuse concave upward ST Segment Elevation
-
Acute Coronary Syndrome
XII. Management
-
NSAIDs for analgesia (preferred over Narcotics)
- Indomethacin 50-100 mg orally three times daily with food or milk
- Corticosteroids (Prednisone) may be considered in patients unable to take NSAIDS
- Identify cause
- Evaluate first for serious causes
- Consider Medication Causes of Pleural Disease
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Related Studies
Definition (CHV) | inflammation of the lining of the lung (pleura) |
Definition (CHV) | inflammation of the lining of the lung (pleura) |
Definition (CHV) | inflammation of the lining of the lung (pleura) |
Definition (MSHCZE) | ZÁNĚT PLEURA (pohrudnice), blány (membrány) pokrývající plíce. Je-li rozšířen na pleura parietalis, pociťuje se bolest v oblasti hrudníku (HRUDNÍK – BOLEST). R |
Definition (NCI) | Inflammation of the pleura. It is usually caused by infections. Chest pain while breathing or coughing is the presenting symptom. |
Definition (CSP) | inflammation of the pleura, with exudation into its cavity and upon its surface; may occur as either an acute or a chronic process. |
Definition (MSH) | INFLAMMATION of PLEURA, the lining of the LUNG. When PARIETAL PLEURA is involved, there is pleuritic CHEST PAIN. |
Concepts | Disease or Syndrome (T047) |
MSH | D010998 |
ICD9 | 511 |
ICD10 | R09.1 |
SnomedCT | 32203001, 266406002, 196075003 |
English | Pleurisies, PLEURISY, PLEURITIS, pleurisy, pleurisy (diagnosis), Pleurisy [Disease/Finding], pleurisies, pleuritis, Inflammation of pleura, Pleurisy (excl TB), Pleurisy (disorder), Pleurisy, NOS, Pleuritis, NOS, Pleurisy (disorder) [Ambiguous], Pleurisy, Pleurisy NOS, Pleuritis, Pleuritides, Pleurisy (excluding TB) |
French | PLEURESIE, Pleurite, Pleurésie (excl TB), PLEURITE, Pleurésie |
Portuguese | PLEURISIA, Pleurisia (excl.TB), PLEURITE, Pleuris, Pleurite, Pleuresia, Pleurisia |
Spanish | PLEURESIA, Pleuresía (excl TB), Pleuritis, PLEURITIS, pleuresía, pleuritis (concepto no activo), pleuritis (trastorno), pleuritis, Pleuresía, Pleuresia |
German | PLEURITIS, Pleuritis (ausser TB), RIPPENFELLENTZUENDUNG, Pleuritis, Brustfellentzündung |
Dutch | pleuritis, pleuritis (excl. TBC), pleura-ontsteking, Pleuritis |
Italian | Pleurite (tubercolare esclusa), Pleurite |
Japanese | 胸膜炎(結核性を除く), キョウマクエン, キョウマクエンケッカクセイヲノゾク, 胸膜炎, 肋膜炎 |
Swedish | Lungsäcksinflammation |
Czech | zánět pohrudnice, pleuritida, pleura - zánět, Pleuritida (mimo TBC), Zánět pohrudnice, Pleuritida |
Finnish | Keuhkopussitulehdus |
Russian | PLEVRIT, ПЛЕВРИТ |
Korean | 늑막염 |
Croatian | PLEURITIS |
Polish | Zapalenie opłucnej |
Hungarian | Mellhártyagyulladás, Pleuritis (kivéve TBC), Pleuritis |
Norwegian | Pleuritt, Plevritt, Lungehinnebetennelse |
Ontology: Chest pain on breathing (C0423729)
Concepts | Sign or Symptom (T184) |
ICD9 | 786.52 |
ICD10 | R07.1 |
SnomedCT | 309552003, 207082006, 75483001, 158395001, 274664007 |
English | Painful respiration NOS, [D]Painful respiration NOS, [D]Painful respiration (context-dependent category), [D]Painful respiration NOS (context-dependent category), Painful respiration [D], Painful respiratory movement, painful respirations were observed, painful respiration, painful respiration (physical finding), breathing pains, pain breathing, Pain;breathing, Pain;respiratory;chest, breath chest pains, painful breath, breath pain, breathing chest pain, breaths painful, pain respiratory, chest breathing pain, Pain;respiration, Pain;respiratory, pain respiration, pain respirations, respiration pain, breathing painful, chest pain breathing, pain chest breathing, breath chest pain, breathing pain, breathing chest pains, [D]Painful respiration (situation), [D]Painful respiration NOS (situation), [D]Painful respiration, Breathing painful (situation), Painful respiration, Breathing painful, Chest pain on breathing, Breathing painful (finding), Chest pain on breathing (finding), chest; pain, on breathing, pain; chest, on breathing, pain; respiration, painful; respiratory, respiration; painful, respiration; pain, Painful respiration [D] (finding), pain during respiration, painful breathing, respiratory chest pain, respiratory pain |
Italian | Respirazione dolorosa |
Japanese | 呼吸時疼痛, コキュウジトウツウ |
Spanish | [D]respiración dolorosa (categoría dependiente del contexto), [D]respiración dolorosa, SAI (categoría dependiente del contexto), [D]respiración dolorosa (situación), [D]respiración dolorosa, SAI (situación), [D]respiración dolorosa, SAI, [D]dolor al respirar, SAI, [D]respiración dolorosa, dolor de pecho al respirar, dolor torácico al respirar (hallazgo), dolor torácico al respirar, movimiento respiratorio doloroso, respiración dolorosa (hallazgo), respiración dolorosa [D] (hallazgo), respiración dolorosa [D], respiración dolorosa, Respiración dolorosa |
German | Brustschmerzen bei der Atmung, schmerzhafte Atmung |
Czech | Bolestivá respirace |
Korean | 숨쉴때의 가슴통증 |
Hungarian | Fájdalmas légzés |
Dutch | ademhaling; pijnlijk, ademhaling; pijn, borst; pijn, bij ademhaling, pijn; ademhaling, pijn; borst, bij ademhaling, pijnlijk; ademhaling, Pijn op borst bij ademhaling, pijnlijke ademhaling |
Portuguese | Respiração dolorosa |
French | Respiration douloureuse |