What are the common causes of chest pain in young adults. How can urgent care providers diagnose pneumomediastinum. What are the key symptoms and management approaches for spontaneous pneumomediastinum.

Unveiling the Case: A 20-Year-Old Female with Chest Pain

In urgent care settings, chest pain presentations require careful evaluation, especially when dealing with younger patients. This article explores a unique case of a 20-year-old female experiencing pleuritic chest pain and shortness of breath, highlighting the importance of considering less common diagnoses beyond acute coronary syndrome, pulmonary embolism, and thoracic aortic dissection.

Patient Presentation and Initial Assessment

The patient arrived at urgent care with the following symptoms:

• Pleuritic chest pain for about 2 hours
• Shortness of breath
• Dull, pressure-like pain in the upper and mid chest
• Radiation of pain to the right side of the neck
• No improvement with acetaminophen

Initial vital signs were within normal ranges, and the patient appeared comfortable without distress. Her medical history was unremarkable except for anxiety, and she reported occasional tobacco use and marijuana smoking 3-4 times a week.

Differential Diagnosis: Looking Beyond the Obvious

When evaluating chest pain in young adults, healthcare providers must consider a broad range of potential causes. In this case, the differential diagnoses included:

• Anxiety
• Gastroesophageal reflux
• Musculoskeletal strain
• Pulmonary embolism
• Pneumothorax

How can urgent care providers effectively narrow down the differential diagnosis for chest pain in young adults? By conducting a thorough history, physical examination, and appropriate diagnostic tests based on the patient’s presentation and risk factors.

Diagnostic Journey: Uncovering Pneumomediastinum

Following the standard chest pain evaluation protocol, an EKG and chest X-ray were ordered. While the EKG showed normal sinus rhythm without ST-T changes, the chest X-ray revealed a surprising finding: lucency along the right superior mediastinum and medial right upper lobe, consistent with spontaneous pneumomediastinum.

Further Imaging and Confirmation

The patient was referred to the emergency department for additional evaluation. A CT scan of the chest and esophagram with oral contrast confirmed moderate pneumomediastinum without pneumothorax or esophageal perforation. This diagnostic journey underscores the importance of considering less common causes of chest pain in young adults, even when initial presentations may seem benign.

Understanding Pneumomediastinum: Causes and Manifestations

Pneumomediastinum, also known as mediastinal emphysema, is a rare condition characterized by the presence of free air in the mediastinal space. What are the common causes of pneumomediastinum?

• Physical trauma (including excessive coughing and vomiting)
• Mechanical ventilation
• Underlying chronic conditions (asthma, interstitial lung disease, COPD, bronchiectasis)
• Lung cysts or malignancies
• Substance inhalation (as in this case)

Spontaneous pneumomediastinum (SPM) can occur in otherwise healthy individuals without apparent causative factors. However, careful history-taking often reveals underlying triggers, such as substance inhalation.

Recognizing the Symptoms

The presentation of pneumomediastinum can vary from acute onset to subacute manifestation. Common symptoms include:

• Retrosternal chest pressure or pain
• Mild dyspnea
• Cough
• Neck pain
• Back pain
• Sore throat

In severe cases or when accompanied by pneumothorax, patients may experience palpitations, anxiety, emesis, dysphagia, or tachypnea. Physical examination is often unremarkable, with only a minority of cases presenting with crepitus in the shoulder region or chest wall.

Diagnostic Approaches: From X-ray to Advanced Imaging

How can healthcare providers effectively diagnose pneumomediastinum? The diagnostic journey typically begins with a plain chest X-ray, which can identify the condition in up to 90% of cases. X-ray findings may include:

• Lucent streaks
• Air bubbles outlining mediastinal structures
• Visible mediastinal pleura

Following a positive X-ray, chest CT is often recommended to assess the extent of pneumomediastinum, identify any concomitant conditions like pneumothorax or pneumopericardium, and potentially pinpoint causative factors. In most cases, additional diagnostic tests such as bronchoscopy, endoscopy, or extensive blood work are unnecessary unless specific risk factors are present.

Management Strategies for Spontaneous Pneumomediastinum

What is the typical approach to managing isolated spontaneous pneumomediastinum? In most cases, treatment is supportive and focuses on symptom management. This may include:

• Rest and observation
• Pain management
• Oxygen therapy if needed
• Avoiding activities that increase intrathoracic pressure

In severe cases or when complications arise, more invasive interventions such as needle or chest tube decompression may be necessary. The prognosis for SPM is generally favorable, with most cases resolving spontaneously within a few days to weeks.

Lessons Learned: Key Takeaways for Urgent Care Providers

This case study offers several important insights for healthcare professionals dealing with chest pain in young adults:

1. Consider a broad differential diagnosis, including less common conditions like pneumomediastinum.
2. Maintain a low threshold for ordering EKG and chest X-ray in cases of chest pain, even in young patients.
3. Be aware that presentations of pneumothorax and pneumomediastinum can be subtle.
4. Take a detailed history, including questions about substance use and activities that may increase intrathoracic pressure.
5. Remember that pneumomediastinum is typically managed symptomatically and has a good prognosis.

Implications for Clinical Practice and Patient Education

The case of this 20-year-old patient with pneumomediastinum related to marijuana use highlights the need for increased awareness among healthcare providers and patients alike. How can this knowledge be applied to improve patient care and outcomes?

• Enhance education for urgent care providers on recognizing less common causes of chest pain in young adults.
• Implement comprehensive screening protocols that include questions about substance use and recent activities.
• Develop patient education materials on the potential risks associated with marijuana use and other activities that may increase intrathoracic pressure.
• Encourage open communication between patients and healthcare providers to ensure accurate and timely diagnoses.

By integrating these lessons into clinical practice, healthcare providers can improve their ability to diagnose and manage rare conditions like pneumomediastinum, ultimately leading to better patient outcomes and more efficient use of healthcare resources.

Advancing Research and Understanding of Pneumomediastinum

While spontaneous pneumomediastinum is a relatively rare condition, cases like this underscore the need for continued research and understanding. What areas of investigation could further enhance our knowledge of this condition?

• Long-term outcomes and potential recurrence rates in patients with SPM
• The relationship between various inhalation techniques and the risk of pneumomediastinum
• Genetic or physiological factors that may predispose individuals to developing SPM
• Novel imaging techniques or biomarkers for early detection of pneumomediastinum
• Optimal management strategies for different severities of pneumomediastinum

By pursuing these research avenues, the medical community can continue to refine diagnostic and treatment approaches, ultimately improving patient care and outcomes for those affected by this rare but potentially serious condition.

In conclusion, the case of this 20-year-old female with chest pain serves as a valuable reminder of the importance of maintaining a broad differential diagnosis, especially when evaluating young adults with chest pain. By considering less common conditions like pneumomediastinum and conducting thorough evaluations, healthcare providers can ensure timely and accurate diagnoses, leading to appropriate management and positive outcomes for their patients.

A 20-year-Old Female with Chest Pain and SOB

Urgent message: Urgent care providers need to be vigilant for more than acute coronary syndrome, pulmonary embolism, and thoracic aortic dissection when patients present with chest pain—such as this 20-year-old who developed pneumomediastinum while smoking marijuana.

Xiangyang Jiao, MD

Case Presentation

A 20-year-old female presented to urgent care for pleuritic chest pain and shortness of breath for about 2 hours. The chest pain was located in the upper and mid chest, was dull, pressure like, mild, and radiated to the right side of the neck. The chest pain was not improved with acetaminophen. She worked as a server at the nearby sports bar and denied any injury or any unusual mental stress. No cough, palpitations, nausea, diaphoresis. No recent travel or any illness, no known exposure to COVID. PMH negative except for anxiety. SH: Occasional tobacco use and smokes marijuana 3-4 times a week.

Vitals BP 120/76, HR 72, R 12, Pulse O2 98%. She appeared comfortable without distress, spoke long, full sentences. Heart and lung auscultation were normal, and no leg tenderness or any swelling.

Differential Diagnosis

The differential diagnoses include anxiety, gastroesophageal reflux, musculoskeletal strain, pulmonary embolism, and pneumothorax.

Testing

As part of our standard chest pain evaluation protocol, EKG and CXR were ordered. EKG was normal sinus rhythm, no ST-T changes.

The chest x-ray showed a lucency along the right superior mediastinum and medial right upper lobe, as well as overlying the right lung apex and base of right neck (Figure 1 and Figure 2) consistent with  spontaneous pneumomediastinum.

Urgent Care Disposition

 The patient was sent to ED for further evaluation. CT of chest and esophagram with oral contrast confirmed moderate pneumomediastinum without pneumothorax or esophagus perforation (Figures 3 and 4). Detailed history suggested its cause from barotrauma from marijuana use (inhalation either through a high-resistance smoking apparatus or forced exhalation against a closed glottis). Patient was observed in hospital for 48 hours, pneumomediastinum was gradually resolving on repeat chest x-ray and patient was asymptomatic upon discharge.

Figure 1Figure 2Figure 3Figure 4

Discussion

Pneumomediastinum, also called mediastinal emphysema, is a rare condition where free air is leaked into mediastinal space from either respiratory or GI tract. It is usually associated with physical trauma (including excessive coughing, vomiting, mechanical ventilation) or underlying chronic conditions (asthma, interstitial lung disease, COPD, bronchiectasis, lung cysts, lung malignancy). Spontaneous pneumomediastinum (SPM) may occur in otherwise healthy subjects without identifiable causative factors,¹ though after detail and careful history taking, many of initially diagnosed SPM are found to be caused by substance inhalation,^1-3 as in this case.

Presenting symptoms of SPM may be acute or have a subacute onset presentation . Retrosternal chest pressure or pain and/or mild dyspnea are most common, followed by cough, neck pain, back pain, sore throat. If large amount air is leaked in a rapid pace, or with concomitant pneumothorax (reportedly in 40% of all pneumomediastinum), palpitation, anxiety, emesis, dysphagia, or tachypnea can also occur. Physical exam is often normal, with crepitus in the shoulder region or chest wall identifiable in less than a quarter of cases, and the pathognomonic Hamman’s sign (a crunch or click sound on auscultation over the cardiac apex and the left sternal border synchronous with the heartbeat), indicating air leaked into pericardial space, rarely present.¹

Diagnosis can be established with a plain chest x-ray. Positive up to 90% of the time, this may show lucent streaks, air bubbles outlining mediastinal structures, or visible mediastinal pleura.¹ Subsequent chest CT is needed to assess the extent of pneumomediastinum, concomitant pneumothorax, pneumopericardium, as well as to identify causative factors. Unless there is underlying risk, other diagnostic tests, like bronchoscopy, endoscopy, mediastinal ultrasound, and extensive blood work are often not needed.

Management of isolated SPM is generally supportive. In severe cases, needle or chest tube decompression may be needed.

Take-Home Points

• Chest pain and or dyspnea require consideration of forced inspiration or expiration at onset, such as with smoking marijuana.
• Maintain a low threshold for EKG and chest x-ray.
• Pneumothorax and pneumomediastinum presentations can be subtle.
• Pneumomediastinum is typically managed symptomatically.

References

1. Kouritas VK, Papagiannopoulos K, Lazaridis G, et al. Pneumomediastinum. J Thorac Dis. 2015;7(Suppl 1):S44–S49.
2. Perna V, Vilà E, Guelbenzuj JJ, et al. Pneumomediastinum: is this really a benign entity  when it can be considered as spontaneous? Our experience in 47 adult patients. Eur J Cardiothorac Surg. 2010;37:573-575. 
3. Weiss ZF, Gore S, Foderaro A. Pneumomediastinum in marijuana users: a retrospective review of 14 cases. BMJ Open Respir Res. 2019;6(1):e000391.

Author affiliations: Xiangyang Jiao, MD, OhioHealth Urgent Care. The author has no relevant financial relationships with any commercial interests.

A 20-year-Old Female with Chest Pain and SOB

Tagged on: Case Report    Chest Pain    Evaluating Chest Pain    Marijuana    Pneumomediastinum    Pneumomediastinum while Smoking Marijuana

27 causes, symptoms, and when to see a doctor

Chest pain can stem from a heart problem, but other possible causes include a lung infection, muscle strain, a rib injury, or a panic attack. Some of these are serious conditions and need medical attention.

Chest pain is the second biggest cause of emergency room (ER) visits in the United States, leading to over 8 million ER visits every year. Worldwide, chest pain affects 20–40% of the general population.

In this article, learn about some possible causes of chest pain and other symptoms that can help identify them.

Various heart problems can cause pain in the chest.

1. Heart attack

Chest pain is one of the five main symptoms of a heart attack. The others are:

• pain in the jaw, neck or back
• lightheadedness or weakness
• pain in the arms or shoulders
• shortness of breath

Females particularly may also experience sudden tiredness, nausea, or vomiting.

If someone thinks they are having a heart attack, they should seek emergency medical help. The quicker a person can get to ER, the quicker treatment can begin.

Getting prompt treatment increases a person’s chances of survival and potentially reduces the severity of the damage to the heart.

How do you recognize the signs of a heart attack?

2. Myocarditis

Myocarditis is when the heart becomes inflamed, resulting in symptoms that are similar to a heart attack, such as:

• chest pain
• shortness of breath
• fast or irregular heartbeat

Myocarditis usually results from a viral infection, according to the Centers for Disease Control and Prevention (CDC).

What is an inflamed heart?

3. Angina

Angina feels like a squeezing pain or pressure on the chest. It occurs when not enough blood is getting to the heart. A person may also feel pain in the:

• shoulder
• back
• neck
• arms
• jaw

Angina can feel like indigestion.

It is a symptom of coronary artery disease.

4. Aortic aneurism and dissection

Aortic dissection is a tear or separation of the inner layers of the aorta, the main artery that leads from the heart. This can lead to a buildup of blood in the artery.

An aortic aneurysm refers to an enlargement in the aorta.

Both conditions can cause the aorta to rupture or burst.

Aortic dissection and a severe aortic aneurysm are emergencies and require immediate medical help.

A stable aortic aneurysm may not need emergency treatment.

5. Coronary artery dissection

Coronary artery dissection is when tearing occurs in the coronary artery wall. If the innermost layer tears, blood can seep through and build up, causing a bulge. It can lead to a heart attack.

Sudden intense pain that appears to “tear” across the chest, neck, back, or abdomen can be a symptom of coronary artery dissection.

This is a rare but serious condition. The American Heart Association (AHA) notes that experts do not know exactly why it happens, but it can affect people without the usual risk factors for heart disease.

6. Pericarditis

Pericarditis is inflammation of the sac around the heart.

It can result in:

• severe chest pain behind the breast bone
• a buildup of fluid around the heart
• cardiac tamponade, when fluid presses on the heart
• obstructive shock, when the heart cannot fill with blood effectively

Pain may be worse when a person breathes in or is lying down but improves when they sit up or lean forward.

It usually results from a viral infection, but there are many other possible causes.

7. Mitral valve prolapse

A mitral valve prolapse is when a valve in the heart is unable to close fully. In mild cases, this condition may have no obvious symptoms.

If symptoms occur, they include:

• rapid heartbeat
• chest discomfort
• fatigue

8. Hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy is when the heart grows too thick due to genetic factors. The thickening of the heart prevents blood from flowing from the heart properly, causing the muscle to work very hard to pump blood.

Symptoms of hypertrophic cardiomyopathy include:

• chest pain
• changes in heart rhythm
• shortness of breath
• dizziness
• lightheadedness
• fainting
• swelling in the feet, ankles, legs, and abdomen

A person who notices this should seek medical advice, as it can worsen over time and lead to other complications, such as blood clots and heart failure.

Various lung problems can cause chest pain.

9. Pulmonary hypertension

Pulmonary hypertension is high blood pressure in the arteries that carry blood to the lungs. In some cases, this may result in chest pain.

It can happen for various reasons and can result in:

• breathlessness and faintness when exercising
• shortness of breath when bending down
• fatigue
• swelling due to fluid buildup

Pulmonary hypertension is not usually immediately life threatening, but it does need medical attention.

10. Pleurisy

Pleurisy is inflammation of the membrane that covers the lungs.

Symptoms include:

• chest or shoulder pain
• pain is worse when breathing, coughing, sneezing, or moving the trunk or chest wall
• pain may be dull, aching, or “catching”

Without treatment, it can lead to life threatening complications.

How can pleurisy affect the upper back?

11. Pneumonia

Lung infections such as pneumonia can cause sharp or stabbing chest pain, especially when breathing deeply or coughing.

Other symptoms of pneumonia include:

• fever, sweating, and chills
• coughing up phlegm, which may be green, yellow, or contain blood
• shortness of breath
• bluish tinge to the lips or fingetips
• rapid, shallow breathing
• low appetite, low energy, and fatigue
• nausea and vomiting (in young children)
• confusion (in older people)

A person with breathing difficulty needs immediate medical attention, as pneumonia can be life threatening.

Find out more about bacterial pneumonia and viral pneumonia.

12. Pulmonary embolism

A pulmonary embolism is when a blood clot gets trapped in an artery feeding blood to the lungs.

Common symptoms include:

• chest pain, especially when breathing in
• back pain
• shortness of breath
• coughing up blood
• leg pain or swelling
• sweating
• lightheadedness, dizziness, or fainting
• blue tinge to lips or nails, known as hypoxia

Pulmonary embolisms can be life threatening without urgent treatment.

What is the risk of a pulmonary embolism after surgery?

13. COVID-19

A person with COVID-19 may experience respiratory symptoms, pain, or pressure in the chest.

A person should seek immediate medical help if they have:

• persistent pain or pressure in the chest
• breathing difficulty
• blue lips or nails
• new confusion
• difficulty staying awake

How does COVID-19 affect the lungs?

14. Tuberculosis

Tuberculosis (TB) is a bacterial infection that usually affects the lungs.

It can cause:

• chest pain
• a bad cough which may produce blood or sputum
• weight loss
• a fever and night sweats

In the past, TB was nearly always fatal. Nowadays, antibiotics can usually treat it successfully.

What is pulmonary tuberculosis?

15. Asthma

Asthma is a common breathing disorder characterized by inflammation in the airways, which can cause chest pain.

Other symptoms include:

• tightness in the chest
• shortness of breath
• coughing
• wheezing

What is severe asthma?

16.

Collapsed lung

When air builds up in the space between the lungs and ribs, leading to a collapsed lung, also known as pneumothorax.

Some people have no symptoms, but the following may occur:

• chest pain, which may radiate to the shoulder
• discomfort when breathing
• faster breathing rate
• shortness of breath
• swelling on one side of the chest
• reduced breathing sounds

A punctured lung is another cause of pneumothorax.

The following conditions affect organs that play a role in digestion. Chest pain can be a symptom.

17. Pancreatitis

Pancreatitis is an inflammation of the pancreas. Acute pancreatitis usually results from gallstones. Chronic, or long-term pancreatitis stems from genetic features or high alcohol consumption.

A person may notice:

• upper abdominal pain which may begin suddenly or slowly, be mild or severe, and last several days
• swollen or tender abdomen
• nausea and vomiting
• fever
• pain that radiates to the back

If a person notices these symptoms for the first time, they should seek medical help at once.

What is the difference between acute and chronic pancreatitis?

18. Esophageal spasms

Esophageal contraction disorders are spasms or contractions in the food pipe.

Symptoms include:

• chest pain
• difficulty swallowing
• regurgitation
• heartburn

These disorders can also cause chest pain.

How do you treat esophageal spasms?

19. Esophageal hypersensitivity

In a person with esophageal hypersensitivity, sensations that are not usually painful can cause severe pain.

Experts do not know exactly why this happens, but cells in the gullet may be particularly sensitive to acid. Stress may trigger symptoms in people who are susceptible.

20. Esophageal rupture

If the food pipe bursts, this can result in sudden, intense chest pain. An esophageal rupture may occur after a procedure involving the esophagus or a traumatic injury.

Other possible symptoms include:

• retching and vomiting
• a crackling sound on touching the chest
• shortness of breath or rapid breathing

21.

Peptic ulcers

Peptic ulcers are sores in the stomach lining.

They can cause:

• pain in the abdomen or upper abdomen after eating
• bloating
• nausea
• vomiting, possibly with blood

They do not usually cause intense pain but can result in a recurring discomfort in the chest.

What are some natural remedies for peptic ulcers?

22. Gastroesophageal reflux disease (GERD)

GERD refers to when the contents of the stomach move back up into the throat.

It can lead to:

• chest pain
• regurgitation
• nausea and vomiting
• difficulty swallowing or pain when swallowing
• a cough, hoarseness, or other symptoms in the throat

Over-the-counter antacids can often relieve GERD.

What is the best diet for a person with GERD?

Here are some other reasons chest pain might occur.

23. Panic attack

A panic attack is a sudden attack of panic or fear. Often a person does not know why it happens, but it may be a symptom of a condition known as panic disorder.

The individual may experience:

• chest pain
• a rapid heartbeat
• fear
• nausea
• dizziness
• sweating
• shaking and trembling

The symptoms can resemble those of a heart attack.

A doctor may prescribe drugs, counseling, or both to help manage panic disorder.

How can you help someone who is having a panic attack?

24. Hiatal hernia

A hiatal hernia is when part of the stomach pushes up into the chest. This type of hernia is common and may not cause any symptoms.

However, if the top of the stomach pushes into the lower part of the chest after eating, it can cause symptoms of GERD.

These include:

• chest pain
• reflux
• heartburn

In some cases, a hiatal hernia may need surgery.

How do surgeons repair a hernia?

25. Costochondritis

Costochondritis is inflammation of the cartilage of the rib cage. It can cause pain and tenderness in the chest. The pain may start suddenly.

Costochondritis pain may get worse when:

• lying down
• doing exercise
• breathing deeply
• coughing or sneezing

26. Muscle strain

Inflammation of the muscles and tendons around the ribs can result in persistent chest pain. If the pain becomes worse with activity, then it may be a symptom of a muscle strain.

Learn more here about a pulled muscle in the chest.

27. Injured ribs

Injuries to the ribs, such as bruises, breaks, and fractures, can cause chest pain. A person may have heard a crack or felt extreme pain at the time of injury if they have a broken rib.

A person with a fractured rib may have:

• pain or discomfort in the chest or back
• an inability to breathe in deeply
• unusual movement in the chest wall

What can you do if you have a broken rib?

It is always best to contact a doctor if chest pain comes on suddenly, especially if taking anti-inflammatory medications does not ease symptoms.

A person should seek emergency medical help if they have:

• pain that spreads to the arms, back, neck, or jaw
• tightness or heaviness in the chest
• pain that started with nausea, vomiting, sweating
• difficulty breathing or changes in breathing rate
• blue lips or nail beds
• severe pain that lasts longer than 15 minutes
• confusion

In some cases, chest pain can be life threatening. For this reason, a person should not ignore it.

Here are the answers to some questions people often ask about chest pain.

How do I know if chest pain is serious?

Pain that is severe or feels like it is squeezing the chest could be a sign of a heart attack. Breathing difficulty is another sign of chest pain that could be serious. People with these symptoms should seek immediate medical help.

Why am I having pain in my chest?

Chest pain can occur for many reasons, ranging from muscle strain to a heart attack. It is best to seek medical advice for any type of chest pain, as some causes can have severe consequences.

What does chest pain feel like?

This will depend on the cause. Pain that is heavy, squeezing, or radiating pain may be a sign of a heart problem. If there is reflux and difficulty swallowing, it could be due to a gastrointestinal problem. Breathing difficulty may indicate a broken rib, a heart condition, or a lung complaint.

Chest pain can happen for many reasons. Often, the other signs that occur with it will give an idea of why chest pain occurs.

However, any severe chest pain needs urgent medical attention, especially if it is radiating to the arm, back, or neck, if the heart rate changes, or if the person has trouble breathing.

Anyone with concerns about chest pain should seek medical advice to rule out life threatening causes and obtain suitable treatment.

Why there are pains in the chest and chest

Enroll

August 24, 2022

read 5 minutes

“If we are discussing chest pain, then at a young age it is most often due to problems with the spine or intercostal muscles. Such pain is characterized by an increase in a certain posture or position of the body (for example, when bending to the side), there may be an increase in inhalation or exhalation, ”says Dr. Lummer.

As a rule, chest pain resolves on its own and does not require a serious examination.

Another option is pain behind the sternum, in the middle of the chest. Such pain may indicate a problem with the heart. A feature of heart pain is a compressive character. In addition, this pain often radiates to the left shoulder, left arm, left shoulder blade. If such pain occurs, you should immediately consult a doctor to exclude angina pectoris and myocardial infarction.

“Pain in the breast can also indicate a wide variety of different problems, from minimal to quite serious. Periodic discomfort associated with the menstrual cycle is quite common and does not indicate any serious pathology. As a rule, after pregnancy and childbirth, this disappears. But twitching pains, especially in combination with fever, reddening of the skin of the gland and a palpable volumetric formation, signal a serious inflammation – mastitis, ”explains Kirill Borisovich.

Moreover, mastitis can be both in nursing mothers and in women outside the period of breastfeeding. This is a reason to immediately consult a doctor. In addition, pain in the mammary gland can be caused by a disease such as fibrocystic mastopathy. This is a dyshormonal disease and, unfortunately, one cannot cope with it without qualified medical assistance.

“And, finally, the most frequent question, does pain in the mammary gland speak of a malignant formation? Unfortunately, this category of diseases is in no way characterized by pain, otherwise they would be much better detected, ”explains Dr. Lummer.

Therefore, it is correct for all women over 25 years old to have an ultrasound of the mammary glands once a year.

Ultrasound specialist
Surgeon

Source Rambler Doctor

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Osteochondrosis of the thoracic spine – symptoms and treatment

Thoracic osteochondrosis is a degenerative disease of the thoracic spine. First of all, the disease affects the intervertebral discs, which leads to back pain and unpleasant symptoms. Also, the specifics of the disease include premature “aging” of the cartilaginous tissue of the disc.

Osteochondrosis can be diagnosed both at the age of 20 and in middle-aged patients.

The disease is less common than other forms of osteochondrosis – cervical and lumbar. This is due to the lower mobility of the thoracic region, as well as the protection of the muscular corset and ribs.

There are 12 vertebrae in the thoracic region – from T1 to T12. Most often, the lowest vertebrae are affected – T10, T11, T12.

Symptoms of thoracic osteochondrosis

Symptoms of osteochondrosis of the thoracic spine include:

• Chest pain
• Labored breathing
• Increasing pain with deep breathing
• Increased fatigue
• Staggering gait
• Sensation of constriction in the chest area
• Stoop
• Appearance of shortness of breath
• Cold feet
• Pain in the region of the esophagus
• Cough

Pain in thoracic osteochondrosis according to their characteristics are divided into dorsago or dorsalgia.

Dorsago – sharp pain in the chest. It occurs when you stay in one position for a long time. Pain can make breathing difficult.

Dorsalgia – moderate pain in the area of ​​the affected discs. Deep breathing intensifies the pain. Unpleasant sensations begin gradually.

Causes of development of thoracic osteochondrosis

The causes of the onset and development of thoracic osteochondrosis are often associated with the patient’s lifestyle and uneven load on the spine. For example, people who spend a long time in a sitting position are at risk: remote or office work at a computer, frequent driving.

A sedentary lifestyle disrupts the functioning of the circulatory and lymphatic systems, and lack of exercise weakens muscle tissue. At the same time, the load on the spine in a sitting position increases.

The occurrence of thoracic osteochondrosis can also be affected by spinal injuries, overweight and weakened immunity.

Osteochondrosis can also develop in women who often wear high heels or who are pregnant.

An exacerbation of thoracic osteochondrosis is possible with an uncomfortable sleeping position, smoking, attending a poor-quality massage, and hypothermia.

Complications

Degenerative processes in the thoracic spine can cause the development of the following pathologies:

• Spinal cord compression – compression of the spinal cord, which leads to a decrease in sensation in the abdomen, back and chest.
• Kyphosis – curvature of the spine.
• Protrusion and herniation of the spine – protrusion of the center of the intervertebral disc, which affects the functionality of the pancreas and intestines.
• Intercostal neuralgia – acute pain in the intercostal space.

The organs that may be affected by the complication depend on the affected vertebra.

Degrees of development of thoracic osteochondrosis

• I degree – mild pain appears, which quickly passes in a comfortable position. Moisture is lost in the intervertebral disc, and the nucleus pulposus is slightly displaced. This stage is not always paid attention, because the pain does not cause much discomfort and passes quickly.
• II degree – cracks appear in the intervertebral disc, keeping the spine in a stable position leads to spasms, pain in the back and chest. The disk begins to lose its elasticity, and its height begins to decrease. Muscles in the affected area become constantly tense.
• III degree – there is a protrusion of the central part of the intervertebral disc – the nucleus pulposus. Because of this, an intervertebral hernia occurs. The pain becomes constant, and the cartilage begins to thin.
• IV degree – the tissue of the fibrous ring is replaced by bone. Bone begins to break down

Diagnosis of thoracic osteochondrosis

If you suspect osteochondrosis of the thoracic spine, you must make an appointment with a general practitioner or neurologist. At the examination, the patient talks about his complaints, and the doctor conducts a physical examination. During examination, attention is paid to the ratio of the level of the shoulder and pelvic girdle, posture, the shape of the chest, the state of the muscular system.

After that, the doctor issues a referral for a diagnostic study. From the studies, the patient may be prescribed:

• X-ray – X-rays are taken of the problem areas of the spine, which show disc changes.
• CT – allows you to assess the condition of the lesion and examine the condition of the disks.
• ECG – recommended if you suspect the presence of diseases of the cardiovascular system.

How to treat thoracic osteochondrosis

For the treatment of osteochondrosis of the thoracic spine, conservative methods are used. They are aimed at eliminating pain, relieving spasms and normalizing blood circulation. These include:

• Massage
• Therapeutic gymnastics
• Physiotherapy
• Taking vitamins and medicines

Massage for chest osteochondrosis

Massage of the cervical-thoracic zone will help relieve pain and inflammation, as well as strengthen the muscles that support the vertebrae in a stable state.

During the session, the following massage techniques are used: stroking, squeezing, kneading, rubbing and vibration. The direction of exposure in osteochondrosis depends on the location of the lesion. Massage should be performed by a specialist who will make the procedure really effective. For greater results, special oils can be used when massaging.

However, before visiting a massage course, you need to make sure that it is not contraindicated for the patient. To do this, you should consult a doctor. The list of contraindications includes cardiovascular pathologies, fever, tuberculosis and skin diseases.

Therapeutic gymnastics

Gymnastics for thoracic osteochondrosis consists of a set of exercises to strengthen the spinal muscles and form a strong muscle corset. In the initial stages, gymnastics will help to avoid taking medications.

What effect does exercise therapy have in thoracic osteochondrosis:

• Deep breathing becomes correct
• Correct posture is formed
• Reduces the load on the spine
• Deep back muscles become less stiff
• Increased mobility of the thoracic region

Exercises for osteochondrosis of the thoracic spine

Before starting gymnastics, you need to warm up. It can warm up and prepare the muscles for physical activity. For warm-up, you can use limb swings, rotations and turns of the torso, neck and pelvis.

Here are a few exercises that are suitable for the treatment of thoracic osteochondrosis:

• “Boat” – you need to lie on your stomach, stretch your arms above your head and keep your legs straight. In this position, you need to bend in the chest – smoothly and simultaneously raise your arms and legs.
• Shoulder Raise – In a standing position and with arms relaxed along the body, each shoulder should be raised in turn.
• Chair Reclining – Sit on a chair with your back firmly pressed against the back. Hands should be down. In this position, while inhaling, you need to put your hands behind your back and bend back. As you exhale, bend forward. You can also do side bends.
• Backbend – standing on all fours, you need to bend your back and maintain this position for several seconds. Then you need to return to the starting position. Exercise is recommended to be performed on a special mat.

Exercise should be done regularly for several months. Therapeutic exercises should not last more than 30 minutes, and you need to do it in comfortable shoes and clothes. In the event of acute pain, you need to stop the load.

Physiotherapy

Physiotherapy is suitable for complex treatment. Can act as an additional therapy, and independent. With thoracic osteochondrosis, the doctor may prescribe the following procedures:

• Magnetotherapy – the effect of a magnetic field on the affected area, which allows you to normalize blood circulation, restore affected tissues and improve the mobility of the lumbar.
• Laser therapy – impact on the affected area with laser beams. Helps improve immunity, gives analgesic and anti-inflammatory effect. There is no pain during the procedure.
• Shock wave therapy – exposure to infrasonic acoustic waves. It promotes the resorption of bone growths, stimulates the production of collagen, and improves blood circulation.
• Medicinal electrophoresis is an effective technique to eliminate pain and improve the nutrition of affected tissues. Electrodes and pads are fixed on the patient’s skin, inside of which there are medicinal substances.

All these procedures will help relieve the discomfort of the symptoms of thoracic osteochondrosis.

Medicinal treatment of osteochondrosis

With drug treatment, the patient is often prescribed a complex of drugs. The doctor determines the duration of the course and the list of specific drugs depending on the clinical manifestations of osteochondrosis. The list of drugs may include, for example, anti-inflammatory, muscle relaxants, vitamins, as well as special ointments or gels.

Nutrition for thoracic osteochondrosis

As an additional measure of treatment, I can prescribe the diet “Table No. 15” to the patient. The diet does not require the rejection of most popular foods, but its peculiarity is in a diet with a high content of vitamins.

As part of the diet, you can eat:

• Bread
• Milk
• Soups
• Lean meat – preferably every day
• Pasta
• Vegetables, either fresh or in salad or cooked
• Eggs
• Fresh fruit
• Fresh berries
• Many types of sweets
• Butter and vegetable oils

From drinks it is allowed to drink weak coffee, tea, juices and kvass.

What not to eat:

• Puff pastry
• Dishes with fatty meat or fish
• Chocolate products

From drinks it is not recommended to drink strong coffee, strong tea, as well as alcoholic beverages.

Prevention of thoracic osteochondrosis

Recommended preventive measures include:

• Swimming or other water sports
• Regular warm-up during prolonged work at the computer
• Sitting posture – back straight and shoulders back
• Avoidance of hypothermia of the back
• Regular exercise therapy

In addition, attention should be paid to the choice of bedding.