Causes of pleuritic chest pain
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Common and Serious Causes of Pleuritic Chest Pain
Pleuritic chest pain is a sharp, stabbing, or burning pain in the chest that worsens with breathing. The most common and serious cause is pulmonary embolism, which is found in 5% to 21% of patients presenting with this symptom in emergency settings. Other life-threatening causes include myocardial infarction, pericarditis, aortic dissection, pneumonia, and pneumothorax. These conditions should be ruled out first using clinical history, physical examination, electrocardiography, troponin assays, and chest radiography before considering less critical diagnoses 12345.
Infectious and Inflammatory Causes
Viral infections are frequent causes of pleuritic chest pain. Common viruses include coxsackieviruses, respiratory syncytial virus, influenza, parainfluenza, mumps, adenovirus, cytomegalovirus, and Epstein-Barr virus. Bacterial infections, such as pneumonia and empyema, can also cause pleuritic pain. Less common inflammatory conditions, such as cryptogenic organizing pneumonia, have also been reported as causes 13456.
Unusual and Rare Causes
Some rare causes of pleuritic chest pain include torsion of extralobar pulmonary sequestration, which can present acutely in adults, and epipericardial fat necrosis, a self-limiting condition. Other unusual causes may be related to chest wall or pericardial pathology, and even complex or multifactorial cases have been described in the literature 3678910.
Diagnostic Approach
A thorough evaluation is essential to identify the underlying cause. This includes a detailed history, physical examination, and appropriate imaging such as chest radiography and, when indicated, CT scans or MRI. Clinical decision rules, such as the Wells score, can help guide further testing for pulmonary embolism. Electrocardiography is useful for assessing cardiac causes, and laboratory tests may help identify infection or inflammation 1245.
Conclusion
Pleuritic chest pain has a wide range of causes, from life-threatening conditions like pulmonary embolism and myocardial infarction to more benign or rare causes such as viral infections and epipericardial fat necrosis. Prompt and systematic evaluation is crucial to ensure serious conditions are not missed and to guide appropriate management based on the underlying diagnosis 12345678+2 MORE.
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