Symptoms, Causes, Tests, and Treatment

Costochondritis is an inflammation of the cartilage in the rib cage. It can happen due to infection, injury, and other health conditions.

This condition usually affects the cartilage where the upper ribs attach to the breastbone, also known as the sternum, in an area known as the costosternal joint or costosternal junction.

Chest pain caused by costochondritis can range from mild to severe. Mild cases may only cause your chest to feel slightly tender or some pain when you push on the area.

More severe cases may get worse with certain movements as well as with deep breaths. The condition often goes away within a few weeks or months, but some cases may require treatment.

People with costochondritis often experience chest pain in the upper and middle rib area on either side of the breastbone. This pain can gradually increase over time, or come on suddenly.

Additional symptoms can include:

• pain that becomes worse when lying down
• pain that becomes worse when there’s pressure on your chest, like when you wear a seatbelt
• pain that intensifies with coughing or deep breaths
• pain that increases with physical activity

It’s important to note that symptoms like chest tightness and radiating pain can indicate other conditions, including a heart attack. Seek immediate medical care if you’re experiencing persistent, intense chest pain.

The exact cause of costochondritis in most people is unknown. But conditions that may cause it include:

• trauma to the chest, such as blunt impact from a car accident or fall
• physical strain from activities, such as heavy lifting and strenuous exercise
• certain viruses or respiratory conditions, such as tuberculosis, that can cause joint inflammation
• severe coughing

There’s some research that suggests costochondritis occurs more often in women, especially those who are athletes. You may also be at a higher risk for this condition if you:

• participate in high-impact activities
• recently had a physical trauma or fall that affected the chest area
• have allergies and are frequently exposed to irritants

While there’s no test to diagnose costochondritis, your doctor will most likely ask a series of questions and do a series of tests to determine the source of your chest pain.

Lab tests

Typically, lab tests aren’t needed to diagnose costochondritis, but depending on your personal health history, your doctor may do some tests to see if your chest pain could be due to other issues like pneumonia or coronary heart disease.

X-rays and ECGs

Your doctor may want you to get an X-ray to make sure there’s nothing abnormal going out with your lungs.

If you’re dealing with costochondritis, your X-ray should look normal. They may also recommend an electrocardiogram (ECG) to make sure your heart isn’t the cause of your chest pain.

Many times, diagnosing costochondritis is a matter of eliminating other possible, more serious causes.

See your doctor right away if you have trouble breathing or are feeling intense chest pain.

Always seek immediate emergency care when you have abnormal and debilitating pain in your chest. It can indicate something serious, such as a heart attack.

Getting care as soon as possible limits the possibility of complications, especially if an underlying issue is causing your costochondritis.

Costochondritis can be treated in several ways.

Most cases of costochondritis are treated with over-the-counter medications. If your pain is mild to moderate, your doctor will probably recommend nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil) or naproxen (Aleve).

Your doctor may also recommend:

• prescription-strength NSAIDs
• oral steroids or injection of a steroid into the area involved
• transcutaneous electrical nerve stimulation (TENS), which is a mild electric current that is delivered to the area via a small, battery-powered device

Lifestyle changes

Your doctor may tell you to make permanent lifestyle changes if you have persistent or chronic costochondritis.

Some types of exercise can aggravate this condition, including rowing and weightlifting. Manual labor may also have a negative effect.

Your doctor may also recommend:

• rest
• physical therapy
• hot or cold therapy using a heating pad and ice

Normally, treatment of the inflammation and pain causes costochondritis to eventually go away on its own.

If you have chronic costochondritis, the pain may persist or return — even with treatment — when you exercise or engage in certain activities. In these cases, you may need to seek long-term care to make sure that costochondritis doesn’t affect your quality of life and ability to take part in daily activities.

Pains associated with costochondritis can indicate other issues. Chest pain can often mean that you’re having heart or lung issues, so see your doctor right away when you feel pain in your chest to make sure that you’re not having a heart attack or have pneumonia.

The chest pain associated with costochondritis can be a symptom of fibromyalgia. With fibromyalgia, you may experience soreness in your chest in addition to:

• pain throughout your body
• fatigue and inability to rest due to pain
• difficulty focusing or concentrating
• feelings of depression
• headaches

If you experience chest pains along with these other symptoms, talk with your doctor about getting tested for fibromyalgia. Understanding this condition can help you address the symptoms and ensure that it doesn’t interrupt your daily life.

Costochondritis is caused by inflammation and typically presents as chest pain that gets worse with certain movements or pressure. This condition usually isn’t persistent. In many cases, costochondritis goes away on its own.

Mild cases of costochondritis may disappear after a few days. Chronic cases can last for weeks or more, but most cases don’t last any longer than a year.

To lower your chances of developing persistent costochondritis, carry and lift heavy loads properly. Try doing fewer high-impact exercises or manual labor, when possible.

Seek medical attention immediately if you experience chest pain while performing any of these activities.

Symptoms, Causes, Tests, and Treatment

Costochondritis is an inflammation of the cartilage in the rib cage. It can happen due to infection, injury, and other health conditions.

This condition usually affects the cartilage where the upper ribs attach to the breastbone, also known as the sternum, in an area known as the costosternal joint or costosternal junction.

Chest pain caused by costochondritis can range from mild to severe. Mild cases may only cause your chest to feel slightly tender or some pain when you push on the area.

More severe cases may get worse with certain movements as well as with deep breaths. The condition often goes away within a few weeks or months, but some cases may require treatment.

People with costochondritis often experience chest pain in the upper and middle rib area on either side of the breastbone. This pain can gradually increase over time, or come on suddenly.

Additional symptoms can include:

• pain that becomes worse when lying down
• pain that becomes worse when there’s pressure on your chest, like when you wear a seatbelt
• pain that intensifies with coughing or deep breaths
• pain that increases with physical activity

It’s important to note that symptoms like chest tightness and radiating pain can indicate other conditions, including a heart attack. Seek immediate medical care if you’re experiencing persistent, intense chest pain.

The exact cause of costochondritis in most people is unknown. But conditions that may cause it include:

• trauma to the chest, such as blunt impact from a car accident or fall
• physical strain from activities, such as heavy lifting and strenuous exercise
• certain viruses or respiratory conditions, such as tuberculosis, that can cause joint inflammation
• severe coughing

There’s some research that suggests costochondritis occurs more often in women, especially those who are athletes. You may also be at a higher risk for this condition if you:

• participate in high-impact activities
• recently had a physical trauma or fall that affected the chest area
• have allergies and are frequently exposed to irritants

While there’s no test to diagnose costochondritis, your doctor will most likely ask a series of questions and do a series of tests to determine the source of your chest pain.

Lab tests

Typically, lab tests aren’t needed to diagnose costochondritis, but depending on your personal health history, your doctor may do some tests to see if your chest pain could be due to other issues like pneumonia or coronary heart disease.

X-rays and ECGs

Your doctor may want you to get an X-ray to make sure there’s nothing abnormal going out with your lungs.

If you’re dealing with costochondritis, your X-ray should look normal. They may also recommend an electrocardiogram (ECG) to make sure your heart isn’t the cause of your chest pain.

Many times, diagnosing costochondritis is a matter of eliminating other possible, more serious causes.

See your doctor right away if you have trouble breathing or are feeling intense chest pain.

Always seek immediate emergency care when you have abnormal and debilitating pain in your chest. It can indicate something serious, such as a heart attack.

Getting care as soon as possible limits the possibility of complications, especially if an underlying issue is causing your costochondritis.

Costochondritis can be treated in several ways.

Most cases of costochondritis are treated with over-the-counter medications. If your pain is mild to moderate, your doctor will probably recommend nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil) or naproxen (Aleve).

Your doctor may also recommend:

• prescription-strength NSAIDs
• oral steroids or injection of a steroid into the area involved
• transcutaneous electrical nerve stimulation (TENS), which is a mild electric current that is delivered to the area via a small, battery-powered device

Lifestyle changes

Your doctor may tell you to make permanent lifestyle changes if you have persistent or chronic costochondritis.

Some types of exercise can aggravate this condition, including rowing and weightlifting. Manual labor may also have a negative effect.

Your doctor may also recommend:

• rest
• physical therapy
• hot or cold therapy using a heating pad and ice

Normally, treatment of the inflammation and pain causes costochondritis to eventually go away on its own.

If you have chronic costochondritis, the pain may persist or return — even with treatment — when you exercise or engage in certain activities. In these cases, you may need to seek long-term care to make sure that costochondritis doesn’t affect your quality of life and ability to take part in daily activities.

Pains associated with costochondritis can indicate other issues. Chest pain can often mean that you’re having heart or lung issues, so see your doctor right away when you feel pain in your chest to make sure that you’re not having a heart attack or have pneumonia.

The chest pain associated with costochondritis can be a symptom of fibromyalgia. With fibromyalgia, you may experience soreness in your chest in addition to:

• pain throughout your body
• fatigue and inability to rest due to pain
• difficulty focusing or concentrating
• feelings of depression
• headaches

If you experience chest pains along with these other symptoms, talk with your doctor about getting tested for fibromyalgia. Understanding this condition can help you address the symptoms and ensure that it doesn’t interrupt your daily life.

Costochondritis is caused by inflammation and typically presents as chest pain that gets worse with certain movements or pressure. This condition usually isn’t persistent. In many cases, costochondritis goes away on its own.

Mild cases of costochondritis may disappear after a few days. Chronic cases can last for weeks or more, but most cases don’t last any longer than a year.

To lower your chances of developing persistent costochondritis, carry and lift heavy loads properly. Try doing fewer high-impact exercises or manual labor, when possible.

Seek medical attention immediately if you experience chest pain while performing any of these activities.

causes of occurrence, in which diseases it occurs, diagnosis and methods of treatment

Heart failure

Renal failure

Cirrhosis

Myxedema

Edema

Cyanosis

Shortness of breath

29210

April 28

Hydrothorax: causes of occurrence, in which diseases it occurs, diagnosis and methods of treatment.

Definition

Hydrothorax is a pathological condition characterized by the accumulation of excess fluid in the pleural cavity. The term “hydrothorax” consists of two Greek roots: “hydor” – water, “thorax” – chest, which literally means “chest dropsy”.

Human lung is covered with two sheets of serous membrane – pleura. One of them densely covers the surface of the lungs and their vessels. The second is tightly adjacent to the ribs and organs that are located between the lungs (heart, esophagus, lymph nodes, etc.).

The pleural cavity is a narrow space between the layers of the pleura.

The main task of the pleura is to participate in the act of breathing. Normally, the pleural cavity contains a small amount of serous fluid, due to which the sheets easily slide relative to each other, protecting the organs from excessive friction and injury during breathing. If the level of fluid between the layers of the pleura exceeds the physiological norm, then they speak of the presence of hydrothorax, which is accompanied by characteristic symptoms of respiratory failure (shortness of breath, heaviness in the chest, cyanosis of the nasolabial triangle).

Pleural effusion is produced by the capillaries of the intercostal arteries, and excess fluid is removed by the lymphatic system.

The accumulation of fluid occurs only in the case of an increase in its flow into the pleural cavity or blocking its reverse outflow.

With hydrothorax, the accumulating fluid is non-inflammatory in nature (transudate), in contrast to exudative pleurisy, in which the effusion is of inflammatory origin (exudate). Transudate is a clear colorless or slightly yellowish liquid, has an alkaline reaction, the protein level in it is not more than 3%. The amount of transudate is very variable and can reach several liters.

All the inconveniences and problems that hydrothorax causes are mechanical in nature. Accumulating in the pleural cavity, the fluid begins to put pressure on the lungs and mediastinal organs. A large volume of fluid in the pleural cavity can provoke a serious complication – acute respiratory failure, which threatens the life of the patient. In addition, there is a high risk of displacement of the mediastinal organs, circulatory disorders and the development of severe cardiac pathology.

In some cases, secondary infection may occur with the development of a purulent inflammatory process in the pleural cavity (pleural empyema).

Varieties of hydrothorax

The classification of hydrothorax is based on the volume and location of the fluid:

• small hydrothorax – the fluid is located within the costophrenic sinus;
• medium hydrothorax – accumulation of fluid is observed from the angle to the level of the middle of the scapula;
• large hydrothorax – fluid level above the middle of the scapula.

There are also right-sided and left-sided hydrothorax, but in most cases, hydrothorax covers both pleural cavities. Bilateral effusions can be symmetrical or asymmetrical.

Based on the amount of transudate, hydrothorax is distinguished:

• encysted – limited by adhesions or other tissues from a larger area of ​​the pleural fissure, can be located on any surface of the pleura;
• partial;
• total.

Possible causes of hydrothorax

Hydrothorax is not an independent disease, that is, it inevitably develops against the background of another disease. The cause of its occurrence is always a chronic or complicated disease of the internal organs, as well as a side effect of treatment. The main causes of hydrothorax include:

• violations of the permeability of the vascular wall;
• lymphatic drainage disorders;
• electrolyte metabolism disorders;
• increase in aldosterone production;
• increase in pressure in the vascular system of the pulmonary circulation;
• physiologically low pressure in the pleural cavity.

Diseases and pathological conditions leading to hydrothorax:

Chronic heart failure , which may be associated with ischemic disease, heart disease, constrictive pericarditis, myocarditis, chronic obstructive pulmonary disease.

The accumulation of transudate in the interpleural space occurs due to venous congestion in the systemic circulation.

Renal failure associated with nephrotic syndrome . It is a consequence of kidney diseases of a different nature, which involve damage to the renal glomeruli: glomerulonephritis, amyloidosis of the kidneys, collagenoses, toxic nephropathy, etc.

Against the background of hypoproteinemia and hypoalbuminemia, generalized edema, hydropericardium, hydrothorax, and ascites develop.

Nutritional dystrophy associated with inferiority or malnutrition (severe form of protein-energy malnutrition). In this case, effusion into the pleural cavity is directly related to a deficiency of vitamins B and C, a decrease in lymph outflow.

Cirrhosis of the liver . Hydrothorax develops in 5-10% of patients in the terminal phase of liver cirrhosis, which indicates the presence of congestion in the blood system. It is due to hypoalbuminemia, portal hypertension, and concomitant ascites. It is a consequence of the ingress of ascitic fluid from the abdominal cavity into the pleural cavity through the diaphragm.

Peritoneal dialysis . This procedure involves the introduction of a large volume of fluid into the abdominal cavity, and then its removal. Hydrothorax occurs due to the movement of dialysis fluid from the abdominal cavity into the pleural cavity. At the same time, right-sided hydrothorax develops in 90% of cases.

Tumors . In oncological diseases, recurrent hydrothorax is often observed, the cause of which can be not only the malignant neoplasm itself, but also its treatment with radiation or chemotherapy. Another possible reason is a malfunction of the lymphatic system due to the defeat of the lymph nodes by metastases or the germination of a cancerous tumor. Most often, the accumulation of fluid in the lungs occurs with cancer of the lung, breast, ovary, stomach, body and cervix, with melanomas, lymphomas, sarcomas, leukemia. With a malignant tumor of the pleura (mesothelioma), the permeability of the vascular wall of the capillaries increases. Fluid from the blood actively enters the lungs, and its pumping out by the lymphatic system, on the contrary, worsens. As a result, stagnation and accumulation of fluid occurs.

Myxedema – lack of thyroid hormones . The mechanism of transudate formation in severe hypothyroidism is unknown. It is assumed that this is due to stagnation of the lymph due to a decrease in the production of thyroid hormones.

Pulmonary embolism . The effusion can be either a transudate or an exudate. The first is characteristic of acute cor pulmonale, the second – for pulmonary infarction.

Fetal hydrothorax during pregnancy . A pleural effusion in a fetus can be caused by genetic problems; infections and malformations, especially of the heart or lungs; situations when, with a Rh conflict, the work of the circulatory system is disrupted. In newborns, hydrothorax can occur when the umbilical cord is entwined or birth trauma.

Which doctors to contact for hydrothorax

The presence of pleural effusion is indicated by the physical examination data and the patient’s current complaints.

X-ray image of patient’s lung showing pleural effusion (yellow arrow)

therapist,
general practitioner or
pulmonologist. Further management of patients is carried out by a specialized specialist:
cardiologist, hepatologist, nephrologist,
endocrinologist. In the hospital, the patient is observed by a thoracic surgeon.

Diagnosis and examination of hydrothorax

Symptoms of hydrothorax are the result of squeezing the lungs with accumulated fluid. Patients are concerned about the feeling of heaviness, pressure in the chest, dry cough, shortness of breath. If a large amount of transudate accumulates in the pleural cavity, the outflow of blood from the jugular veins becomes difficult. Then their swelling becomes noticeable. There is a total swelling of tissues, accumulation of fluid in the abdominal cavity, sometimes in the pericardium. Characteristic objective signs are tachypnea, asymmetry of the chest, limited mobility of the affected side during breathing, cyanosis of the skin.

The doctor detects the presence of excess fluid in the pleural cavity at the initial stages of the examination. The specialist examines the chest, conducts percussion (percussion) and auscultation (listening with a stethoscope).

The following diagnostic algorithm is used to confirm hydrothorax:

• Ultrasound examination of the pleural cavities makes it possible to detect the presence of even a minimal amount of effusion in the chest cavity, to determine its amount with high accuracy. In addition, ultrasound is used for labeling and control during pleural puncture.

Ultrasound of the pleural cavity

Examination of the pleural cavity for the diagnosis of various pathologies of the lungs, including traumatic injuries of the pleura.

RUB 1,890

Sign up

Chest x-ray provides detailed information about the pathological condition. The radiological sign of pleural effusion is a homogeneous darkening of the lung fields with an oblique upper border of the fluid.

Plain chest x-ray

X-ray examination of the structure of the lungs to diagnose various pathologies.

RUB 2,440

Sign up

CT of chest and mediastinum

A study that allows you to obtain data on the state of the organs of the chest and mediastinum.

RUB 5,490

Sign up

Diagnostic puncture is performed to determine the nature of excess fluid in the respiratory organs, its further analysis and removal from the pleural cavities.

Examination of transudates, exudates, secretions

Material for research:

smears prepared in the laboratory from the sediment of transudates, exudates, secrets, excreta and urine;

smears prepared from …

Up to 2 working days

Available with home visit

RUB 1,030

Add to cart

Additional studies are carried out in order to determine the cause of the appearance of pathological contents (trauma, infection, tumor process, etc. ). It is advisable to perform an ultrasound examination of the abdominal organs and kidneys, mediastinum, thyroid gland.

Comprehensive ultrasound examination of the abdominal organs (liver, gallbladder, pancreas, spleen)

Scanning of the internal organs of the abdominal cavity to assess its functional state and the presence of pathology.

RUB 3,090

Sign up

Comprehensive ultrasound examination of the urinary system (kidneys, ureters, bladder)

Comprehensive ultrasound scan of the urinary system, which allows to detect pathology at an early stage of development.

RUB 2,990

Sign up

Ultrasound of the thyroid gland, parathyroid glands and regional lymph nodes

Examination of the thyroid and parathyroid glands, which allows to assess their structure, as well as to detect pathological changes in these organs and regional lymph nodes. ..

2,040 rubles

Sign up

If heart failure is suspected, echocardiography, electrocardiography is performed.

Echocardiography

Examination to assess functional and organic changes in the heart, its contractility, as well as the condition of the valvular apparatus.

RUB 4,190

Sign up

ECG in 5 minutes

Examination of the functionality of the heart – fast, painless and informative.

RUB 1,790

Sign up

Laboratory diagnostic methods may show:

• urinalysis;

General urinalysis (Urine analysis with sediment microscopy)

Method of determination

Determination of physical and chemical parameters is carried out on an automatic analyzer using the “dry chemistry” method.

Hardware microscope…

Up to 1 business day

Available with house call

410 RUB

Add to cart

Blood biochemistry: basic profile

Up to 1 business day

Available with home visit

2 565 RUB

Add to cart

Thyroid gland: extended examination

Up to 1 business day

Available with home visit

RUB 3,185

Add to cart

What to do about hydrothorax

The occurrence of hydrothorax is often asymptomatic, but the gradual accumulation of transudate signals itself with the following symptoms:

• feeling of heaviness in the chest;
• shortness of breath;
• breathing is facilitated in a sitting position;
• peripheral edema.

The presence of prerequisites for the development of hydrothorax and the combination of these symptoms are the reason for urgent medical attention.

With hydrothorax of the lungs, the patient is subject to hospitalization in the hospital in the department of thoracic surgery, since in many cases pleural hydrothorax is a symptom of another disease, so the treatment is aimed at eliminating the underlying disease.

Treatment of hydrothorax

Treatment of hydrothorax consists of conservative therapy aimed at the underlying disease, and pleural puncture to evacuate excess fluid, if necessary.

Small hydrothorax does not require special treatment. The fluid resolves on its own with successful treatment of the underlying disease.

Massive volumes of effusion require immediate intervention. The complete removal of fluid is called thoracentesis. The procedure is performed in the operating room by a thoracic surgeon under local anesthesia. A thin needle is inserted into the gap between the lower pairs of ribs, through which the exudate is evacuated. The intervention is carried out under ultrasound control. In the future, a catheter (a long narrow tube) and a special bag for the continuous outflow of excess fluid remain at the puncture site. Treatment of pulmonary hydrothorax with thoracentesis improves the patient’s condition, reduces shortness of breath.

Pleurodesis is the introduction of sclerosing agents into the pleural cavity, which stick together the thoracic and parietal pleura. After that, the liquid becomes nowhere to accumulate. Pleurodesis is usually performed after the effusion has been drained (thoracentesis). In oncological diseases, chemotherapeutic agents are used for pleurodesis, which have a cytostatic effect and at the same time glue the pleural petals.

Removal of the pleura in oncological diseases is usually performed laparoscopically.

In order to reduce respiratory disorders, unloading punctures or permanent drainage of the pleural cavity are performed.

If the cause of fluid accumulation was not an oncological disease, drug therapy with diuretics (diuretics), anti-inflammatory drugs, antibiotics, bronchodilators, expectorants and other drugs is used according to indications.

In heart failure, which caused hydrothorax, the main task is to reduce the load on the heart and normalize its contractile function, and therefore use cardiac glycosides and β-adrenergic stimulants, vasodilators, ACE inhibitors, diuretics.

Therapy of nephrotic syndrome requires the appointment of antihypertensive drugs that reduce the loss of proteins in the urine (ACE inhibitors), intravenous infusions of albumin, immunosuppressants, potassium-sparing diuretics, anticoagulants.

For hepatic hydrothorax, hepatoprotectors, preventive antibiotic therapy with third-generation cephalosporins are recommended.

Myxedema is treated with thyroid hormone replacement therapy.

In all cases of hydrothorax, a therapeutic diet is recommended (table No. 7, No. 10). Exclude salt from the diet, limit the intake of fluids and protein foods, enrich the diet with potassium-containing foods (dried fruits, vegetables). Arrange special fasting days.

Sources:

1. Chuchalin, A. G. Pulmonology. National leadership. Brief edition / ed. A. G. Chuchalina. – M.: GEOTAR-Media, 2018. – 800 p.
2. Chuklin S.N. Hydrothorax in patients with liver cirrhosis (hepatic hydrothorax) // Medicine and Pharmacy. Gastroenterology. – 2007 (226).
3. Clinical and radiological syndromes of the respiratory system / Ryabova L.V., Kolyadich M.I.; ed. I.I. Shaposhnik. — 2015.
4. Big Medical Encyclopedia (BME), edited by Petrovsky B.V., 3rd edition, volume 5.

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.