History and Physical Examination

Pleurodynia should be considered in all cases of acute and subacute chest pain that present in the ER or in internal medicine, cardiology, or cardiothoracic surgery outpatient clinics. The onset of chest pain is acute. During attacks, the pain is severe, intense, and excruciating, lasting seconds to a minute. Pain is paroxysmal, occurring in attacks separated by minutes to hours. Severe attacks can result in difficulty breathing. The thoracic pain is usually over the lower ribs and is unilateral, but it can also occur over the front, back, or substernal area. Between attacks, patients usually have a constant, dull, pleuritic chest pain. A very important quality of the pain is its direct relationship to sneezing, coughing, laughing and deep breathing, which can cause the patient to look tachypneic and even diaphoretic.^[12]The pain typically lasts 1 to 4 days, although pain lasting as long as 45 days has been reported.^[2]

Patients can present with a wide range of signs and symptoms including the following^[12]:

Upper respiratory tract symptoms, including sore throat (85%)
Acute and subacute chest pain
Constitutional symptoms, including headaches (50%), fever (97%), and malaise
Gastrointestinal symptoms, including nausea, vomiting, diarrhea (50%); abdominal pain (usually in the epigastric area) in children
Testicular pain (ie, orchitis) in 10% of males
Dermatitis (25%) and otitis (25%)

Differential Diagnoses

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Author

Irina Petrache, MD Professor, Department of Medicine, Wollowick Chair in COPD Research, Chief, Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health

Irina Petrache, MD is a member of the following medical societies: American Thoracic Society

Disclosure: Nothing to disclose.

Coauthor(s)

Karina A Serban, MD Assistant Professor of Medicine, Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health

Karina A Serban, MD is a member of the following medical societies: American College of Chest Physicians, American Thoracic Society, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Zab Mosenifar, MD, FACP, FCCP Geri and Richard Brawerman Chair in Pulmonary and Critical Care Medicine, Professor and Executive Vice Chairman, Department of Medicine, Medical Director, Women's Guild Lung Institute, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine

Zab Mosenifar, MD, FACP, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Thoracic Society

Disclosure: Nothing to disclose.

Additional Contributors

Helen M Hollingsworth, MD Director, Adult Asthma and Allergy Services, Associate Professor, Department of Internal Medicine, Division of Pulmonary and Critical Care, Boston Medical Center

Helen M Hollingsworth, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Chest Physicians, American Thoracic Society, Massachusetts Medical Society

Disclosure: Nothing to disclose.

Acknowledgements

Gregg T Anders, DO Medical Director, Great Plains Regional Medical Command , Brooke Army Medical Center; Clinical Associate Professor, Department of Internal Medicine, Division of Pulmonary Disease, University of Texas Health Science Center at San Antonio

Disclosure: Nothing to disclose.

Ninotchka Liban Sigua, MD Fellow, Department of Pulmonary and Critical Care, Indiana University School of Medicine

Disclosure: Nothing to disclose.

Pleurodynia Clinical Presentation

History and Physical Examination

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