Painful Breathing

Pain occurring when breathing and especially by inspiration is a relatively common problem. In most cases it is annoying but harmless. Sometimes it may be on the other side connected with more serious conditions. Since it is often (but not always!) caused by pleural affections we refer it to as pleural type of pain.

Causes

Neuromuscular pain

It appears particularly after physical activity that cause straining of intercostal respiratory muscles. “Stinging” pain also often occurs as part of thoracic spine and its nerves disorders.

Pleurisy

This is an inflammation of membrane that covers lungs and lines both chest cavities. The condition is usually present together with symptoms of respiratory tract infection. The pain worsens during inspiration and there is also elevated body temperature, fatigue, muscle and joint pain. It should be noted that pleurisy may have a number of other non-infectious causes that are mentioned in relevant text. Some of them may be dangerous (autoimmune diseases, malignant diseases). Chest X-ray or possibly computed tomography is important to exclude pneumonia or lung tumor and sometimes it even shows local pleural thickening by inflammation process.

Pneumonia

This is relatively common infectious disease of lung tissue that can lead to irritation of the pleura and following breathing pain. Chest X-ray is essential for proper diagnostics.

Lung cancer

Certain forms of lung cancers can cause pain by inspiration, it is however not a typical sign of this disease. Pain typically occurs when cancer growth irritates nearby located pleural lining.

Pulmonary embolism

This serious condition may also cause breathing pain and often it very well mimics neuromuscular disorders. We should be warned when the problem is connected with sudden shortness of breath, or blood expectoration. Some ECG changes may be present and blood D-dimers levels are elevated, however it is often challenging to diagnose it correctly.

Chest injuries

Injuries to the thorax are often associated with subsequent pain when breathing. Quite typically by rib contusions or fractures. A chest X-ray should be done with focus on ribs on the painful side.

Pneumothorax

Pneumothorax means an inflow of air into pleural cavity and subsequent collapse of related lung. In addition to a sudden chest pain of affected side and shortness of breath, there may emerge an unpleasant breathing pain.

Mesothelioma

This very dangerous malignant tumor of pleura is associated with its thickening and local non-infectious inflammation. Pleural pain is inevitable consequence. Some forms of mesothelioma are closely linked to asbestos exposure.

Diagnostic approach

It is important to know medical history and determine any other present symptoms. Cautious physical examination is also necessary, especially listening with a stethoscope. Imaging methods should be performed as well; chest X-ray is the cheapest an most available. Further approach should continue according to outcome or previously named examination procedures. If fluid presence is found in pleural cavity by the imaging techniques, it can be evacuated by a needle and sent for microbiological, cytological and biochemical examination.