June 18, 2024

Vitavo Yage

Best Health Creates a Happy Life

Causes, Treatment, and When to See a Healthcare Provider

11 min read

The causes of lung pain are many. Some may involve the lungs themselves (such as with pneumonia or COPD), while others may involve the chest wall or muscles (such as with fibromyalgia or rheumatoid arthritis). Conditions affecting adjacent structures like the esophagus or heart might also be the source of pain, such as can occur with acid reflux or angina.

Pinpointing the exact cause of lung pain not only ensures the correct treatment but also the timely treatment of potentially life-threatening conditions like a pulmonary embolism, lung cancer, or heart attack.

This article explores 32 possible causes of lung pain, including how they are diagnosed and treated. It also explains when it is time to seek immediate treatment from a healthcare provider or emergency department.

Verywell / Alexandra Gordon


Pulmonary Issues

Pulmonary issues are those involving the lungs. These include conditions like asthma, COPD, infections, pulmonary embolism, pleuritis, pneumothorax, and, in rare instances, cancer.

Asthma and COPD

Asthma and chronic obstructive pulmonary disease (COPD) are obstructive respiratory diseases in which the airways of the lung will narrow and spasm, causing tightness across the chest during a flare-up.

Other symptoms of asthma include a cough that gets worse at night, difficulty breathing, and wheezing (a high-pitched whistling sound).

Wheezing can also occur in people with COPD, along with shortness of breath, a chronic cough, and sputum (phlegm) production.

Asthma and COPD are both treated with rescue inhalers which open the airways and improve breathing during attacks. There are also daily medications, like long-acting bronchodilators and steroids, that can help control asthma and COPD and prevent attacks.

Lung Infections

There are many different types of lung infections that vary by their cause, location, and symptoms. These include:

  • Pneumonia: A viral or bacterial infection that causes the blockage of the air sacs of the lungs
  • Acute bronchitis: Inflammation of the larger airways, most often due to a viral infection
  • Lung abscess: A pus-filled cavity in the lungs that form as a result of infection

All of these can cause lung pain and tightness. Often, the infection will be accompanied by a fever and a deep, productive (“wet”) cough.

Antibiotics may be prescribed for bacterial pneumonia. Viral lung infections may benefit from antiviral drugs or may only require the management of symptoms. Intravenous antibiotics (delivered into a vein) may be needed for a lung abscess.

Pulmonary Embolism

Pulmonary embolism is a potentially life-threatening condition that occurs when a blood clot in the legs (deep vein thrombosis) breaks off and travels to the lungs.

The chest pain is generally very sharp. Some people describe it as feeling like you’re having a heart attack. The pain can get worse when you inhale, cough, or lean over and may even stop you from being able to take a deep breath.

Other symptoms include a persistent cough, shortness of breath, a fast heart rate, and calf tenderness with warmth and swelling.

Anticoagulants (blood thinners) are the most common treatment for a blood clot in the lungs. In severe cases, a surgery called a thrombectomy or embolectomy may be used to remove the clot.

Pleuritis

Pleuritis, also known as pleurisy, is the inflammation of the tissues lining the lungs (called the pleura). Pain is the central feature of pleuritis, which generally feels sharp and increases with deep breaths. There may also be generalized chest tightness.

There are many health conditions that can trigger pleuritis, including autoimmune diseases like lupus and rheumatoid arthritis. Bacterial or viral infections of the lung can do the same.

Pain relief is central to the treatment of pleuritis until the underlying case is resolved. This typically involves a nonsteroidal anti-inflammatory drug (NSAID) like Advil (ibuprofen). Severe cases may benefit from using a stronger pain reliever like Tylenol 3 (acetaminophen with codeine).

Pneumothorax

Pneumothorax (a collapsed lung) can cause sudden, sharp chest pain along with difficulty breathing. It is often recognized by crackling lung sounds and popping sensations known as crepitus.

Pneumothorax can occur for many different reasons. It can happen on its own (often in people in their 20s with no lung disease) or as a result of an underlying lung disease like COPD. Chest trauma can also cause pneumothorax.

The treatment of pneumothorax may involve removing excess air from the chest cavity with a needle or catheter. There are medications that can help lung tissues to stick together so that the lung returns to its normal state. Surgery may be needed to repair leaks or burst air blisters.

Cancer

Cancers that manifest with chest pain include:

Chest pain can also be caused by non-cancerous lung tumors such as hamartomas.

The pain caused by lung tumors tends to be achy but persistent but can become sharp when laughing, coughing, or taking a deep breath. Wheezing, coughing up blood (hemoptysis), and weight loss are also common.

Cancer treatment may involve lung or chest surgery, chemotherapy, radiation, and immunotherapy based on the type of cancer you have.

Muscle Pain

Chest muscle pain can feel like it’s coming from the lungs. The underlying cause could be the result of costochondritis, fibromyalgia, or an autoimmune condition like rheumatoid arthritis.

Costochondritis

Costochondritis is a chest pain syndrome that causes inflammation in the area where the ribs join the sternum (breastbone). People with costochondritis commonly describe the pain as being sharp, stinging, or gnawing in one or several ribs.

Costochondritis more often affects the left side of the sternum. The pain tends to get worse with movement, coughing, sneezing, and when taking a deep breath. There may also be chest pressure and radiating pain to the arms or shoulders.

Costochondritis can be caused by many different things, like bacterial or viral infections, trauma, arthritis, overuse injuries, and tumors.

The treatment for costochondritis can vary based on the underlying cause. To manage pain, NSAIDs like Advil or Aleve are typically prescribed. A heating pad on the chest may also provide relief.

Fibromyalgia

Fibromyalgia is a central sensitivity syndrome that causes widespread nerve pain in the absence of any injury, infection, or disease. People with fibromyalgia commonly describe tender areas (called tender points) on either side of the sternum or a few inches below the collarbone.

The pain tends to be persistent but can get worse and ease off. It is often described as being aching, burning, or throbbing interspersed with pain that can feel like electrical shocks.

The prescription drugs Cymbalta (duloxetine) and Savella (milnacipran) may help ease fibromyalgia pain and fatigue. The antidepressant Elavil (amitriptyline) or muscle relaxant Flexeril (cyclobenzaprine) can also relieve and promote sleep. Anti-seizure drugs may also help.

Autoimmune Conditions

A couple of autoimmune diseases caused by a malfunctioning immune system are characterized by chest/lung pain:

Both RA and AS can be treated with NSAIDs for pain relief and oral corticosteroids (steroids) like prednisone to ease inflammation. Disease-modifying antirheumatic drugs (DMARDs) like methotrexate suppress the abnormally reactive immune system.

Heart Conditions

Pain in the chest or lung area may be related to an underlying heart condition, such as aortic dissection, pericarditis, or a heart attack,

Aortic Dissection

Aortic dissection is a tear in the inner layer of the large blood vessel branching off from the heart (called the aorta). It is a medical emergency that can be recognized by sudden and severe chest and back pain. People often describe it as feeling like something is ripping inside of your chest.

Aortic dissections are thought to be caused by an underlying weakness of the aorta that may be inherited. Persistent high blood pressure can also weaken the aorta in susceptible people, causing a tear.

Aortic dissection is sometimes treated with medications that lower heart rate and blood pressure to prevent the tear from getting worse. In other cases, surgery may be needed to repair the tear with a tissue graft or to replace the aorta with a synthetic tube.

Pericarditis

Pericarditis refers to inflammation of the sac that surrounds the heart (called the pericardium). It can cause sharp or stabbing chest pain that gets worse while inhaling or coughing. The pain is usually eased by sitting up and leaning forward.

Pericarditis can be the result of a viral or bacterial infection, autoimmune disease, chest trauma, cancer, medication, heart attack, and other causes.

NSAIDs, corticosteroids, or a drug called Colcrys (colchicine) may be used to reduce heart inflammation. Surgery may be needed to drain fluid from around the heart (pericardiocentesis) or to remove the pericardium entirely (pericardiectomy)

Heart Attack

Sharp, shooting chest pains (angina) along with chest pressure are characteristic of a myocardial infarction, also known as a heart attack.

A heart attack is caused when a coronary artery in the heart is blocked. The chest pressure can be extreme and is often described as feeling like someone is standing on your chest. The pain and pressure (in the center or left side of the chest) get worse with exertion.

Other symptoms include a cold sweat, shortness of breath, nausea or vomiting, heart palpitations, and pain that radiates to the neck, jaw, or shoulder.

If you’ve had a heart attack, a procedure called coronary angioplasty with stenting or a surgery called a coronary artery bypass graft (CABG) can open or reroute a blocked artery. Medications like aspirin, blood thinners, and thrombolytics (“clot busters”) can help limit heart damage until the blood flow is amply restored.

Esophageal Issues

The esophagus is the hollow tube that carries food and liquid from your mouth to your stomach. Conditions affecting the esophagus, like GERD and esophagitis, can cause pain perceived to originate in the lungs.

GERD

Gastroesophageal reflux disease (GERD) is a chronic form of acid reflux that occurs when stomach acids seep through the muscular valve that separates the stomach from the esophagus, called the lower esophageal sphincter (LES).

With GERD, the pain can be felt in the front of the chest just behind the sternum and is often described as burning and gnawing. GERD most commonly occurs after eating and may be accompanied by regurgitation, coughing, sore throat, and a bitter taste in the mouth.

GERD is usually controlled with medications like antacids, proton pump inhibitors (PPIs), and H2 blockers as well as a change in diet. In severe cases, a surgery called fundoplication can tighten the LES to prevent the backflow of stomach acid.

Esophagitis

Esophagitis is the inflammation of the esophagus. It has many of the same features of GERD, with a burning or gnawing pain felt in the middle of the chest just behind the sternum. People will often describe the sensation of having something stuck in their throat. There may also be a cough, sore throat, and hoarseness.

There are many causes of esophagitis, including infections, food allergies, drug side effects, chest radiation, and an immune overreaction called eosinophilic esophagitis.

The treatment differs by the esophagitis type. It may involve GERD medications to ease acid reflux or antibiotics to clear infections. Problematic drugs may be discontinued and medications like Dupixent (dupilumab) or Pulmicort (budesonide) may be given to treat eosinophilic esophagitis.

Other Causes

Sometimes, pain stemming from diseases of the digestive tract, like the gallbladder or kidneys, can be felt in the chest. Chest pain can also be referred, meaning that the pain might arise from a pinched nerve in the spine. The pain might also be purely neurological (nerve-related) or psychological.

If some of the more common causes of chest/lung pain cannot be confirmed, a healthcare provider may explore uncommon causes, such as:

Because the possible causes are many, it may be in your best interest to see a specialist in lung diseases called a pulmonologist if a cause cannot be found by your primary care provider. A specialist in digestive diseases (gastroenterologist) or heart diseases (cardiologist) may also be needed.

Diagnosis

The diagnosis of lung pain begins with a detailed medical history and physical examination.

Medical History

Your healthcare provider will ask you many questions in order to determine the source of your pain, such as:

  • How long have you had lung pain?
  • Is the pain constant or does it come and go?
  • Is the pain sharp or is it vague and achy?
  • Is the pain in one spot or do you feel it throughout your chest?
  • Does the pain get worse with a deep breath?
  • Have you been coughing?
  • Do you have a fever?
  • Do you have any pain in your legs?
  • Have you recently experienced unexplained weight loss?

Your healthcare provider will also inquire about your personal and family medical history, as this can provide clues to your diagnosis. Some related questions may include:

  • Do you have any medical conditions, such as heart disease or lung conditions, or autoimmune conditions like rheumatoid arthritis?
  • Do you have a family history of any heart or lung problems?
  • Do you have a history of smoking?

Physical Examination

During the physical examination, your healthcare provider will talk with you to see how well you are breathing.

Noting your coloring is also an important step. Blue lips and/or nails are worrisome and require immediate medical attention, as they suggest low oxygen delivery throughout your body.

After assessing your overall comfort and breathing status, your healthcare provider will inspect your back and chest wall to look for any rashes or chest and spine deformities.

They will then listen carefully to your lungs and heart sounds with a stethoscope. The provider may also perform an abdominal exam or joint exam if they suspect that the pain could be stemming from a gastrointestinal or rheumatological issue.

Tests and Imaging

Depending on the results of your physical exam, your healthcare provider may order one or more of the following tests or imaging studies:

  • Spirometry: A pulmonary function test that measures how much air you can breathe in and out, and how quickly you can empty your lungs. This test is key to diagnosing asthma and COPD.
  • Chest X-ray: To look for signs of infection
  • Blood tests: To rule out a heart attack and to look for evidence of inflammation or autoimmune conditions
  • Electrocardiogram (ECG): A test to evaluate the heart’s electrical activity, to evaluate for a heart attack
  • Stress test: Assesses your heart’s functioning during physical activity, which can aid in the diagnosis of heart disease
  • Echocardiogram: Uses sound waves to produce an image of your heart. This is used to evaluate your heart valves, look for fluid around your heart, or detect heart damage.

When to See a Healthcare Provider

Although extensive, this list of possible causes of lung pain is not exhaustive. This is why it’s important to make an appointment to see your healthcare provider, even if you feel there is an obvious reason for your pain.

For example, while chest wall tenderness is a hallmark feature of musculoskeletal chest pain, the presence of tenderness does not exclude a life-threatening cause like a heart attack or a blood clot in the lung.

When to Call 911

Call for emergency medical attention if you experience chest pain that is:

  • Severe, prolonged, or worsening
  • So bad that you feel like you’re going to pass out
  • Making it hard to breathe without gasping

Summary

If you have pain in the lung or chest area at large, see your healthcare provider about it—and be prepared to give them plenty of time to come up with a diagnosis. There are many possible causes, including pulmonary issues, chest muscle pain, heart conditions, and esophageal issues.

The diagnosis process can also become complicated if the pain is referred, meaning that it feels like it’s occurring in the chest but really is coming from another region.

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