Yaari Shaul, Juravel Elchanan, Daana Murad, Heyman Samuel N
Department of Medicine, Hadassah Hebrew University Hospital, Mt. Scopus, Jerusalem, Israel.
Eur J Case Rep Intern Med. 2020 Jul 23;7(10):001657. doi: 10.12890/2020_001657. eCollection 2020.
Stab-like localized chest pain, aggravated by breathing, is compatible with pleuritic pain or with aching related to chest wall abnormalities. Local tenderness inflicted by palpation helps to differentiate pleuritic from musculoskeletal chest pain and serves as a principal accessory manoeuvre in the algorithm of chest pain evaluation. Herein, we report the case of a 27-year-old patient with pulmonary thromboembolism and right lower lobe consolidation/atelectasis. The patient presented with right-sided chest pain, radiating to the shoulder, related to pleural irritation, yet associated with confounding intense chest wall tenderness and guarding, also involving the costovertebral angle. We propose that spinal reflex-related chest wall tenderness was involved, similar to peritoneal signs evoked by irritation of the parietal peritoneum. This case report illustrates that localized chest wall tenderness and guarding, triggered by palpation, may not serve as unequivocal indicators of musculoskeletal pain, and could be unrecognized features of pleuritic chest pain also.
Pleuritic chest pain may be associated with local tenderness and guarding.These unrecognized features of pleurisy supposedly reflect a spinal reflex, initiated by nociceptors in the parietal pleura.Local pain inflicted upon palpation and guarding may not serve as unequivocal indicators of musculoskeletal chest pain.
类似刺伤的局限性胸痛，呼吸时加重，可能是胸膜炎性疼痛或与胸壁异常相关的疼痛。触诊引起的局部压痛有助于区分胸膜炎性胸痛与肌肉骨骼性胸痛，是胸痛评估流程中的主要辅助检查手段。在此，我们报告一例27岁患有肺血栓栓塞症及右下叶实变/肺不张的患者。该患者表现为右侧胸痛，放射至肩部，与胸膜刺激有关，但伴有令人困惑的强烈胸壁压痛和肌卫，肋椎角也有压痛。我们认为这涉及与脊髓反射相关的胸壁压痛，类似于壁层腹膜受刺激时引发的腹膜征。本病例报告表明，触诊引发的局限性胸壁压痛和肌卫可能并非肌肉骨骼性疼痛的确切指标，也可能是胸膜炎性胸痛未被识别的特征。
胸膜炎性胸痛可能伴有局部压痛和肌卫。这些胸膜炎未被识别的特征可能反映了一种由壁层胸膜中的伤害感受器引发的脊髓反射。触诊时的局部疼痛和肌卫可能并非肌肉骨骼性胸痛的确切指标。
