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Old 11-05-2005, 10:41 AM   #1
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Intercostal muscles, costochronditis or pleurisy?

Sorry for the long post!

I am a 44 year old male. I was a light smoker in my 20s and early 30s (less than 9 pack years) and I quit completely nearly ten years ago.

Over a month ago, I caught a nasty cold from one of my daughters who picked it up at day care. Sore throat, cough, congestion, etc. lasted nearly two weeks. It then turned into sinusitis, so I saw my Dr. and he gave me 5 days of Levaquin which resolved the sinusitis. Post-nasal drip was causing a lot of coughing, some violent, so I started taking 24-hour sudafed tablets daily and my coughing stopped.

Nearly two weeks ago I started developing chest pains in my right hand side - made worse when coughing, sneezing or deep breathing. They felt muscular in nature, or like the ribs were involved. The pain did not come on suddenly, it took a few days.

Anxiety and stress are causing me to take "air hunger" type breaths (sighing or yawning to catch a full breath, which are not always satisfying - has been happening for years). I have been on Clonazapam 1mg daily for anxiety, and I found if I took and extra .5mg when I was having these episodes, it helped me to relax and breathe more normally. I have also started to try deep breathing from my diaphragm rather than shallower breathing which causes the rib cage to overexpand. I was taking 600mg ibuprofen twice daily which took a slight edge off the pain. (As a side note, I saw a previous Dr. of mine who diagnosed mild asthma about 6 years ago, but then I saw a prominent allergist about a year later who tested me for asthma, allergies and lung function and told me that I definitely did not have asthma and that all test were fine. I am allergic to a bunch of stuff though, including many plants, dust, and some animals.)

On palpation, the right edge of my sternum feels quite tender and painful when I press. I can also trace the tenderness and pain along a rib or two from the sternum to under my right arm. There is also a muscle under my right arm that feels tender. Holding these areas when coughing or sneezing seems to help the pain.

After ten days of this pain, I went to see the Dr. again, although he was out and I saw the Nurse Practitioner. She seemed experienced and knowledgeable. My blood pressure was normal, heart rate a little fast (probably stress), temperature normal. She asked me to describe the history above and point to the pain. She did not palpate it herself. She listened to my lungs across my back, but not my front. She said there was no evidence of bronchitis or pneumonia. Her diagnosis was that I had injured one or more intercostal muscles between the ribs and recommended upping my ibuprofen to 800mg three times daily. This was two days ago. It certainly has helped dull the pain, though I can feel it a little bit, mostly under my arm. I mentioned my smoking history to her, but she did not seem 'statistically' concerned given the amount I had smoked and the age at which I had quit.

In searching the internet, there seem to be several conditions which have nearly the same symptoms: intercostal muscle damage/inflammation; costochondritis; and pleurisy.

The first two of these are generally not a big deal. Seems like rest and a long course of anti-inflammatories should resolve them. She said it would be at least two weeks on top of the 10 days I have already been experiencing it.

My concern is really around pleurisy. I was wondering if people with any of the three conditions I've mentioned could relate their experiences, symptoms, etc. The reason pleurisy concerns me, is that it is a symptom of another underlying disorder. Given my absence of fever and my physical exam, bacterial and viral causes would presumably be ruled out. This leaves more sinister causes like perhaps lung cancer, lupus, etc?

The NP did not order any tests like a chest x-ray (my last one - normal - was two years ago as part of barium swallow and esophagram study for GERD. I take Prevacid for that, though I have no heartburn symptoms.).

If it were pleurisy, would she have been able to hear the characteristic 'friction rub' by listening to my lungs through the back? I was also concerned that she did not bother to palpate the front of my chest where the pain was. I merely pointed to the areas and pressed them myself.

Given my history of anxiety, aches and pains lead me to all sorts of morbid conclusions. Am I just overthinking this, and I should I just stay on the higher dose of ibuprofen for at least another couple of weeks and hope it resolves? How long does it take intercostal muscles to heal?

I don't want to appear to be a hypochondriac by demanding chest x-rays, CT scans, etc. if it really is just some inflamed muscles as it was diagnosed.

For folks that have had pleurisy, could it be palpated? Did the ribs and muscles feel tender and painful when additional pressure was applied? Or is it a more diffuse sort of pain, deeper than the surface/ribs? I also read that pleurisy pain tends to come on suddenly and severely, which mine did not.

Thanks to anybody who made it through this whole post and has something to say about it!

Last edited by sir-tainly; 11-05-2005 at 12:52 PM. Reason: Additional information

 
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Old 11-07-2005, 10:56 AM   #2
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Re: Intracostal muscles, costochronditis or pleurisy?

Many years ago I had a bought of pleurisy after bronchitis and the feeling was one that I've not forgotten. As you may know pleurisy is a fancy name for a swelling on the sack around your heart, and is cause vy excess fluid built up there. My cough from the bronchitis had persisted and been rather sevier causeing bruising of the muscles in my ribs on the left side. The more I coughed the worse my chest hurt, then one day I felt like I was having a heart attack! my chest hurt deep in side, beyond the pain in my ribs and I lay on the bed gasping for air after the sharp pain subsided. We went to the clinic, and the doagnosys was no heart attack but pleurisy. I was given a very good cough med. and an expectorant to clear the congestion quickly. Told to cough when I needed to but too much and told to take increased ibuprofin to reduce the inflamation.....
Does that sound like your experience? For me it passed in a couple weeks, and boy was I glad it did. About that time our Governor was diagnosed with pleurisy, but it was later discovered that he'd experienced a mild heart attack! Let the Doctor figure it out, but follow what your told

Best of luck,

Jeff

 
Old 11-07-2005, 11:42 AM   #3
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Re: Intracostal muscles, costochronditis or pleurisy?

Hi Jeff,

What tests were you given to diagnose pleurisy? (Actually, from what you have described, you had pleural effusion which is when the space between the pleura get filled with liquid. Dry pleurisy is where the pleura get inflamed and rub against each other causing pain.)

I guess my situation is different in that I didn't/don't have a chest infection and my cough was caused by post-nasal drip from sinusitis, but it was sure violent at times.

Were your chest pains localized enough that you could press on them with your finger and feel pain, or more "all over"?

 
Old 11-08-2005, 07:51 AM   #4
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Re: Intracostal muscles, costochronditis or pleurisy?

I don't recall any tests, and your right it wasn't dry pleurisy. I could pick out the painful spots in the ribs easily but the deeper pain was more general... Redusing the cough helped with the ribs eventually and time and anti-inflamitories did the rest for me.
Best of luck,

Jeff

 
Old 11-14-2005, 05:57 PM   #5
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Re: Intracostal muscles, costochronditis or pleurisy?

first let me say i'm on coumadine for a blood clotting disorder, so meds are few and far between for me because of theinteraction of coumadine with so many other drugs. i have had a virus for onve 3 weeks now, one which included a severe sore throat at first. then it moved to my nose and ears. now i have a persistent and phlegmy cough. i also have a severe pain in my rib cage going around to my back. took a chest xray and it is clear. what is this pain? can you see pleuracy on an xray? doc gave me diagnosis of post nasal drip, take claritan d for 2 weeks, and tylenol with codeine for the pain. how can i be sure this is the right diagnosis and that it is not pleuracy or something worse. i also have a little blood in my phlegm. im' thnking about going to a pulmonary specialist. i'm somewht conforted to hear about someone else having the similar story, but am sorry for your pain. it is excruciating especially when i cough.

 
Old 11-14-2005, 06:07 PM   #6
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Re: Intracostal muscles, costochronditis or pleurisy?

Quote:
Originally Posted by planetbean814
first let me say i'm on coumadine for a blood clotting disorder, so meds are few and far between for me because of theinteraction of coumadine with so many other drugs. i have had a virus for onve 3 weeks now, one which included a severe sore throat at first. then it moved to my nose and ears. now i have a persistent and phlegmy cough. i also have a severe pain in my rib cage going around to my back. took a chest xray and it is clear. what is this pain? can you see pleuracy on an xray? doc gave me diagnosis of post nasal drip, take claritan d for 2 weeks, and tylenol with codeine for the pain. how can i be sure this is the right diagnosis and that it is not pleuracy or something worse. i also have a little blood in my phlegm. im' thnking about going to a pulmonary specialist. i'm somewht conforted to hear about someone else having the similar story, but am sorry for your pain. it is excruciating especially when i cough.
If the x-ray was clear it is unlikely you have pneumonia or anything like that. Pleurisy is unlikely to show up on an x-ray but can usually be heard by the Doctor with a stethoscope. However, Pleural Effusion can sometimes be seen on an x-ray. That's where the space between the pleura fills with liquid.

As for your pain, if it is localized and you can literally point to it and it is tender to the touch, then there is a good chance it is musculoskeletal (persistent coughing can do a number of nasty things to ribs, ligaments and cartilage). It may be excruciating when you cough, but it is important that you continue to cough as this prevents further infection and helps existing infection to heal.

I am still in pain in my ribs... I have a call in to the Doctor to see if I can switch from Ibuprofen to the Codeine they originally offered me. Today marks the third week I've had the pain. There have been a couple of days when it has gone down a bit, but this weekend it was like a sharp knife stabbing me most of the time, especially when I moved to pick up either of my infant daughters, who weigh about 30 pounds. Ouch!

 
Old 11-25-2005, 11:52 PM   #7
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Re: Intracostal muscles, costochronditis or pleurisy?

Well, I have no information to "help" you out, in fact you sound WAY more knowledgeable than me. I discovered your post this evening while scanning the net for symptoms that led me to the same question you posted regarding WHAT you thought your issues may be. I have not yet been to the doctor, as my first in about 20 yrs concerns started about 2 hours ago.

I too caught some cold-ish thing from my kids in day care (gotta love daycare!!!! ). I had pneumonia when I was 16 and since then EVERY head cold I get goes into my chest. I have had periodic bouts of bronchitis and "walking" pneumonia since. So this recent cold has also gone to my lungs I expect except there are some greatly different symptoms this time. I have had NO pain (until tonight), except some stiffness after coughing fits. I can hear stuff going on in my lungs but I can't really "feel" anything. Coughs have been productive but I have not yet been able to cough anything "all the way up" to check out the mucus..... Tonight though, I suddenly got sharp, severe, stabbing pains in the right side of my upper chest....they get worse on breathing deeply and moving and sneezing (interestingly though, NOT when coughing). For a dashing few moments I was caught up in the possibility of an oncoming heart attack...but after checking some things out decided it might more likely be lung related given my history. I am 38 (and a half!! - the half mark is very important to the kids you know!!!lol) and have not completely discounted heart issues since I know I have some poor lifestyle habits. (mostly inactivity and diet- I don't drink or smoke, have never smoked and try to stay away from second hand smoke)

I am a procrastinator BIG TIME and will likely put off going to the hospital/doctor until someone physically takes me so I suppose I'm looking for some reassurance that I'm not going to die before I check the site in the morning. ( okay I realize that was a totally pointless comment given the logistics involved in getting a response prior to the morning - lol).

In all seriousness though, I do welcome anyones input on how serious this really "could" be.....and yes, actually I really will be going to the doctor this weekend especially if it continues or morphs overnight. I just don't see myself as 'old enough' to have a 'serious' condition and at the same time am scared to death that I might.

I would add that I am not a hypochondriac....however, if I were, would I know/admit it anyway?? (lol)

thx to all who actually made it through my monologue and were able to understand it.

Colleen

 
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