Causes of Pain With Deep Breathing

Pain with breathing is always something to see a healthcare provider about. That's whether it comes with regular breathing or when taking a deep breath.

Pain from taking a deep breath is called pleuritic chest pain or pleurisy. The names come from the membranes lining the lungs, called pleura.

The term pleurisy is sometimes used to describe any sharp pain with a deep breath. But it can also be used to describe inflammation of the pleura.

This article looks at pleurisy symptoms, the various possible causes of it, and how it's diagnosed.

Symptoms

Pleuritic pain may be triggered by medical conditions or injuries involving the lungs, pleura, or nearby tissues or organs, including:

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

Symptoms that accompany pleuritic chest pain often point to the underlying cause. They include:

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

Lung-Related Causes

The lungs don't have pain receptors. Still, medical conditions involving the lungs can cause pain in several ways. That includes irritation of the pleura.

These conditions can be cancerous, infectious, or non-infectious.

Cancer

Cancerous causes of pleurisy include lung cancer, mesothelioma, and malignant pleural effusions.

Lung Cancer

The most common type of lung cancer is lung adenocarcinoma. It tends to grow around the edges of the lung near the pleura.

It's most common in:

• People who've never smoked
• People assigned female at birth
• Young adults

The earliest symptom may be pain from cancer reaching the pleura.

Mesothelioma

Mesothelioma is a type of cancer that arises in the pleura. It's most common in people who've been exposed to asbestos.

You can be exposed to asbestos at work or when remodeling homes built before asbestos was banned.

Malignant Pleural Effusion

Malignant pleural effusions cause fluid to build up in the pleura. The fluid contains cancer cells.

Effusions can occur due to lung cancer, breast cancer, and cancers that spread to the lungs.

Infectious Causes

Infectious causes of pain with breathing include:

• Pneumonia: A bacterial, viral, or fungal lung infection.
• Viral infections: Coxsackie virus, respiratory syncytial virus (RSV), influenza (flu), COVID-19, adenovirus, cytomegalovirus (CMV), and the Epstein Barr virus (EBV).
• Tuberculosis (TB): A bacterial infection that's uncommon in the United States but very common worldwide.

Non-Infectious Causes

Non-infectious causes of breathing-related pain include:

• Pleural effusion: Accumulation of fluid between the layers of the pleura. Can be caused by lung disease, heart disease, and autoimmune disorders.
• Pneumothorax: Partial or total lung collapse. Can trigger severe chest pain and shortness of breath. This is a complication of emphysema and other lung diseases.
• Pulmonary embolism: Potentially life-threatening. A blood clot breaks off and travels to the lungs. Risk factors are recent surgery, heart disease, and deep vein thrombosis (DVT).
• Pulmonary infarction (lung infarction): Occurs when a section of lung tissue dies because its blood supply is cut off.
  

Heart-Related Causes

The heart lies near the lungs and the pleura. So heart conditions may cause pain with breathing.

Some heart-related conditions that cause pleuritic chest pain include:

• Pericarditis: Inflammation of the membrane lining the heart (pericardium). Causes include infection, lung and breast cancer, kidney disease, and autoimmune diseases like lupus.
• Myocardial infarction (heart attack): Caused by blocked blood flow to a portion of the heart muscle.
• Aortic dissection: A medical emergency. A weak aorta (artery) allows blood to spill into its inner lining. It often causes severe, tearing pain in the chest and back.
• Pulmonary hypertension: High blood pressure in the pulmonary artery. Causes include heart disease, lung disease, connective tissue disorders, and some medications.

Musculoskeletal Causes

Conditions involving bony or soft tissue structures in the chest may cause pain associated with breathing.

Some of these include:

• Rib fractures: Pain develops suddenly. It may worsen with deep breaths or coughing.
• Costochondritis: A rare condition caused by inflammation between the ribs and sternum (breastbone). Pain can resemble that of a heart attack.

Other Causes

Other common conditions that cause pain with breathing usually cause other symptoms, as well. These conditions include:

• Hemothorax: Accumulation of blood in the pleural space, usually due to an injury.
• Shingles (herpes zoster): Reactivation of the chickenpox virus. May cause pleuritic pain if it affects the chest. Pain is followed after a few days by a painful rash.
• Gastroesophageal reflux disease (GERD): Can cause severe acid reflux, heartburn, and sometimes a chronic cough with pleuritic pain.

Diagnosis

Depending on your symptoms, your healthcare provider may order several tests. These include imaging, bloodwork, and other tests.

Imaging

Imaging studies include:

• Chest X-ray: May show some problems but is often of limited use. Chest X-rays are negative in up to 25% of people with lung cancer.
• Computed tomography (CT): A type of X-ray using multiple images to create three-dimensional pictures.
• Magnetic resonance imaging (MRI): An imaging test that can show details of the body's soft tissue.
• CT lung angiography: Checks for pulmonary embolisms or arteriovenous malformations (abnormal veins) in the lungs.
• CT heart: Examines the structure of the heart.
• Echocardiogram: This is an ultrasound test of your heart that can visualize the heart while it's in motion.
• Bronchoscopy: During 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).

Bloodwork

Blood tests your provider may order include:

• Erythrocyte sedimentation rate (ESR)
• C-reactive protein (CRP)

These look for markers of inflammation. They can help identify autoimmune diseases and other inflammatory conditions.

Other Tests

You may also be sent for:

• Electrocardiogram (EKG): Used to check for heart rhythm abnormalities.
• Thoracentesis: A needle is used to extract fluid from the pleural cavity to diagnose (and treat) pleural effusion.
• Lung tissue biopsy: A tissue sample is taken and examined by a pathologist. Often used to diagnose cancer.
• Oximetry: A non-invasive test to measure blood oxygen levels.
• Pulmonary function tests: These measure lung capacity and performance.

Summary

Many things can cause pleurisy. That includes several lung conditions, heart conditions, infections, and musculoskeletal problems.

Breathing-related pain can be diagnosed using a wide array of imaging studies, bloodwork, and other tests.

You should always treat breathing-related problems as a medical emergency and get immediate help.

A Word From Verywell

Pain with breathing can be scary. You should always pay attention to this symptom and get medical attention.

Most causes of pleurisy aren't life-threatening. But enough of them are to warrant a proactive approach. Getting an early diagnosis and treatment can mean a faster recovery.