Is chest pain caused by breathing in a sign of pleuritic chest pain?

Chest Pain During Breathing Is Characteristic of Pleuritic Chest Pain

Yes, chest pain caused by breathing in is a defining characteristic of pleuritic chest pain. Pleuritic chest pain is specifically characterized by sharp, stabbing, or burning pain that worsens during inspiration and expiration 1.

Definition and Characteristics of Pleuritic Chest Pain

• Pleuritic chest pain is sharp, stabbing, or burning pain that is provoked or worsened by respiration (breathing in or out) 2
• This type of pain is typically localized and may be described as "knifelike" in quality 2
• The pain occurs due to inflammation or irritation of the pleura (the membrane surrounding the lungs) 2
• Pain is most intense during deep breathing, coughing, or other respiratory movements 2

Clinical Significance and Differential Diagnosis

• Pleuritic chest pain requires careful evaluation as it can indicate several potentially serious conditions 3
• Pulmonary embolism (PE) is the most common serious cause of pleuritic chest pain, found in 5-21% of emergency department presentations 1
• Other serious causes that must be ruled out include:
  • Pneumonia (may present with localized pleuritic pain and friction rub) 2
  • Pneumothorax (presents with dyspnea and pleuritic pain with unilateral absence of breath sounds) 2
  • Pericarditis (pain typically increases in supine position and may be associated with friction rub) 2
  • Myocardial infarction (can occasionally present with pleuritic features) 2

Distinguishing Features from Other Types of Chest Pain

• Non-pleuritic chest pain typically does not worsen with respiration 2
• Anginal pain from coronary artery disease is usually described as pressure or heaviness rather than sharp or stabbing 2
• Features that help identify pleuritic pain include:
  • Pain that is reproducibly worsened by deep breathing 1
  • Pain that may be localized to a specific area of the chest 3
  • Pain that may be accompanied by a pleural friction rub on examination 2

Diagnostic Approach

• Initial evaluation should include history, physical examination, and chest radiography for all patients with pleuritic chest pain 3
• Electrocardiography is essential to exclude cardiac causes, especially if there is suspicion of myocardial infarction or pericarditis 3
• Additional testing may include:
  • D-dimer testing, ventilation-perfusion scanning, or CT angiography if pulmonary embolism is suspected 1
  • Blood cultures if infectious causes are suspected 4
  • Thoracic imaging if structural causes are suspected 5

Common Pitfalls and Caveats

• Not all pleuritic chest pain is benign - serious conditions like pulmonary embolism must be ruled out first 1
• Pleuritic features can occasionally be present in myocardial infarction (13% of patients with pleuritic pain in one study had acute myocardial ischemia) 2
• Some patients with pulmonary embolism may be asymptomatic or have atypical presentations 6
• Pain that is reproducible with chest wall palpation may suggest musculoskeletal origin but does not completely rule out serious conditions (7% of patients with reproducible pain on palpation had acute coronary syndrome in one study) 2