Is pleurisy or costochondritis the cause of chest soreness?

Question

Hello doctor,

I am a 36-year-old, otherwise healthy (as far as I know) female. I was a smoker earlier. No history of heart disease. My mother has COPD, but has been a long-time smoker. Two and a half weeks ago, I went on a hayride with my sons. I have a short stature. To get on and off the hayride, I had to pull myself up onto the trailer. (Imagine pulling yourself out of a swimming pool.)

The next morning, I woke up with chest soreness. I had pain in the upper left chest area, a few inches to the left of the sternum. That was a radiating pain over the breast towards the armpit. Pain worsened on bending over. Also, I could locate very tender spots when pressing on the area with my fingers. I had no pain during regular breathing, but very deep breaths caused pain to worsen (from the left of the sternum radiating across and to the left breast).

Over the past two and a half weeks, pain has improved, but it still has not completely subsided. Most of the pain (while bending) is gone, but I still have tender areas across upper left chest when poking around with finger (trigger points?). I have some minor discomfort on taking deep breaths, but greatly improved from what it was. And now the pain is just in an area to the left of my left breast. Now, pain is mostly towards the armpit area and may be slightly radiating to the upper, bottom sides of the arm. I do not have much pain as it was in the beginning, but more soreness. It is not constant; it occurs mostly just when I move in a certain way or tense my chest.

Also, I am noticing upper left back discomfort, not really pain. Local FNP suspects a strained muscle. No X-rays were done. I have no cough, no shortness of breath, no loss of appetite, no indigestion or heartburn. Otherwise, I feel fine. My concern is that I still have some pain and discomfort after almost three weeks. Shouldn't a muscle strain be healed by now? I am a bit concerned as it may be something more serious than a strained muscle, perhaps pleurisy or costochondritis?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

You are right, muscular pain will not last so long.

Pleurisy:

It is an inflammation of the outer covering of the lungs.
It is most commonly caused by infections, in which case there will be fever, which is not present in your case.
Rarely can it also be caused by chest trauma, i.e, what has happened in your case.
Get a Decubitus chest x-ray to rule it out.
Treatment is by simple analgesics such as tablet Ibuprofen thrice a day for two to three weeks.

Chostochondritis:

This is caused due to physical strain/injury/arthritis/infections.
Symptoms of pleurisy and costochondritis are the same, i.e, pain during deep respiration/tenderness on applying pressure.
Treatment here also is the same, i.e, analgesics.

Another possibility is that you might have a rib fracture.

Start taking analgesics and hot fomentation 2-3 times a day for the painful region. Use a thoracic belt to restrict movements of the affected part. Get a chest x-ray done immediately and revert to a general practitioner online.

Thankyou.