Question

Jackson, age 65, comes to the doctor’s office complaining of a sharp pain in the right side of his chest. He says his chest hurts when he breathes deeply or coughs. This is a problem, he says, because he has been coughing a lot, has difficulty drawing breath, and feels a tightness in the center of his chest. What condition or conditions might the doctor suspect? What methods of diagnosis would the doctor use, and what specific signs would the doctor look for to pinpoint the cause?

Answer 1

Any sort of chest pain needs emergency management as it is a first sign of heart attack. It shouldnot be ignored. Chest pain may be caused by any problem in lungs, esophagus,muscles, ribs, nerves, ,etc.Causes may be heart attack, acute coronary syndrome, pericarditis, pneumothorax, tumours in lungs ,pleurisy,pneumonia, pulmonary embolism,bronchitis, gastro esophageal reflux disease, asthma, costochondritis , pancreatitis, etc. But sharp pain in right side of chest and coughing may be cause of pleurisy, or pneumonia or costo chronditis.

Pleurisy is inflammation of membranes surrounding the lungs.Main symptoms are sharp, stabbing pain while breathing .

Pneumonia is inflammation and infection in lung caused by micro organisms.  People older than age 65 are at high risk of pneumonia.Symptoms include chest pain while breathing, shortness of breath, cough.

Costochondritis is inflammation of cartilage in the ribs. Causes may be any trauma. Symptoms are chest pain , pain during coughing & breathing,

Doctor may auscultate breath sounds and heart sounds.

• If friction rub is heard while auscultating which is produced by the rubbing of the two inflamed layers of pleura with each breath indicates pleurisy.  
• If bubbling or crackling sounds are heard while auscultating it may be due to pneumonia.
• While physically examining patient if doctor feels tenderness or swelling along breastbone it may be a sign of costochondritis.

Finally, Mr. Jackson should be provided oxygen , comfortable bed and calm environment and needed care.