Chest pain away from the center (breastbone) is primarily due to diseases of the lung and associated structures like the pleura, or of the chest wall itself (skin, ribs, cartilage, muscles but not the breastbone). However, pain that originates centrally, as discussed under pain in the center of the chest, may also refer more laterally (towards the sides of the chest).

Causes of Side Chest Pain

Injury/Trauma and Strain

  • Fractures
    • Rib fractures need to be excluded as a cause of non-central chest pain especially if the onset was preceded by trauma. This may include a blow, blunt force trauma, car accident, fall or even a firm grasp around the chest (squeeze, ‘bear hug’).
  • Collapsed Lung
    • A pneumothorax (collapsed lung) may also occur with a rib fracture and sharp force injury that penetrates the chest wall.
  • Muscle Strain
    • The intercostal and pectoral muscles may also chest pain. Weight lifting, strenuous physical activity especially if it involves the upper limbs, a persistent cough and strained breathing may result in muscle strain or tears.
  • Cartilage Inflammation
    • Tietze’s syndrome (costochondritis) affects the costal cartilages and or the joints with the rib or sternum (breastbone). This may arise from strain or injury but is also seen in inflammatory diseases like rheumatoid arthritis.
  • Nerve Compression
    • Pressure or injury of the intercostal nerve at its root (pinched nerve) or along its course will result in pain.

Infection

  • Lungs
    • Pneumonia is the inflammation of the lung tissue usually as a result of infection.
    • Pulmonary tuberculosis is a lung infection caused by the bacteria, Mycobacterium tuberculosis.
  • Airways
    • Bronchiectasis is when the airways (bronchi, bronchioles) widen and become scarred due to prolonged inflammation from an infection.
  • Pleurisy
    • Inflammation of the pleura (pleuritis) may be due to many factors including an infection and may arise with pneumonia or tuberculosis.
  • Chest Wall
    • Shingles caused by the herpes zoster virus may result in pain as a result of nerve injury.
    • Bornholm’s disease is a condition that results in muscle pain (myalgia) caused by the Coxsackie group B virus.

Malignancy

This may cause pain within the thoracic cavity or affect the chest wall.

  • Lung cancer
  • Mesothelioma
  • Metastasis from a neighboring or distal site
  • Bony metastases – rib

Other

  • Pulmonary infarction is the death of lung tissue due to a lack of oxygen often as a result of a pulmonary embolus.
  • Connective tissue diseases like SLE (systemic lupus erythematosus).
  • Referred pain from conditions affecting the bronchi, heart, mediastinum, esophagus, stomach, colon, liver.

Article reviewed by Dr. Greg. Last updated on October 1, 2010