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| 22KS-009 |
Diagnosis and treatment of uncommon chest pain due to pleurisy using ultrasound
Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Seoul, South Korea1, Department of Anesthesiology and Pain Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Gyeonggi-do, South Korea2
Background
Pleurisy, also called pleuritis is inflammation of the parietal pleura, and has a characteristic pleuritic pain. Most common cause of pleurisy is infection, and other causes of pleurisy include rheumatoid arthritis, malignancy, rib fracture or trauma, but can occur spontaneously also [1]. This increases the time and cost required for differential diagnosis. Ultrasonography can also be a good diagnostic tool. Here, we review the diagnosis and treatment using ultrasonography for an atypical case of pleuritic chest pain due to pleurisy with no apparent cause and no underlying medical conditions.
Case
The patient was informed and has provided written consent for the publication of this case report. A patient complained of left anterior chest pain which began 4 months ago while playing golf. The intensity of the pain was rated as 7/10 in Numerical rating scales (NRS). No specific cause was found despite various exams in department of cardiology, department of cardiac surgery, department of pulmonary medicine, and department of gastroenterology such as echocardiography and coronary angiography, lung High-resolution computed tomography(HRCT), esophagogastroduodenoscopy and bone scan, but the pain persisted. Ultrasonography was a key for diagnosing pleurisy. In ultrasonography finding performed by the department of anesthesia and pain medicine, there was small amount of effusion below rib cartilage. (Fig.1) Oral nonsteroidal anti-inflammatory drugs and ultrasound guided intercostal nerve block (Fig.2) were effective for the pain.
Conclusions
This case demonstrates that ultrasonography could be a good diagnostic and therapeutic tool for patients with persistent chest pain of unknown cause. Ultrasonography is ideally suited to the identification of fluid collections throughout the body because fluid is relatively echo-free compared with other body tissues, thus the sonographer may readily identify pleural effusions of even small size.[2]
[1] Hunter, Michael P., and Hariharan Regunath. \"Pleurisy.\" StatPearls 2021 Jul 7
[2] Collins JD, Burwell D, Furmanski S, et al. Minimal detectable pleural effusions. Radiology 1972;105:51
Pleurisy, also called pleuritis is inflammation of the parietal pleura, and has a characteristic pleuritic pain. Most common cause of pleurisy is infection, and other causes of pleurisy include rheumatoid arthritis, malignancy, rib fracture or trauma, but can occur spontaneously also [1]. This increases the time and cost required for differential diagnosis. Ultrasonography can also be a good diagnostic tool. Here, we review the diagnosis and treatment using ultrasonography for an atypical case of pleuritic chest pain due to pleurisy with no apparent cause and no underlying medical conditions.
Case
The patient was informed and has provided written consent for the publication of this case report. A patient complained of left anterior chest pain which began 4 months ago while playing golf. The intensity of the pain was rated as 7/10 in Numerical rating scales (NRS). No specific cause was found despite various exams in department of cardiology, department of cardiac surgery, department of pulmonary medicine, and department of gastroenterology such as echocardiography and coronary angiography, lung High-resolution computed tomography(HRCT), esophagogastroduodenoscopy and bone scan, but the pain persisted. Ultrasonography was a key for diagnosing pleurisy. In ultrasonography finding performed by the department of anesthesia and pain medicine, there was small amount of effusion below rib cartilage. (Fig.1) Oral nonsteroidal anti-inflammatory drugs and ultrasound guided intercostal nerve block (Fig.2) were effective for the pain.
Conclusions
This case demonstrates that ultrasonography could be a good diagnostic and therapeutic tool for patients with persistent chest pain of unknown cause. Ultrasonography is ideally suited to the identification of fluid collections throughout the body because fluid is relatively echo-free compared with other body tissues, thus the sonographer may readily identify pleural effusions of even small size.[2]
[1] Hunter, Michael P., and Hariharan Regunath. \"Pleurisy.\" StatPearls 2021 Jul 7
[2] Collins JD, Burwell D, Furmanski S, et al. Minimal detectable pleural effusions. Radiology 1972;105:51
