EpistemisLocalized rib pain of pneumological origin
Specialty: Respiratory.
Why it occurs
- Bacterial pneumonia with peripheral consolidation that directly contacts the parietal pleura (the parietal pleura is densely innervated by intercostal nerves, which generates a stabbing pain exquisitely localized over the corresponding costal arch, exacerbated by deep breathing and cough)
- Subpleural pulmonary infarction due to pulmonary thromboembolism
- Pathological rib fracture secondary to bouts of violent and repetitive coughing in patients with osteoporosis or underlying bone metastases
- Localized pleural empyema (encapsulated purulent pleuritis that irritates the parietal pleura and the soft tissues of the chest wall)
- Malignant pleural mesothelioma with direct invasion of the costal periosteum and intercostal nerves.
Initial workup
Chest x-ray (PA, lateral and costal oblique projections); Ultrasound of the chest wall (very sensitive to detect small rib fractures not visible on radiography and septate pleural effusions); High-resolution chest computed tomography (CT); Bone scan or chest MRI if neoplastic bone invasion is suspected.
red flags
Pain accompanied by physical instability of the costal arch on palpation (bone crepitation suggesting multiple fractures or unstable chest), rapidly progressive dyspnea at rest, persistent high fever with foul-smelling sputum, or rapidly growing palpable mass over the affected rib.
Standard management
- Dexketoprofen — 25 mg orally every 8 hours, or 50 mg intravenously every 8-12 hours as an anti-inflammatory analgesic with excellent tissue penetration
- Paracetamol — 1 g intravenous every 8 hours combined
- 5% Lidocaine skin patch (applied locally to the painful area for a maximum of 12 hours a day if there is associated intercostal neuralgia).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Respiratory
- Listed causes
- 5
- Treatment options
- 3