CHEST TENDERNESS

Ask the following questions:

1. Is there a history of trauma? Fractured or bruised ribs head the list of traumatic conditions that can cause chest tenderness. Intercostal myositis and burns may cause tenderness.
2. Are there significant signs of systemic diseases? Signs of petechiae or ecchymoses elsewhere may suggest blood dyscrasia. Splenomegaly and hepatomegaly may also suggest a systemic disease. Evidence of arthritic changes of the joints may suggest ankylosing spondylitis.
3. Is there a rash in the area of the tenderness? A rash in the area of tenderness suggests herpes zoster. At times only a few vesicles or bullae may be present, and it is easy to miss this diagnosis in the early stages.
4. Are there abnormalities on auscultation and percussion of the lung? The pleura and pericardium may elicit a friction rub that will indicate pericarditis or pleurisy. Flatness or dullness to percussion may indicate pleural effusion, lobar pneumonia, or empyema. There may be a murmur beneath the area of tenderness and aortic aneurysm.

DIAGNOSTIC WORKUP

In any case of unexplained tenderness of the chest, x-rays of the chest and the ribs will be extremely useful in the diagnosis. If a systemic disease is suspected, a CBC and sedimentation rate, chemistry panel, and arthritis profile should be done. If cardiac disease is suspected, serial EKGs and serial cardiac enzymes may be necessary. A bone scan may diagnose subtle fractures or metastatic neoplasm of the ribs. A CT scan may be helpful in mediastinal tumors. Trigger point injections may help diagnose costochondritis. In confusing cases, a cardiologist should be consulted .

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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