Experiencing a sharp pain in the left back that worsens with breathing can be unsettling. This sensation might feel sudden, stabbing, or like a deep ache that intensifies with inhales or exhales. The discomfort can range from a mild annoyance to a severe, debilitating symptom. Understanding the nature of this pain involves considering various potential origins within the body.
Common Explanations for the Pain
Musculoskeletal issues, such as muscle strains (especially intercostal muscles), rib bruising, or fractures, are common causes. These can result from sudden movements, strenuous exercise, forceful coughing, or trauma, leading to sharp, localized pain worsened by breathing.
Costochondritis, inflammation of the cartilage connecting ribs to the breastbone, is another frequent cause. Though usually felt in the front, pain can radiate to the back, intensifying with deep breaths or pressure. It may mimic heart issues.
Pleurisy, inflammation of the pleura (membranes lining the lungs and chest cavity), commonly causes sharp pain with breathing. Inflamed layers rub during respiration, leading to a sharp, stabbing pain in the side or back, worsened by coughing, sneezing, or deep breaths.
Nerve compression, like a pinched nerve in the thoracic spine, can refer sharp pain to the left back. This pain radiates along the nerve’s path, becoming more noticeable with movements, including breathing, and may include tingling or numbness.
Digestive issues, such as acid reflux or gastritis, can cause referred pain in the left back. Though primarily affecting the stomach and esophagus, irritation may be felt in the upper back or chest, especially after eating or lying down. This pain is not directly tied to breathing but may coincide.
Urgent Medical Concerns
A sudden onset of sharp pain in the left back with breathing can signal a serious medical emergency. Pneumothorax, a collapsed lung, occurs when air leaks into the space between the lung and chest wall, causing deflation. It presents with sudden, sharp chest pain radiating to the back, shortness of breath, and chest tightness.
A pulmonary embolism, a blood clot in the lungs, is an urgent concern. Symptoms include sudden sharp chest or back pain, rapidly worsening shortness of breath, coughing (sometimes with blood), and a fast heart rate. This requires immediate medical attention due to potential severe lung impairment.
Severe infections like pneumonia or infectious pleurisy cause intense pain with breathing. Unlike milder cases, they often include high fever, chills, productive cough with phlegm, and increasing difficulty breathing. Pain arises from inflamed lung tissue or pleural lining.
Cardiac issues, though often associated with chest pain, can radiate to the left back, worsened by breathing. A heart attack can cause pain spreading to the shoulder, arm, back, neck, or jaw, with sweating, nausea, dizziness, or chest pressure. Pericarditis, inflammation around the heart, also causes sharp chest pain radiating to the left shoulder and back, often worsening when lying down or taking deep breaths.
Aortic dissection, a rare but life-threatening tear in the aorta’s inner layer, causes sudden, severe, tearing pain often starting in the chest and radiating to the back, described as “ripping.” This demands immediate emergency care due to rapid progression and high mortality. Seek emergency care if pain is sudden and severe, with difficulty breathing, dizziness, profuse sweating, chest pressure, blue lips, confusion, or high fever.
How Doctors Diagnose the Cause
When sharp pain in the left back occurs with breathing, doctors begin with a comprehensive medical history. They inquire about pain’s location, onset, duration, severity, and factors that worsen or alleviate it. Questions about associated symptoms like fever, cough, shortness of breath, or recent injuries guide diagnosis.
Following history, a physical examination is performed. This often includes listening to lungs for abnormal sounds and palpating the back and chest wall for tenderness or swelling. This assessment helps pinpoint musculoskeletal pain or underlying lung issues, and checks for inflammation or infection.
Imaging tests visualize chest and back structures. A chest X-ray can reveal pneumonia, pneumothorax, or rib fractures. For more detail, a computed tomography (CT) scan of the chest or spine may be ordered, providing cross-sectional views to identify blood clots or other abnormalities.
Blood tests provide clues, such as a complete blood count (CBC) for infection or inflammation. D-dimer may be tested for suspected blood clots, and cardiac enzymes for heart muscle damage. These tests help confirm or rule out systemic conditions.
Other specialized tests are used depending on the suspected cause. An electrocardiogram (ECG) assesses heart electrical activity, helping rule out cardiac events.
References
Pleurisy. Mayo Clinic.
Pinched nerve. Mayo Clinic.
Pneumothorax. National Heart, Lung, and Blood Institute.
Pulmonary embolism. Mayo Clinic.
Pneumonia. Centers for Disease Control and Prevention.
Heart attack. American Heart Association.