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Clinical investigations from the RACP

Pleuritic chest pain: a systematic approach to investigation

Christopher Worsnop, Rob Pierce

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Abstract

The causes of pleuritic chest pain can be difficult to diagnose, and range from acute life threatening conditions like pulmonary embolism to benign conditions like costochondritis. It is therefore important to make a diagnosis and not just to treat the symptoms.

Key Points

  • Establish a diagnosis when a patient presents with pleuritic chest pain – do not just treat with analgesics.
  • The diagnosis of pulmonary embolism is important but can be difficult to make, so investigations such as CT pulmonary angiography and nuclear medicine V/Q scans are usually necessary. These tests need to be interpreted in the context of the clinical situation.
  • If the patient is also short of breath, assess his or her oxygen requirements.
  • Consider a CT scan if there is a suspicion of cancer in the chest.
  • The sudden onset of pleuritic chest pain may be caused by a pneumothorax; a chest x-ray with expiratory views is needed to make this diagnosis.

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