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Chapter 14: Anterior Thorax Pain

Yogi Matharu

Description of the Symptom

This chapter describes pathology that may lead to anterior thorax pain. Local causes are defined as pathology occurring within the chest wall structures. Remote causes are defined as pathology occurring outside this region, most notably deep to the parietal pleura.

Special Concerns

  • Acute chest pain with nausea, pallor, anxiety, vomiting, or diaphoresis

  • Severe fatigue or shortness of breath

  • Pain unresolved by rest or change in position, or worse at night

  • Pain that worsens following meals or while inhaling

  • Fainting, dizziness, or vertigo

  • Persistent cough that is dry in the presence of limited medical follow-up, productive, or includes blood

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CHAPTER PREVIEW: Conditions That May Lead to Anterior Thorax Pain
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CHAPTER PREVIEW: Conditions That May Lead to Anterior Thorax Pain
T  Trauma
REMOTE LOCAL
COMMON
Not applicable

Delayed-onset muscle soreness 254

Dorsal nerve root irritation 254

Fracture of the rib or sternum 255
UNCOMMON
Not applicable Not applicable
RARE
Pneumothorax 250 Not applicable
I  Inflammation
REMOTE LOCAL
COMMON

Aseptic

Gastroesophageal reflux disease 246

Septic

Bronchitis 245

Aseptic

Costochondritis 253

Septic

Not applicable
UNCOMMON

Aseptic

Pleuritis secondary to rheumatic disease 250

Septic

Pericarditis 249

Pleurisy/pleurodynia 250

Pneumonia 250

Tracheobronchitis 251

Tuberculosis 252

Aseptic

Fibromyalgia 255

Galactocele 255

Rheumatoid arthritis-like diseases:

  • Dermatomyositis 257

Septic

Candida breast infection 253

Herpes zoster 256

Mastitis 256

Vertebral osteomyelitis 258
RARE

Aseptic

Esophageal rupture 246

Septic

Infectious esophagitis 247

Infectious esophagitis (secondary):

  • Candida species infection 247

  • Cytomegalovirus 247

  • Herpes simplex virus 247

Subdiaphragmatic abscess 251

Aseptic

Precordial catch syndrome 256

Rheumatoid arthritis-like diseases:

  • Inclusion body myositis 257

  • Polymyositis 257

Septic

Breast abscess 253

Septic mediastinitis 258
M  Metabolic
REMOTE LOCAL
COMMON
Not applicable

Cyclic breast pain 254

Early pregnancy 254
UNCOMMON

Medication or stimulant use/abuse:

  • Illicit substances:

    • Amphetamine, cocaine, or "crack" use/abuse 248

    • Ecstasy/3,4-methylenedioxymethamphetamine (MDMA) use/abuse 248

  • Over-the-counter substances:

    • Caffeine use/abuse 248

    • Monosodium glutamate intake 248

    • Pseudoephedrine (allergy/cold medicine) use/abuse 249

  • Prescription substances:

    • Beta-agonist use 249

    • Bronchodilators/nonspecific beta-agonist use 249

    • Withdrawal from beta blockers 249

 Iatrogenic muscle pain 256
RARE
Not applicable Not applicable
Va  Vascular
REMOTE LOCAL
COMMON

Angina:

  • Stable angina 244

  • Unstable angina/acute coronary insufficiency 244

  • Variant angina 244

Myocardial infarction 249

Pulmonary embolism/infarction 251

 Not applicable
UNCOMMON
Aortic dissection (ascending aorta or thoracic descending aorta) 245 Not applicable
RARE
Sickle cell pain crisis 251 Mondor's disease 256
De  Degenerative
REMOTE LOCAL
COMMON
Not applicable Not applicable
UNCOMMON
Not applicable Thoracic disk herniation 258
RARE
Not applicable Not applicable
Tu  Tumor
REMOTE LOCAL
COMMON
Not applicable Not applicable
UNCOMMON
Not applicable

Malignant Primary, such as:

  • Breast adenocarcinoma (women) 253

Malignant Metastatic:

Not applicable

Benign, such as:

  • Fibrocystic breast disease 254
RARE

Malignant Primary, such as:

  • Esophageal tumor 252

  • Lung tumor 252

  • Mesothelioma 252

Malignant Metastatic:

Not applicable

Benign:

Not applicable

Malignant Primary, such as:

  • Breast adenocarcinoma (men) 253

Malignant Metastatic:

Not applicable

Benign...

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