Pleurisy and Chostochondritis

Question 1

• Chest wall pain or costosternal syndrome, a benign and often temporary inflammation of the costal cartilage which connects each rib to the sternum at the costosternal joing
• most common cause of chest pain
• any of the 7 can be affected (sternal or rib)
• more than one site affected 90% of tim
• 2nd to 5th junctions most commonly involved

Answer 1

Costochondritis

Question 2

Rare disorder involving swelling of a single costal joint only (2nd rib most common)
* Reproducible point chest wall tenderness with palpable edema

Answer 2

Tietze syndrome

Question 3

physical examination of costochondritis would display?

Answer 3

• Sharp, aching, or pressure-like localized pain
• exacerbated by UE movement deep breathing and exertional activities
• +/- prior injury, illness with coughing, recent strenous exercise
• reproducible pain with palpation

Question 4

treatment of chostochondritis?

Answer 4

• Acetaminophen or NSAID
• heating pad or warm compresses
• limit aggravating activities
• cough suppressants
• refractory cases–> local injection

Question 5

• viral infections spreading from the lungs to the plerual cavity are the most common
• visceral pleura w/o nociceptors, parietal pleura with
• a careful, focused history and physical as to course and onset of sxs can reveal the diagnosis

Answer 5

Pleurisy

Question 6

how will a patient with pleurisy present?

Answer 6

• localized pleuritic chest pain secondary to forceful breathing
• coughing
• sneezing or other chest movements that exacerbate pain
• prior URI history
• pain is sharp and stabbing
• friction rub is the classic feature

Question 7

diagnosis of pleurisy includes?

Answer 7

• chest x-ray
• ECG
• CT scan
• D-dimer
• V/Q scan

Question 8

Treatment of pleurisy

Answer 8

Control Pleuritic chest pain

• initial therapy is NSAIDS
• narcotics can be used for severe pain
• PO corticosteroids

Treat underlying condition
smoking cessation