Causes of Pain With Deep Breathing

Understanding Pleurisy and Pleuritic Chest Pain

If you are having pain with breathing, whether normal breathing or when taking a deep breath, you’re likely feeling worried. Doctors describe the kind of pain that occurs with taking a deep breath as either pleuritic chest pain or pleurisy. The name is derived from the membranes lining the lungs known as pleura.

The term pleurisy is sometimes used to describe any sharp pain that occurs with a deep breath, but can also be used to describe inflammation of the pleura. Pleuritic pain may be triggered by any number of disorders, diseases, or injuries involving the lungs, pleura, or associated tissues or organs, including:

  • Ligaments, muscles, and soft tissues of the chest
  • The thoracic spine
  • The heart and pericardium (lining of the heart)
  • The esophagus
  • The breast

Symptoms

There are a number of symptoms which may occur alongside with painful breathing, depending on the underlying cause, including:

  • Coughing
  • Shortness of breath
  • Hoarseness
  • Wheezing
  • Pain spreading the back or shoulder
  • Fever and/or body chills

Pleuritic pain may occur only with breathing or be omnipresent but worsen while taking a breath. Pleuritic pain tends to be sudden, sharp, stabbing, and intense.

Lung-Related Causes

While the lungs themselves do not have pain receptors, medical conditions involving the lungs can cause pain in several ways, including those that cause irritation of the pleura. Some of these include:

  • Pneumonia
  • Viral infections can often cause pleuritic pain. These include the Coxsackie virus, respiratory syncytial virus (RSV), influenza, parainfluenza, mumps, adenovirus, cytomegalovirus (CMV), and the Epstein Barr virus (EBV).
  • Lung cancer is commonly accompanied by pleuritic pain. The most common type, lung adenocarcinoma, tends to grow in the periphery of the lung near the pleura and is most common in people who have never smoked, women, and young adults with lung cancer.
  • Pleural effusion is the accumulation of fluid between the layers of the pleura and may be caused by any number of diseases, including lung disease, heart disease, and autoimmune disorders (like rheumatoid arthritis). Malignant pleural effusions are pleural effusions associated with lung cancer, breast cancer, and metastatic cancers that spread to the lungs.
  • Pneumothorax is a collapse of part or all of a lung which can trigger severe chest pain and shortness of breath. Pneumothorax is a common complication of emphysema and other lungs diseases.
  • Pulmonary embolism is a potentially life-threatening condition in which a clot in a vein will break off and travel to the lungs. Risk factors for a pulmonary embolus include recent surgery, heart disease, and deep vein thrombosis (DVT).
  • Mesothelioma is a type of cancer that arises in the pleura and is most common in people who have been exposed to asbestos.
  • Tuberculosis (TB) is a relatively uncommon cause of pleuritic pain in the United States very common cause worldwide.

Studies of pleuritic chest pain have shown that pulmonary embolism is the most common life-threatening cause and the source of the pain in 5 percent to 21 percent of cases.

Heart-Related Causes

Since the heart lies near the lungs (and pleura) and moves with respiration, heart conditions may cause pain with breathing. Some heart-related conditions which cause pleuritic chest pain include:

  • Pericarditis is the inflammation of the membranes lining the heart (pericardium). Pericarditis has many causes including infections, cancer (most commonly lung cancer and breast cancer), autoimmune conditions such as lupus, and kidney disease.
  • Myocardial infarction (heart attack)
  • Aortic dissection is a medical emergency in which a weakening in the aorta allows blood to spill into the inner lining of the aorta. It often causes a severe, tearing type of pain that may be felt in the chest and the back.
  • Pulmonary hypertension is a serious condition in which the blood pressure in the pulmonary artery is elevated. Pulmonary hypertension can be caused by any number of conditions including heart disease, lung disease, connective tissue disorders, and even some medications.

Musculoskeletal Causes

Conditions involving any of the bony or soft tissue structures in the chest may cause pain which occurs or gets worse with breathing. Some of these include:

  • Rib fractures often cause pain that develops gradually and worsens with a deep breath and with coughing.
  • Costochondritis is the inflammation of the junction of the ribs, often evidenced pain while breathing and swelling around the sternum. Costochondritis is often mistaken for a heart attack.

Other Possible Causes

  • Hemothorax is the accumulation of blood in the pleural space, usually as a result of an injury.
  • Shingles (herpes zoster) is the reactivation of chickenpox virus which may cause pleuritic pain if it occurs in one of the dermatome (nerve groups) of the chest. Shingles is most common in older people, with the risk increasing the older one gets.
  • Gastroesophageal reflux disease (GERD) can cause severe acid reflux and trigger symptoms, often in the middle of the night, that are mistaken for a heart attack. Pain with breathing is sometimes experienced.

Diagnosis

Depending on your symptoms, there are a number of different tests your physician may recommend. These include:

  • Chest X-ray
  • Computed tomography (CT), a type of X-ray in which multiple images create "slices" of internal organs or body parts
  • Magnetic resonance imaging (MRI), which is better at imaging soft tissue
  • CT angiography, to check for heart disorders
  • Electrocardiogram (EKG), to check for heart rhythm abnormalities
  • Echocardiogram, an ultrasound test of your heart
  • Thoracentesis, a procedure used to extract fluid from the pleural cavity with a needle and syringe
  • Bronchoscopy, a test in which a flexible tube is inserted through the mouth and threaded down into the large airways of the lungs (the bronchi)
  • Thoracoscopy, a procedure in which a scope is inserted into the chest cavity to directly visualize the lung (usually to diagnose lung cancer)
  • Lung tissue biopsy
  • Oximetry, to measure blood oxygen level
  • Blood tests, including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) both of which detect generalized inflammation
  • Pulmonary function tests, to measure lung capacity and performance
  • D-dimer tests used to detect blood clots

    Treatment

    The treatment options for painful breathing will depend on the specific cause. The outcome of treatment depends on the severity of the underlying disease. As with any disease, early diagnosis is typically associated with greater treatment success.

    A Word From Verywell

    Pleuritic pain can mean something serious or something that is relatively mild and readily treatable. As such, it is important that you neither ignore the pain nor mask it with pain medication. In the end, pain while breathing can never be considered normal or readily dismissed.

    When to Call a Doctor

    • If the pain is severe or persists for more than a couple of days
    • When the symptoms develop suddenly and profoundly
    • When the pain interferes with breathing
    • If you feel lightheaded, dizzy, or feel like fainting
    • If you cough up blood, however light
    • If there is a high fever (over 100.4 F) and/or body chills
    • If you experience rapid or irregular heartbeats


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