Pain in the thorax arises from a pathological process in the chest wall, respiratory organs, heart or aorta, and can also be caused by irradiation to the chest from the spine, abdominal organs, etc.
So, pain in the chest should be distinguished by origin, localization, character, intensity, duration, irradiation, connection with the act of breathing, coughing and the position of the body. Sometimes the pain in the chest appears as an undefined pressure.
Most pain in the chest arises in the case of pleural damage (with the development of dry pleurisy, at the beginning of exudative pleurisy, with pleural adhesions, pleural tumor), as well as lung diseases (pneumonia, pulmonary infarction, tuberculosis, lung cancer, etc.). , in the development of which the inflammatory process involves the pleura (pleura is rich in nerve endings).
Pleural pain occurs during a deep breath. The deposits on the pleural sheets of fibrin and their friction cause pain due to irritation of the sensory nerves located in the pleura leaves. To reduce the intensity of pain, the patient tries to breathe superficially, restrains coughing movements, lies on the diseased side. When the patient tilts to a healthy side, the pain is intensified by stretching the pleura.
In the presence of exudative pleurisy, pain in the chest arises only at the onset of the disease. Subsequently, the appearance of effusion, the pleural sheets diverge and the pain disappears. Minor pain can be observed with pleural adhesions after a pleurisy. It is especially strong in the chest with pleural lesions of malignant tumors or germination of a lung tumor in the pleura. In the case of damage to the diaphragmatic pleura (diaphragmatic pleurisy), due to irritation of the diaphragmatic nerve, pain can radiate to the shoulder, neck. Often it is localized in the abdomen. In such cases, erroneously diagnose appendicitis, cholecystitis, etc
Very characteristic is the pain that occurs with pneumothorax, when due to the breakthrough of the visceral pleura into the pleural cavity air enters. The patient suddenly feels acute intense pain in a restricted area of the chest in the place where the pleura penetrates. Simultaneously, acute dyspnoea, cyanosis appear, blood pressure decreases due to the decrease in lungs (compression atelectasis) and displacement of the mediastinal organs. Pain also occurs due to intercostal neuralgia, myositis, shingles, rib injuries (in case of fracture, metastatic cancer). Pain caused by intercostal neuralgia increases with the patient tilting toward the lesion. Sometimes there is an irradiation of pain in the chest (in the case of radiculitis, acute cholecystitis, spleen infarction, diaphragmatic hernia, etc.).
In the presence of diseases of the cardiovascular system, the pain in the chest is localized behind the sternum, in the region of the heart. He often radiates to the left arm, shoulder, shoulder blade. Some blood diseases (Addison-Birmer's anemia, leukemia) are accompanied by pain in the sternum. They are better detected when tapping on flat bones.
In the chest, pain associated with pleural lesions is more often noted, which may be primary or accompany other lung diseases