Stabbing pain when breathing describes a symptom known medically as pleuritic pain. The sharp pain is typically felt in the chest but sometimes radiates into the shoulder and/or neck. Pleuritic pain characteristically worsens when inhaling deeply, coughing, sneezing and moving the chest in certain ways -- such as when bending, stooping and rolling over in bed. The pain occurs due to inflammation of the pleural sac, which surrounds each lung and lines the chest cavity. A handful of medical conditions account for most cases of pleuritic pain, although several other disorders less commonly provoke this type of discomfort.
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Viral infections are the most common cause of pleuritic pain. This symptom can develop in association with influenza (the flu) or the mumps. Other characteristic signs and symptoms typically confirm the diagnosis. Infection with other viruses -- such as adenovirus, cytomegalovirus (CMV), Epstein-Barr virus (EBV) and parainfluenza virus -- can also lead to pleuritic pain. Tuberculosis and bacterial or viral pneumonia also sometimes cause stabbing chest pain. Treatment typically includes nonsteroidal anti-inflammatory medications, such as ibuprofen (Advil, Motrin), and antibiotics for bacterial pneumonia and tuberculosis.
Pulmonary embolism (PE) refers to a sudden blockage of a lung artery caused by a blood clot that traveled from elsewhere in the circulation. Most PEs occur due to blood clots that formed in the deep veins of the legs. PE is a potentially life-threatening condition as large clots can deprive the body of life-sustaining oxygen. Symptoms characteristically occur suddenly and commonly include:
- Chest pain, which is usually pleuritic in nature
- Shortness of breath
- Cough, which might produce bloody phlegm
- Anxiety or apprehensiveness
- Rapid heart and breathing rates
- Excessive sweating
A pneumothorax -- commonly known as a collapsed lung -- occurs when air leaks from the lung into the chest cavity. As air accumulates in the chest, pressure builds and partially or completely collapses the lung. Pneumothorax can occur due to lung injury or disease, such as chronic obstructive pulmonary disease (COPD), asthma or cystic fibrosis. The condition can also occur spontaneously, meaning without any known cause, particularly in tall, thin young men. Smoking increases the risk for a spontaneous pneumothorax. Symptoms depend on the extent of lung collapse and may include:
- Sudden pleuritic chest pain that might radiate to the shoulder or back, and often transitions to more constant, aching pain
- Shortness of breath, which might be mild to severe
- Rapid heart rate
A large pneumothorax can quickly become life threatening. Treatment typically involves removal of the accumulated air in the chest through a needle or tube. In the case of small amounts of air leakage, treatment might not be needed although observation is needed to ensure the condition doesn't worsen.
A number of other conditions can cause pleuritic pain, some representing relatively minor, short-term ailments and others more serious and often chronic. Examples of these conditions include:
- Musculoskeletal: rib fracture, sore chest muscles
- Inflammatory: lupus, rheumatoid arthritis, pericarditis (inflammation of the sac around the heart)
- Cardiovascular: heart attack (pleuritic pain is not typical), aortic dissection (tear of the large artery that carries blood from the heart to the rest of the body)
- Cancer: lung cancer, mesothelioma
Warnings and Precautions
Although some causes of pleuritic pain pose no long-term health threat, this symptom also occurs with life-threatening conditions. Therefore, seek immediate medical care if you suddenly develop stabbing chest pain -- especially if accompanied by shortness of breath or other symptoms.
Reviewed and revised by: Tina M. St. John, M.D.
REFERENCES & RESOURCES
- American Family Physician: Pleurisy
- Family Practice Notebook: Pleuritic Chest Pain
- General Medicine, 3rd Edition; Robert Parker and Asheesh Sharma
- ABC of Emergency Differential Diagnosis; Francis Morris and Alan Fletcher
- Oxford Medical Education: Differential Diagnosis for Pleuritic Chest Pain
- Family Practice Notebook: Pulmonary Embolism
- Merck Manual Professional Version: Pneumothorax
- FamilyDoctor.org: Chest Pain, Acute