Chest pain on the right
Chest pain on the right is stabbing, burning, compressing pain in the right side of the chest. Soreness occurs in pathologies of the lower respiratory tract and pleura, chest injuries, diseases of the hepatobiliary system, damage to the neuromuscular apparatus. To find out the cause of chest pain, radiography and sonography of the chest and abdominal cavity, endoscopic diagnostic methods, ECG, a complex of laboratory studies are used. In order to relieve pain, analgesics, physiotherapeutic methods, etiotropic medications are prescribed.
Causes of chest pain on the right
Respiratory diseases
Pleurisy
Chest injuries
Pneumothorax
Intercostal neuralgia
Diseases of the biliary system
Pathology of the liver
Rare reasons
Diagnostics
Treatment
Help before diagnosis
Conservative therapy
Surgical treatment
Prices for treatment
Causes of chest pain on the right
Respiratory diseases
Pathological processes in the lung and bronchi are the most common causes of pain on the right side of the chest. In acute simple or obstructive bronchitis, the patient experiences moderate pain and a feeling of heaviness in the chest, which increase during coughing attacks. The soreness has no clear localization, is accompanied by shortness of breath, hoarseness of voice. With chronic bronchitis, periodic discomfort and dull pains on the right side of the chest prevail, which are provoked by hypothermia, inhalation of polluted air.
With right-sided croup pneumonia, the pain syndrome is very strong, diffuse, by the nature of the pain acute, burning. Symptoms worsen with deep breaths and coughing, so patients avoid breathing “full chest”. In the case of focal pneumonia on the right, there is heaviness and discomfort in the chest. The pain is combined with febrile body temperature, cough with the release of purulent sputum, chills. Interstitial pneumonia begins less often, for which chest pain and severe shortness of breath are typical, occurring without pronounced catarrhal phenomena.
Pleurisy
Patients with dry pleurisy are concerned about constant severe pain on the anterolateral surface of the chest. With deep breathing, coughing, talking, the pain syndrome worsens, becomes unbearable. To relieve the condition, patients prefer to lie on their sick side, slightly bent to reduce the friction of the inflamed pleura. The appearance of effusion with the development of exudative pleurisy is accompanied by a shift of painful sensations to the lower parts of the chest. The pain is dull, constant, there are also breathing difficulties, asymmetry of the chest.
Chest injuries
Most often there are soft tissue bruises and bruises, which are characterized by moderate chest pain. Sensations are enhanced by bending the torso, wearing tight clothes, physical exertion. Normally, the pain syndrome disappears after a few days. Traumatic causes can cause rib fractures, which is manifested by sharp chest pains. The pain is intense, aggravated by talking, deep breaths, movements of the trunk. On the right of the chest, edema and hyperemia of the skin are detected. When palpating the damaged area, acute pain and crepitation are felt.
Pneumothorax
Spontaneous rupture of the pulmonary parenchyma on the right with the release of air into the pleural cavity usually occurs against the background of constant moderate chest pain in chronic diseases. At the time of the formation of a pneumothorax in the chest on the right it hurts very much, it becomes difficult for a person to breathe. With severe pain syndrome, pallor of the skin, cold sweat, and a decrease in blood pressure are noted. Valve pneumothorax of traumatic etiology is more dangerous, in which sharp pain sensations are combined with increasing shortness of breath and cyanosis of the skin.
Intercostal neuralgia
Pathology of intercostal nerve endings is manifested by sharp stabbing or burning pains on the anterior and lateral surface of the chest on the right. Pain syndrome in intercostal neuralgia is more often paroxysmal, unpleasant sensations provoke causes such as touching the affected area, loud laughter or coughing, deep breathing. In addition to painful sensations, the patient is concerned about tingling and twitching of the pectoral muscles, numbness of certain areas of the skin. Often the pain is given to the collarbone or shoulder blade on the right, sometimes the pathological process spreads to the lumbar nerves.
Diseases of the biliary system
Inflammation of the gallbladder (cholecystitis) and amniotic fluid is accompanied by irritation of the nerve endings of the diaphragmatic nerve. This causes the irradiation of pain from the right hypochondrium to the chest and clavicle area. The pain is acute, paroxysmal, and resembles neuralgia in nature. With biliary colic, excruciating unbearable pains occur in the upper abdomen and chest on the right, which force a person to constantly change the position of the body. For biliary dyskinesia as the cause of the symptom, dull pain in the lower part of the chest on the right is typical.
Pathology of the liver
Liver damage is much less likely to lead to thoracalgia, pain is bothered only with extensive organic damage to the organ with stretching of the capsule. Visceral sensations do not have a clear localization, so they can be perceived as chest pain on the right. With hepatitis A and E, symptoms persist for several weeks, for hepatitis B and C, chronic pain syndrome is typical, lasting at least 2-3 months. Pain is also caused by the formation of bulky formations in the liver tissue: echinococcal cysts, hemangiomas, malignant tumors.
Rare reasons
“Pulmonary heart”: with primary pulmonary hypertension, chronic obstructive processes in the bronchi, polycystic lung disease.
Shingles.
Pulmonary embolism.
Gastroduodenal pathology: hyperacid gastritis, peptic ulcer, achalasia of the cardia.
Malignant tumors: bronchial cancer, central and peripheral lung cancer.
Tuberculosis.
Diagnostics
With a pain syndrome in the chest, a therapist’s consultation is shown on the right, in the future the doctor can refer the patient to narrow specialists. Diagnostic search involves carrying out instrumental methods of visualization of the thoracic and abdominal cavities, specific laboratory methods of examination are performed to clarify the cause of thoracalgia. The most informative are:
Radiography. An overview radiograph of the lungs is recommended for suspected pneumonia: pay attention to focal heterogeneous darkening of the pulmonary parenchyma, expansion of the roots of the lungs and strengthening of the bronchial pattern. In case of detection of a rounded shadow with a path to the root on the top of the lung on the right, a preliminary diagnosis of tuberculosis is made.
Ultrasound examination. If it hurts on the right not only in the chest, but also in the hypochondrium, an ultrasound of the abdominal cavity is prescribed. During sonography, the anatomical position and structure of the gallbladder, liver, and bile ducts are evaluated. The method also helps to identify bile concretions and inflammation as possible causes of the development of thoracic pain syndrome.
Endoscopy. Bronchoscopy is indicated for severe respiratory diseases of unclear etiology, suspected malignant tumor of the bronchi. Washing water and areas of the affected tissue are taken for laboratory diagnostics. Extensive inflammatory processes in the pleura are the basis for thoracoscopy — examination of the pleural cavity with an endoscope through a puncture in the chest wall.
ECG. To exclude the cardiac cause of pain, an electrocardiogram is recorded in 12 standard leads to detect typical signs of a “pulmonary heart”: a deviation of the electrical axis of the heart to the right, a high P wave, a violation of the conductivity of the right leg of the Gis beam. Echocardiography and duplex vascular scanning are used to clarify the diagnosis.
Laboratory analysis. To establish the etiological factor of pneumonia and bronchitis, morning sputum is collected for sowing on enriched nutrient media. To confirm the defeat of the gallbladder, the level of cholesterol, direct and indirect bilirubin, alkaline phosphatase is measured. Additionally, a blood test is performed for the level of cancer markers.
Chest X-ray
Chest X-ray
Treatment
Help before diagnosis
With moderate chest pain on the right caused by a bruise, it is enough to rest for a few days, apply dry compresses and ointments with anti-inflammatory agents to relieve unpleasant sensations. If the pain does not subside, accompanied by swelling and cyanosis of the skin, you should visit a specialist for timely detection of rib fracture as a probable cause of the symptom. The pain syndrome that occurs against the background of coughing and shortness of breath serves as an indication for contacting a doctor — independent treatment of diseases of the respiratory system is fraught with serious complications.
Conservative therapy
In most cases, it is sufficient to treat the main cause of pain, but with severe and unbearable pain in the right chest, analgesics (both NSAIDs and narcotic drugs) are indicated. To eliminate the pain syndrome, physiotherapy methods are used: electrophoresis, compresses on the affected area with dimexide, corticosteroids, anti-inflammatory drugs. As an etiotropic therapy, medications such as:
Antibiotics. Medications are used to destroy bacterial microorganisms that have caused pneumonia or purulent bronchitis. Beta-lactam antibiotics and macrolides are often taken or administered. Fluoroquinolones and interferon are effective for the treatment of atypical pneumonia.
Nonsteroidal anti-inflammatory drugs. NSAIDs reduce the production of cytokines and active mediators, reduce local manifestations of the inflammatory process, bring down the febrile temperature. In case of chest injuries, they eliminate pain well. The funds are used both orally and externally in the form of ointments.
Expectorant drugs. Medications provide dilution of sputum, which allows you to clear the airways and speed up the recovery time. Mucolytics and reflex herbal remedies are used. Gargling with antiseptics is recommended for the rehabilitation of the upper respiratory tract.
Derivatives of ursodeoxycholic acid. The drugs reduce the concentration of toxic acids and reduce the rate of stone formation in the gallbladder by normalizing the chemical composition of bile. UDCA also has hypolipidemic and hypocholesterolemic effects, protects hepatocyte membranes.
Vitamins. Thiamine, pyridoxine and other B vitamins improve the nutrition of nerve fibers and accelerate the regeneration of the myelin sheath. For better assimilation, they can be combined with ascorbic acid. Tocopherol is prescribed as an antioxidant.
Surgical treatment
With pneumothorax, it is necessary to make a pleural puncture in the 2-3 intercostal space to aspirate air and ensure rapid expansion of the lung. In case of severe atelectasis or recurrent pneumothorax, permanent active drainage is used. Refractory to conservative therapy pleurisy is an indication for pleurodesis — obliteration of the pleural cavity. With cholelithiasis in the advanced stage, cholecystectomy is performed by laparoscopic or traditional method.
