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Pleuritic Chest Pain: Sorting Through the Differential Diagnosis
Brian V Reamy1, Pamela M Williams1, Michael Ryan Odom1
1Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
American Family Physician
|September 20, 2017
Summary
Pleuritic chest pain, often caused by pulmonary embolism, requires prompt diagnosis using clinical decision rules and tests like CT angiography. Viral infections are also common causes, managed with NSAIDs, while pneumonia needs radiographic follow-up.
Area of Science:
- Medical Diagnostics
- Pulmonology
- Infectious Disease
Background:
- Pleuritic chest pain presents as sharp, sudden chest discomfort during respiration.
- Pulmonary embolism (PE) is a critical cause, affecting 5-21% of emergency department patients with this symptom.
- Other serious differential diagnoses include myocardial infarction, pneumonia, and pneumothorax.
Purpose of the Study:
- To outline diagnostic strategies for pleuritic chest pain.
- To emphasize the importance of ruling out life-threatening conditions like PE.
- To discuss the role of clinical decision rules and diagnostic imaging.
Main Methods:
- Utilizing validated clinical decision rules for pulmonary embolism assessment.
- Employing diagnostic tests such as d-dimer assays, V/Q scans, and CT angiography.
- Ruling out other cardiac and pulmonary causes through history, physical exam, ECG, troponin, and chest radiography.
Main Results:
- Pulmonary embolism is a frequent and serious cause of pleuritic chest pain.
- Viral infections are common etiologies, responsive to NSAIDs.
- Pneumonia requires follow-up chest radiography to confirm resolution.
Conclusions:
- Accurate diagnosis of pleuritic chest pain relies on a systematic approach, prioritizing critical conditions.
- Clinical decision rules and appropriate testing are essential for managing potential pulmonary embolism.
- Identifying the underlying cause, whether infectious or other, guides effective treatment and monitoring.
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