Exercise dependent pleurisy in a soccer athlete

Except for traumatic or spontaneous pneumothorax, little information is known about exercise associated pleural pathologies. We present the case of a 22-year-old athlete with symptoms of musculoskeletal disorders of his upper back after a first league soccer match. Clinical examination initially showed a blockage of the costotransversal joints six and seven with subsequent muscular tension representing an interscapulovertebral pain syndrom. Temporary complete pain relief with following severe reoccurrence of symptomes led to further diagnostic procedures after 3 days. Contrast Enhanced Magnetic Resonance Images (CE-MRI) surprisingly revealed an intrathoracic tumenescence in front of the cardiac apex with surrounding pleural effusion. After excluding all alternative diagnosis for unclear pleurisy we assumed an exercise dependent local pleurisy with subsequent pleural effusion due to local friction by a posttraumatic intrathoracic hematoma. Several invasive and non-invasive therapeutical options were discussed in this rare case with a final decision for a conservative strategy. Seven weeks after injury the player was able to return to play. Even if musculoskeletal problems are most likely in high impact athletes, referred pain due to less common disorders has always to be kept in mind.