Pleuritic chest pain causes
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Overview of Pleuritic Chest Pain Causes
Pleuritic chest pain is a sharp, stabbing, or burning pain in the chest that worsens with breathing. It is most often caused by irritation or inflammation of the pleura, the lining around the lungs, but can also result from other chest wall or heart conditions. The causes range from benign to life-threatening, so careful evaluation is essential 1235.
Life-Threatening Causes of Pleuritic Chest Pain
Pulmonary Embolism and Pneumothorax
Pulmonary embolism is the most common serious cause of pleuritic chest pain, found in 5% to 21% of patients presenting to emergency departments with this symptom. Tension pneumothorax is another immediately life-threatening cause that must be considered 12345.
Other Critical Conditions
Other serious causes include myocardial infarction, pericarditis, aortic dissection, pneumonia, and empyema. These conditions should be ruled out early using history, physical examination, electrocardiography, troponin assays, and chest radiography 12345.
Infectious and Inflammatory Causes
Viral and Bacterial Infections
Viruses are common causes of pleuritic chest pain, including 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 135.
Unusual Inflammatory Conditions
Rare causes include cryptogenic organizing pneumonia, which can present with pleuritic pain and is diagnosed after other causes are excluded . Pleurisy itself, often viral, is a diagnosis made after ruling out more serious conditions .
Non-Infectious and Uncommon Causes
Chest Wall and Cardiac Conditions
Pain can also arise from the chest wall, ribs, intercostal muscles, or pericardium, and is considered somatic pain. Conditions like pericarditis and myocardial infarction can mimic pleuritic pain 23.
Rare and Complex Causes
Rarely, pleuritic chest pain can be caused by conditions such as torsion of extralobar pulmonary sequestration, which requires advanced imaging for diagnosis . Heart failure with pleural effusion can also present with pleuritic pain, and imaging such as CT and ultrasonography can help distinguish between heart- and lung-related causes .
Diagnostic Approach
A thorough history and physical examination are essential. Chest radiography is recommended for all patients, and further tests such as CT, ultrasonography, and laboratory markers are used based on clinical suspicion. Validated clinical decision rules help guide the exclusion of pulmonary embolism and coronary artery disease 13459.
Conclusion
Pleuritic chest pain has a wide range of causes, from life-threatening conditions like pulmonary embolism and pneumothorax to viral infections and rare diseases. Prompt recognition and systematic evaluation are crucial to identify the underlying cause and guide appropriate treatment 12345679.
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