Patient education: Pleuritic chest pain (The Basics)

What is pleuritic chest pain? — 

This is a type of sharp, stabbing pain. It gets worse when you breathe in and even worse when you take a deep breath, laugh, or cough. 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? — 

It can be caused by:

●Pneumothorax – This is when air gets trapped between the lung and the rib cage (figure 1). This air presses on the lung and makes it deflate or collapse. Causes of pneumothorax include injuries to the chest, smoking cigarettes, and certain lung infections.

●Pleural effusion – This 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 – This is inflammation of the pleura. It 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 – This is an infection in the fluid between the lung and the rib cage.

●Pericarditis – This is inflammation of the tissues around the heart. Sometimes, the pain from pericarditis is similar to pleuritic chest pain.

Will I need tests? — 

Your doctor or nurse will decide which tests you should have based on your age, other symptoms, and individual situation.

The most common tests used to find the cause of pleuritic chest pain are:

●Blood tests – These can show if you have an infection. They can also show if your blood has certain proteins that get released into the blood during a heart attack.

●Pulse oximetry – This uses a small device that goes on your finger. It checks the amount of oxygen in your blood.

●Chest X-ray – This can show if your lungs are inflating all the way. It can also show if there is air or fluid between your lungs and your ribcage.

●Chest CT scan – This can show if you have a blood clot in your lung, and can also find other causes of pleuritic pain.

●Thoracentesis – You might get this procedure if you have fluid around your lung. A doctor uses a needle to take a sample of the fluid. Then, they test it for infection and find out what kind of cells are in it.

●Heart tests – Because heart problems can cause chest pain, some people with pleuritic chest pain have heart tests. One example is an electrocardiogram ("ECG"), which measures the electrical activity of the heart. Another is an echocardiogram, which uses sound waves to create pictures of the heart as it beats.

How is pleuritic chest pain treated? — 

It depends on what is causing the pain:

●Pneumothorax – Sometimes, a pneumothorax heals on its own. If it 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 – Doctors can give medicine to dissolve the clot or prevent it from getting bigger.

●Medicines – 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. These 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 taking pain-relieving medicines such as ibuprofen (sample brand names: Advil, Motrin) or naproxen (sample brand name: Aleve).

What can I do on my own? — 

You should do the following:

●Take all your medicines as instructed.

•You can take non-prescription medicines to relieve pain, such as acetaminophen (sample brand name: Tylenol), ibuprofen (sample brand names: Advil, Motrin), or naproxen (sample brand name: Aleve).

●Take 10 to 15 slow deep breaths at least 4 times each day. Your doctor might give you a device called an "incentive spirometer" to help you do this. If so, follow the instructions for using it. This helps keep your lungs fully open, and might lower your chances of getting a lung infection.

●If you have discomfort when you cough or sneeze, hold a pillow to your chest to ease the pain.

●Lie on the side that hurts. This can make breathing more comfortable.

●Quit smoking, if you smoke. Your doctor or nurse can help.

●If your pain is caused by a muscle strain or similar injury, ice can help ease the pain:

•Put a cold gel pack, bag of ice, or bag of frozen vegetables on the injured area every 1 to 2 hours, for 15 minutes each time. Put a thin towel between the ice (or other cold object) and the skin. Use for the first 24 to 48 hours.

When should I call the doctor? — 

Call for emergency help right away (in the US and Canada, call 9-1-1) if you:

●Have signs of a heart attack, including chest pain, pressure, or discomfort with:

•Trouble breathing, sweating, nausea, or cold, clammy skin

•Pain in your arms, back, or jaw

•Worse pain with activity like walking up stairs

•Fast or irregular heartbeat

•Feeling dizzy, faint, or weak

●Are having so much trouble breathing you can only say 1 or 2 words at a time

●Need to sit upright to be able to breathe

●Cough up more than a tablespoon (15 mL) of blood at once

Call for advice if you:

●Cough up a small amount of blood, or mucus that looks green or yellow

●Have trouble breathing when talking or sitting still

●Have a fever of 100.4°F (38°C) or higher, or chills

●Have bad pain that does not get better after taking pain medicine

●Have new or worsening symptoms

More on this topic

Patient education: Chest pain (The Basics)
Patient education: Pneumothorax (collapsed lung) (The Basics)
Patient education: Pleural effusion (The Basics)
Patient education: Pericarditis in adults (The Basics)
Patient education: Pericarditis in children (The Basics)
Patient education: How to use a pulse oximeter (The Basics)
Patient education: Pulmonary embolism (blood clot in the lung) (The Basics)
Patient education: Thoracentesis (The Basics)
Patient education: Chest tubes and catheters (The Basics)
Patient education: How to care for a chest tube or catheter (The Basics)
Patient education: How to use an incentive spirometer (The Basics)
Patient education: Flank pain (The Basics)

Patient education: Chest pain (Beyond the Basics)
Patient education: Pericarditis (Beyond the Basics)
Patient education: Pulmonary embolism (Beyond the Basics)
Patient education: Thoracentesis (Beyond the Basics)