Chest pain with deep breathing and often when coughing may be due to a host of causes related to the thoracic cavity, upper abdomen and even the neck. It is often thought that the pain is only emanating from the lungs but strictly speaking, the lungs do not feel pain as its nerve supply is mainly autonomic. However, this should not detract from the fact that many respiratory conditions may be associated with pain, either from within the bronchi, pleura or chest wall, all of which are related to respiration.
Chest pain, like abdominal pain and pain anywhere else in the body, is non-specific. This means that on its own, pain is not a direct indication of a specific condition. While it is a prominent feature of inflammation, there are many non-inflammatory causes that can elicit pain. Identifying concomitant signs and symptoms with like sputum, fever, dizziness or aggravating factors like pain upon deep breathing or coughing, provides a better indication of the possible causes. Nevertheless, the list of causes can be quite exhaustive.
The causes of chest pain discussed below arises or is exacerbated when breathing in deeply and coughing. This does not mean that a cough will be present in every one of these causes. Refer to the article on chest pain with coughing for a list of diseases that cause the symptoms chest pain and coughing together.
Causes of Chest Pain with Deep Breathing, when Coughing
Chest wall pain is one of the more common causes of chest pain with deep breathing and coughing. Soft tissue injury, muscle strain, fractured ribs or sternum and joint/cartilage disorders like costochondritis need to be considered. Usually chest wall causative factors present with tenderness over the inflamed area and swelling or redness may also be visible on the surface.
Airways, Lungs and Pleura
Although conditions isolated to the lung may not cause pain, infection and masses may either inflame or irritate the pleura (pleuritic pain) and should therefore be considered. The most important cause to consider is pleuritis and pleurisy where pain with deep breathing, particularly inhalation, and coughing is a characteristic symptoms. Other conditions like bronchitis and pneumonia may not cause significant chest pain, however, these cases often cause chest wall pain due to persistent coughing. In cases of sudden severe pain, especially where there is difficulty breathing, a spontaneous pneumothorax needs to be considered.
Heart and Blood Vessels
Pericarditis is one of the more common cardiovascular causes of chest pain when breathing in deeply or coughing. Most other cardiovascular causes are not significantly altered by deep breathing. If the pain arises suddenly, then conditions like thoracic aortic dissection and pulmonary embolism also need to be considered.
Other causes of chest pain when breathing deeply or coughing may be related to the gastrointestinal system and abdominal contents. This includes :
- gallbladder and bile duct diseases and gallstones
- acute pancreatitis
- hiatal hernia
- liver disease
- liver, subdiaphragmatic abscess