Stabbing pain in chest
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These studies suggest that stabbing pain in the chest can be caused by a variety of conditions including pulmonary embolism, myocardial infarction, pericarditis, aortic dissection, pneumonia, pneumothorax, asthma, and complications from chest trauma or surgery.
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Stabbing Chest Pain: Causes and Diagnostic Approaches
Introduction to Stabbing Chest Pain
Stabbing chest pain is a sudden, sharp, and intense pain that can be alarming and may indicate various underlying conditions. This article synthesizes research findings on the potential causes, diagnostic challenges, and management strategies for stabbing chest pain.
Common Causes of Stabbing Chest Pain
Pleuritic Chest Pain
Pleuritic chest pain is characterized by sharp, stabbing pain that worsens with inhalation and exhalation. Pulmonary embolism is a significant cause, found in 5% to 21% of patients presenting with pleuritic chest pain in emergency settings. Other serious causes include myocardial infarction, pericarditis, aortic dissection, pneumonia, and pneumothorax.
Pneumothorax
Pneumothorax, or collapsed lung, can occur immediately or be delayed after chest trauma. In a study of patients with stab wounds, 10% developed pneumothorax between twelve hours and three days post-injury, highlighting the need for prolonged observation and serial radiography.
Acute Asthma
Chest pain is common during acute asthma attacks, often presenting as a dull ache or sharp, stabbing pain. This pain is typically worsened by coughing, deep inspiration, or movement and is relieved by sitting upright.
Constrictive Pericarditis
Constrictive pericarditis can develop after chest trauma, such as a stab wound, leading to symptoms like dyspnea, chest pain, and fatigue. Diagnosis often requires multimodal imaging, and treatment may involve surgical intervention.
Diagnostic Challenges
Evaluating Chest Pain History
The history of chest pain alone is not a reliable predictor of acute coronary syndrome (ACS) or acute myocardial infarction (AMI). Stabbing, pleuritic, positional, or reproducible pain by palpation generally decreases the likelihood of ACS or AMI. However, diagnostic testing remains essential to rule out serious conditions.
Imaging and Clinical Decision Rules
For pleuritic chest pain, validated clinical decision rules and imaging techniques such as d-dimer assays, ventilation-perfusion scans, and computed tomography angiography are crucial for diagnosing conditions like pulmonary embolism.
Case Studies and Rare Conditions
Subcutaneous Emphysema
A young man with intermittent stabbing chest pain and neck discomfort was found to have subcutaneous emphysema and required further imaging to rule out serious conditions.
Congenital Absence of the Pericardium
This rare condition can present with non-exertional paroxysmal stabbing chest pain. It may be identified incidentally or through imaging modalities, and complications are more common with partial absence, necessitating surgical intervention.
Conclusion
Stabbing chest pain can arise from various conditions, ranging from benign to life-threatening. Accurate diagnosis requires a combination of patient history, physical examination, and appropriate diagnostic testing. Understanding the potential causes and employing validated clinical decision rules can aid in effective management and treatment.
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