Pain in right side of chest
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Persistent Right-Sided Chest Pain: Causes and Diagnoses
Right-sided chest pain can be a symptom of various underlying conditions, ranging from benign to life-threatening. This article synthesizes findings from multiple case studies to provide a comprehensive overview of potential causes and diagnostic approaches.
Esophageal Microperforation and Empyema Thoracis
One rare but serious cause of persistent right-sided chest pain is esophageal microperforation, which can lead to empyema thoracis. A case study described a 64-year-old male who presented with a 3-day history of right-sided chest pain exacerbated by breathing, coughing, and talking. Imaging revealed multiple opacified lesions in the right lung field and an encapsulated right-sided pleural effusion with bubble formation, indicating the presence of a high-density material in the esophagus.
Pneumothorax and Menstrual Cycle Correlation
Recurrent right-sided chest pain can also be associated with pneumothorax, particularly in women. A 34-year-old woman experienced sharp, pleuritic chest pain and dyspnea during vigorous exercise and the first day of her menses. Chest radiographs revealed a small apical right-sided pneumothorax, managed conservatively with high-flow oxygen. This case highlights the potential link between the menstrual cycle and pneumothorax.
Pleuritic Chest Pain and Leg Swelling
Another case involved a 33-year-old man with right-sided chest pain that worsened with deep inspiration and lying down. He also had mild swelling of his lower legs. Despite the absence of common symptoms like cough or fever, the pain's pleuritic nature and associated leg swelling suggested a complex underlying condition .
Hydropneumothorax and Tracheal Shift
A 45-year-old woman presented with right-sided chest pain and progressive dyspnea over six months. Clinical examination revealed a leftward shift of the trachea and mediastinum, with signs of fluid and air on the right side. Chest radiographs confirmed right-sided hydropneumothorax, and intercostal drainage provided symptom relief, although lung expansion was not achieved.
Menstrual-Related Chest Pain
A 33-year-old woman reported right-sided chest pain that worsened around her menstrual periods and when lying on her right side. Physical examination showed diminished breath sounds and increased fremitus and egophony on the right side. Imaging studies were necessary to further investigate the cause.
Postpartum Chest Pain and Coronary Artery Disease
In a postpartum woman, atypical right-sided chest pain was linked to coronary artery disease. A treadmill exercise test and stress echocardiography revealed a critical lesion in the proximal left anterior descending artery, highlighting the importance of considering cardiac causes in postpartum women with chest pain.
Chest Pain with Coryzal Illness
A man in his 60s experienced right-sided chest pain at rest, accompanied by symptoms of a coryzal illness. Despite stable vital signs and normal heart sounds, the patient's right chest wall was tender to palpation, suggesting a musculoskeletal origin of the pain.
Acute Chest Pain and Dyspnea
A 27-year-old man presented with acute right-sided chest pain and dyspnea. The pain was sharp, worse on deep inspiration, and not reproducible with palpation. The absence of fever, cough, or trauma pointed towards a non-infectious cause.
Giant Thymic Cyst
A 24-year-old woman with a 3-day history of right-sided chest pain and worsening shortness of breath was found to have a giant thymic cyst. Initial imaging suggested a large pleural effusion, but further investigation revealed a cyst almost filling the right hemithorax.
Conclusion
Right-sided chest pain can stem from a variety of causes, including esophageal perforation, pneumothorax, pleuritic conditions, hydropneumothorax, coronary artery disease, musculoskeletal issues, and even large cysts. Accurate diagnosis often requires a combination of patient history, physical examination, and imaging studies. Understanding the diverse etiologies is crucial for effective management and treatment.
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