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Q. What causes severe pain in the lower chest while coughing?

Answered by
Dr. Penchala Prasad Kandikattu
and medically reviewed by Dr. Divya Banu M
This is a premium question & answer published on Jun 12, 2020

Hello doctor,

I recently fell off a roof. After ER visit w/ct scans and X-rays I received 7 staples in my head and was discharged. Prescribed Cephalexin and Percocet I went home for recovery. Two days ago while coughing I felt an excruciating pain what seemed to be under and behind my lowest rib on my right side. This pain continued only when I strain myself such as with a cough or sneeze, etc. Since beginning this pain has gotten more intense with each involuntary strain.

Dr. Penchala Prasad Kandikattu

General Medicine Internal Medicine


Welcome to

Have you undergone any chest X-ray? While coughing is there any sputum? Have you feeling any pain in the abdomen? Is there any blood in urine? Did you land on head or abdomen during fall? If possible, answer above questions please.

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Thank you doctor,

No chest X-ray, sputum, pain in center or left abdomen or blood in urine. Everything is normal. I landed on head.

Dr. Penchala Prasad Kandikattu

General Medicine Internal Medicine


Welcome back to

The possible causes are as follows:

1. Rib fracture (Pain aggravates with chest movements, tender point may be located externally also).

2. Intercostal muscle spasm (Due to vigerous coughing may lead to excessive use of muscle lead to pain).

3. Pleuracy (It is the temporary infection or inflammation of the layer around the lung. Pain aggravates more on deep inspiration, pricking type of pain, non radiating).

4. Hepatitis (Due to right side of abdomen/ chest and associated with high colour urine with decread appetite. Pain usually aggravated on deep inspiration and also aggravated on pressing on rt hypocondrium).

5. Nerve root compression (Possible due to vertical compression of vertebrae lead root originating from the T8 or 9 . Pain radiating from back to right hypocondrium aggravated on spine movements and respiration).

6. Right pleural effusion (Yes, it is possible due to trauma or secondary infection).

7. Rectus muscle spasm (If you are doing abdominal crunches or push ups then there is a possibility of pain which is aggravated by getting up from lying down position or while coughing).

8. Cholecystitis or cholilithiasis (Pain at the tip of ninth or tenth rib aggravated on peak of deep inspiration).

So, I have just mentioned possible causes in a row (from above to below). Use tablet Aceclofenac with Chlorzoxazone twice a day for five days. Avoid sleeping on right lateral position. For dry cough use steam inhalation thrice a day. Use tablet Levocetirizine twice a day for five days. If no improvement, please get it done ultrasound abdomen and chest X-ray AP view. Liver function tests may also be useful. Please review with reports or consult with your physician, he will examine and treat you accordingly. Take care.

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