From the Guidelines
Pleuritic chest pain is primarily caused by conditions that lead to inflammation of the pleura, with pulmonary embolism being a critical cause that requires immediate medical attention, as approximately 75% of patients with pulmonary embolism and pleural effusion have a history of pleuritic pain 1.
Common Causes of Pleuritic Chest Pain
- Respiratory infections such as pneumonia, viral pleuritis, and bronchitis
- Pulmonary embolism, which is a serious condition requiring immediate medical attention, often presenting with pleuritic pain and dyspnea out of proportion to the size of the effusion 1
- Pneumothorax (collapsed lung)
- Pericarditis (inflammation of the heart sac)
- Autoimmune conditions like lupus or rheumatoid arthritis
- Chest trauma
- Certain cancers, particularly lung cancer and mesothelioma
- Less common causes include costochondritis (inflammation of rib cartilage), certain medications, and asbestos exposure
Importance of Clinical Assessment
Clinical assessment alone can often identify the cause of pleuritic chest pain, especially in cases where the presentation is typical for a specific condition, such as left ventricular failure with a confirmatory chest radiograph 1. However, a thorough drug history is also crucial as certain medications can cause exudative pleural effusions, highlighting the need for a comprehensive approach to diagnosis.
Diagnostic Approach
Diagnosis typically involves a physical examination, chest imaging, and sometimes blood tests to identify the underlying cause of the pleuritic chest pain. Given the potential for serious causes, such as pulmonary embolism, a high index of suspicion is required, especially in patients presenting with atypical features or those who fail to respond to initial therapy 1.
From the Research
Causes of Pleuritic Chest Pain
The causes of pleuritic chest pain are diverse and can range from life-threatening to benign conditions. Some of the potential causes include:
- Pulmonary embolism, which is the most common potentially life-threatening cause, found in 5 to 20 percent of patients who present to the emergency department with pleuritic pain 2, 3
- Pericarditis, pneumonia, myocardial infarction, and pneumothorax, which are other clinically significant conditions that may cause pleuritic pain 2, 3, 4
- Viral pleurisy, which is among the most common causes of pleurisy 2, 3
- Pulmonary hypertension, lung cancer, and mesothelioma, which can cause constant pain unrelated to respiratory movements 4
- Acute exacerbation of chronic obstructive pulmonary disease (COPD), which can cause pleuritic chest pain and should be differentiated from cardiac comorbidities such as acute coronary syndrome (ACS) 4
Specific Causes and Their Characteristics
Some specific causes of pleuritic chest pain have distinct characteristics, such as:
- Pulmonary embolism, which can be masked by pneumonia and should be considered in patients with pneumonia who have an initial therapeutic response followed by worsening of the condition during treatment 5
- Pleural effusion due to pulmonary emboli, which can cause pleuritic chest pain and is usually exudative but can be transudative in some cases 6
- Primary spontaneous pneumothorax, which is characterized by acute chest pain 4