Cancer Lung Cancer Living With Causes of Pain With Deep Breathing Understanding Pleurisy and Pleuritic Chest Pain By Lynne Eldridge, MD facebook Lynne Eldrige, MD, is a lung cancer physician, patient advocate, and award-winning author of "Avoiding Cancer One Day at a Time." Learn about our editorial process Lynne Eldridge, MD Medically reviewed by Medically reviewed by Doru Paul, MD on December 01, 2019 Doru Paul, MD, is board-certified in internal medicine, medical oncology, and hematology. Learn about our Medical Review Board Doru Paul, MD Updated on March 23, 2020 Print Table of Contents View All Table of Contents Symptoms Lung-Related Causes Heart-Related Causes Musculoskeletal Causes Other Possible Causes Diagnosis Treatment 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. Worried about the new coronavirus? Learn about COVID-19, including symptoms and how it's diagnosed. 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 chestThe thoracic spineThe heart and pericardium (lining of the heart)The esophagusThe breast Illustration by JR Bee, Verywell. Symptoms There are a number of symptoms which may occur alongside with painful breathing, depending on the underlying cause, including: CoughingShortness of breathHoarsenessWheezingPain spreading the back or shoulderFever 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 is an infection in the lungs that may be bacterial, viral, or fungal.Viral infections can often cause pleuritic pain. These include the Coxsackie virus, respiratory syncytial virus (RSV), influenza, parainfluenza, the novel coronavirus (COVID-19), 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. Sometimes these cancers first cause symptoms when they extend to the pleura and cause pain.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 containing cancer cells that are associated with lung cancer, breast cancer, and metastatic cancers that has 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 pulmonary embolism include recent surgery, heart disease, and deep vein thrombosis (DVT).Pulmonary infarction, also called lung infarction, occurs when a section of lung tissue dies because its blood supply has become blocked.Mesothelioma is a type of cancer that arises in the pleura and is most common in people who have been exposed to asbestos. Asbestos exposure can occur at work, or in people who remodel homes built before asbestos was banned for this use.Tuberculosis (TB) is a relatively uncommon cause of pleuritic pain in the United States but a very common cause worldwide. That said, it appears that tuberculosis is increasing in the United States, and anyone who has traveled should be tested if they are coping with lung pain. 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% to 21% 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) is caused by a blockage of blood flow to a portion of the heart muscle.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 There are also causes that may not be initially obvious. 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. While shingles is usually associated with a rash, pain often precedes the rash by a few days, making the initial diagnosis challenging at times.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. GERD can also cause a chronic cough and other symptoms easily attributed to the lungs. Diagnosis Depending on your symptoms, there are a number of different tests your physician may recommend. These include: Chest X-ray: A chest X-ray may be helpful if it shows a problem, but a negative X-ray cannot rule out many of the potential causes of pleuritic chest pain. For example, chest X-rays are negative in up to 25% of people with lung cancer.Computed tomography (CT): This is a type of X-ray in which multiple images create "slices" of internal organs or body parts.Magnetic resonance imaging (MRI): An MRI is better at imaging soft tissue.CT angiography: This is used to check for heart disorders.Electrocardiogram (EKG): Used to check for heart rhythm abnormalities.Echocardiogram: This is an ultrasound test of your heart.Thoracentesis: This procedure is used to extract fluid from the pleural cavity with a needle and syringe.Bronchoscopy: In this test, a flexible tube is inserted through the mouth and threaded down into the large airways of the lungs (the bronchi).Thoracoscopy: A scope is inserted into the chest cavity to directly visualize the lung (usually to diagnose lung cancer).Lung tissue biopsy: A tissue sample is obtained and examined by a pathologist.Oximetry: This measures blood oxygen level.Blood tests: These include erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) both of which detect generalized inflammation.Pulmonary function tests: These measure lung capacity and performance.D-dimer test: This is used to detect blood clots (pulmonary emboli). 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 daysWhen the symptoms develop suddenly and profoundlyWhen the pain interferes with breathingIf you feel lightheaded, dizzy, or feel like faintingIf you cough up blood, however lightIf there is a high fever (over 100.4 F) and/or body chillsIf you experience rapid or irregular heartbeats What Right-Sided Chest Pain Means Was this page helpful? Thanks for your feedback! Limiting processed foods and red meats can help ward off cancer risk. These recipes focus on antioxidant-rich foods to better protect you and your loved ones. Sign up and get your guide! Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Reamy BV, Williams PM, Odom MR. Pleuritic Chest Pain: Sorting Through the Differential Diagnosis. Am Fam Physician. 2017;96(5):306-312. Karkhanis VS, Joshi JM. Pleural effusion: diagnosis, treatment, and management. Open Access Emerg Med. 2012;4:31-52. doi:10.2147/OAEM.S29942 Khandaker MH, Espinosa RE, Nishimura RA, et al. Pericardial disease: diagnosis and management. Mayo Clin Proc. 2010;85(6):572-93. doi:10.4065/mcp.2010.0046 Tulay CM, Yaldiz S, Bilge A. Do we really know the duration of pain after rib fracture?. Kardiochir Torakochirurgia Pol. 2018;15(3):147-150. doi:10.5114/kitp.2018.78437 Patrini D, Panagiotopoulos N, Pararajasingham J, Gvinianidze L, Iqbal Y, Lawrence DR. Etiology and management of spontaneous haemothorax. J Thorac Dis. 2015;7(3):520-6. doi:10.3978/j.issn.2072-1439.2014.12.50 Additional Reading Berchuck J, Patel, S. An Often-Overlooked Etiology of Pleuritic Chest Pain. Journal of General Internal Medicine. 2016. 31(1):138. doi:10.1007/s11606-015-3316-4 Hogg K, Dawson D, Mackway-Jones, K. Outpatient diagnosis of pulmonary embolism: the MIOPED (Manchester Investigation Of Pulmonary Embolism Diagnosis) study. Emerg Med J. 2006;23(2):123-27. DOI: 10.1136/emj.2005.027110. Jany, B. Pulmonary Causes of Chest Pain. Internist. 2017. 58(1):22-28. doi:10.1007/s00108-016-0169-9 Yan G, Littlewood A, Latimer, M. Unusual Cause of Pleuritic Chest Pain in a Child. BMJ Case Reports. 2016. pii: bcr2016217307. doi:10.1136/bcr-2016-217307 Reamy, B., Williams, P., and M. Odom. Pleuritic Chest Pain: Sorting Through the Differential Diagnosis. American Family Physician. 2017. 96(5):306-312.