Pain while breathing can result from many causes, some of which can be very serious. This kind of pain may result from an obvious injury, but it may also be a sign of an infection, a blood clot or problems with your heart. Lung cancer and autoimmune disease are two other possible causes of pain while breathing. Although your pain may not be serious, you should be aware of several warning signs, which, if present, should prompt immediate medical evaluation.
An injury to the chest wall may produce pain when breathing. For example, if you’ve broken a rib, as your chest wall expands and contracts with normal respiration, the fragments of your broken rib will rub together and cause pain. A pulled muscle or bruising can cause pain from movement in the same way. Less commonly, your lung may be punctured from a penetrating chest wall injury or from fragments of a broken rib. This may result in a condition called "pneumothorax," which can cause pain while breathing, a collapsed lung and life-threatening consequences.
Pneumonia, an infection of the lungs, may cause pain with breathing. Some common causes of pneumonia include influenza, a virus and streptococcus, a bacterium. If the pneumonia spreads to the outer surface of your lungs, known as the pleura, a condition called "pleuritis" results. Pneumonia characteristically causes shortness of breath and fever, but when the pleura becomes involved, painful breathing may be more prominent. Infection in your abdomen can also cause painful breathing, especially if it involves organs such as the liver or spleen. These organs are adjacent to the diaphragm, and infections in them can cause pain as the diaphragm moves up and down with normal respiration.
A blood clot in your lungs, called a pulmonary embolism, is a very serious cause of pain when breathing. It can lead to shock, which if untreated can rapidly cause death. If you’re having pain while breathing, pulmonary embolism may be more likely if you’ve had clots before, if you’re coughing up blood or if your heart is racing. It may also be more likely if you have signs of a "deep vein thrombosis," or DVT, which is a blood clot that has formed in a deep vein in your body, most commonly in the legs. In some cases it can travel to your lungs and cause an embolism. A DVT may be present if one of your legs is bigger around than the other or if your leg has suddenly and unexpectedly become red, swollen or tender.
The heart is surrounded by a thin layer of tissue called the pericardium. The pericardium abuts the lining of your lungs, or the pleura. Therefore, any inflammation of the pericardium -- called pericarditis -- is likely to cause pain with breathing. A number of conditions can cause pericarditis, but most commonly it’s thought to be due to a viral infection and usually goes away on its own. Additionally, although pericarditis isn't classically associated with an active heart attack, it may develop in the days to weeks following a heart attack, as damaged heart tissue triggers an inflammatory response that may affect the pericardium.
Lung cancer commonly develops in elderly people with long smoking histories and presents with cough, shortness of breath and weight loss. Chest wall pain, or pain with breathing, may also be present, especially if the cancer involves the pleura. Less commonly, other diseases affecting the pleura can cause pain while breathing, such as the autoimmune diseases rheumatoid arthritis and lupus. In these cases, it's unlikely that pain with breathing would be the only symptom you develop.
While all unexplained pain while breathing ought to prompt evaluation by a medical professional, there are some symptoms that when accompanied by pain with breathing should prompt you to seek attention right away. These include fever, dizziness, a racing heartbeat, swelling in one or both legs or coughing up blood. Signs of a heart attack should also prompt immediate attention; these include nausea; sweating; chest pain that radiates to your shoulders, back, jaw or abdomen; and chest pain that increases with exertion.
- Tintinalli's Emergency Medicine: A Comprehensive Study Guide, Seventh Edition; Judith Tintinalli, M.D., et al.
- Current Diagnosis & Treatment in Emergency Medicine, Seventh Edition; C. Keith Stone, M.D., and Roger L. Humphries, M.D.
- Symptom to Diagnosis: An Evidence-Based Guide, Second Edition; Scott Stern, M.D., et al.
- Harrison's Principles of Internal Medicine, Eighteenth Edition; Dan L. Longo, M.D., et al.
- American Family Physician: Pleurisy