A sharp, often sudden pain in the chest that intensifies with a deep breath is known as pleuritic chest pain. This symptom is a common reason for seeking medical attention, as irritation to structures within the chest cavity causes pain upon inhalation. When the lungs expand, they press against surrounding tissues, and if those tissues are inflamed or injured, the pain becomes pronounced. Determining the origin of this pain—whether it stems from the chest wall, the lungs, or the heart—is the first step toward finding an appropriate solution.
Pain Originating in the Chest Wall
Many cases of pain exacerbated by deep breathing come from the musculoskeletal structures that form the rib cage. The chest wall includes the ribs, muscles, and cartilage, and inflammation or injury to any of these can mimic more serious problems. While these causes are not life-threatening, they can still cause significant discomfort.
A frequent source of this localized pain is costochondritis, which involves inflammation of the cartilage that connects the ribs to the breastbone, or sternum. The pain from costochondritis is typically sharp, located along the sternum, and can worsen with movement, coughing, or taking a full breath. A defining characteristic is that the pain is often reproducible; pressing directly on the affected cartilage will recreate the intense soreness.
Another common cause is a simple muscle strain, particularly affecting the intercostal muscles that run between the ribs. Straining these muscles can occur from vigorous exercise, heavy lifting, or even persistent, forceful coughing during a respiratory illness. This pain is usually localized to a specific area and is often described as a dull ache that sharpens with deep inhalation or twisting motions. Minor rib injuries, such as bruising or a slight fracture, will also cause pain that is highly sensitive to the mechanics of breathing and movement.
Causes Related to the Lungs and Pleura
When pain worsens during deep breathing, it often points to irritation of the pleura, the thin, two-layered membrane surrounding the lungs and lining the chest wall. Normally, lubricating fluid allows these layers to glide smoothly as the lungs expand and contract. Pleuritic pain occurs when these two layers become inflamed and rub against one another instead of gliding.
The most direct cause related to this mechanism is pleurisy, which is the inflammation of the pleural lining itself. Pleurisy typically causes a sharp, stabbing pain that is increased by deep breaths, coughing, or sneezing. This condition is frequently a complication of an underlying infection, such as pneumonia, or a viral illness.
Pneumonia, an infection that inflames the air sacs in the lungs, is a common cause of pleurisy, especially if the infection spreads to the outer surface of the lung. The deep-breathing pain from pneumonia is often accompanied by a cough, fever, and shortness of breath. A pneumothorax, or collapsed lung, is a more acute cause resulting from air leaking into the space between the lung and the chest wall. This condition causes a sudden onset of sharp chest pain and shortness of breath, as the lung is no longer able to fully inflate.
Critical Conditions Involving the Heart and Blood Vessels
While many causes of pain upon deep breathing are benign or manageable infections, conditions involving the heart and major blood vessels require immediate medical attention. These causes are less common but carry a risk of serious complications. The pain associated with these conditions can often be differentiated by specific characteristics and accompanying symptoms.
Pericarditis involves the inflammation of the pericardium, the sac surrounding the heart. The pain is often described as sharp or stabbing, and it characteristically worsens with deep inhalation, coughing, or when lying flat on the back. The pain may improve slightly when sitting up and leaning forward, which helps relieve pressure on the inflamed sac.
A pulmonary embolism (PE) is caused by a blood clot traveling to and lodging in a lung artery, blocking blood flow. Pleuritic chest pain that worsens with deep breathing is a common symptom of PE, particularly when the clot is large or near the pleural surface. This pain is frequently accompanied by a sudden onset of shortness of breath, an elevated heart rate, and sometimes coughing up blood.
When to Seek Immediate Medical Attention
Distinguishing between a minor ache and a medical emergency can be difficult, but certain warning signs signal the need for immediate care. Any sudden, severe, or crushing chest pain that lasts longer than a few minutes warrants an emergency call, especially if it is new or unexplained.
Symptoms that accompany chest pain, such as pain radiating to the jaw, neck, back, or down the arm, are particularly concerning and suggest a potential cardiac issue. The presence of severe shortness of breath, dizziness, lightheadedness, or excessive sweating alongside the pain should prompt an immediate trip to the emergency room.
If the chest pain is accompanied by a high fever, a persistent cough, or coughing up blood, this combination of symptoms indicates an infection or lung condition. These signs require urgent diagnosis and treatment.