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Pleuritic Chest Pain
Aka: Pleuritic Chest Pain, Pleuritic Pain, Pleurisy
- Definition
- Pleuritic Chest Pain (Symptom)
- Chest Pain exacerbated by forceful breathing
- Pleurisy
- Inflammation of parietal pleura
- One of many conditions resulting in Pleuritic Pain
- Pathophysiology
- Parietal pleura (not visceral) has sensory nerves
- Nerve distribution
- Intercostal nerves referred to associated dermatomes
- Rib Cage
- Lateral hemidiaphragm
- Phrenic nerve referred to ipsilateral neck, Shoulder
- Central hemidiaphragm
- Causes: Serious and life-threatening
- Pulmonary Embolism (represents 5-20% of Pleurisy in ER)
- Pneumothorax
- Pneumonia
- Pericarditis
- Myocardial Infarction (Pleuritic Pain is atypical)
- Spontaneous Pneumomediastinum
- Causes: Infection
- Bacteria
- Bacterial Pneumonia
- Tuberculous pleuritis
- Mediterranean Spotted Fever, Tuberculosis
- Virus
- Adenovirus
- Coxsachievirus
- Cytomegalovirus (CMV)
- Epstein-Barr Virus (EBV)
- Influenza
- Parainfluenza
- Respiratory Syncytial Virus
- Mumps
- Parasite
- Amebiasis
- Causes: Other
- Musculoskeletal Causes
- Musculoskeletal Chest Pain
- Cough fracture
- Cardiopulmonary Causes
- Post-Myocardial Infarction, Cardiac injury, surgery
- Asbestosis
- Hematologic and oncologic conditions
- Malignancy
- Familial Mediterranean Fever (recurrent episodes)
- Sickle Cell Anemia
- Inflammatory Conditions
- Reactive Eosinophilic pleuritis
- Rheumatologic pleuritis (Lupus, Rheumatoid Arthritis)
- Sjogren's Syndrome
- Other Conditions
- Inflammatory Bowel Disease
- Chronic Renal Failure
- Symptoms
- Sharp Chest Pain on forceful breathing
- Perceived Dyspnea (due to suppressed respirations)
- Provocative factors
- Movement
- Forceful breathing
- Deep breathing
- Coughing
- Sneezing
- Symptoms: Red flags for serious or atypical causes
- Night Sweats
- Significant weight loss
- Joint pain
- Syncope
- Productive cough
- Signs: Red Flags on cardiopulmonary exam
- Hypotension
- Tachycardia
- Tachypnea
- Pericardial Friction Rub
- Rales, asymmetric or absent lung sounds
- Labs
- Consider D-Dimer
- Consider cardiac enzymes
- Diagnostic Tests
- Chest XRay (obtain in all patients)
- Consider Electrocardiogram
- Management
- NSAIDs for analgesia (preferred over Narcotics)
- Indomethacin 50-100 mg PO tid with food or milk
- Identify cause
- Evaluate first for serious causes
- Consider Medication Causes of Pleural Disease
- References
- Kass (2007) Am Fam Physician 75:1357-64