Sensation of substernal weight with deep inspiration

Specialty: Respiratory.

• substernal inspiratory heaviness
• retrosternal oppression when taking a deep breath

Why it occurs

• Severe acute tracheobronchitis in the initial phase (diffuse inflammation of the mucosa of the major airways causes a sensation of heaviness and diffuse burning behind the sternum that is noticeably exacerbated by stretching the trachea during deep inspiration)
• Acute or desquamative interstitial pneumonitis in early stages (stiffness of the central lung parenchyma that resists thoracic elastic expansion)
• Chronic fibrosing or low-grade infectious mediastinitis (infection or inflammation of the mediastinal connective tissue that limits the normal excursion of the intrathoracic organs)
• Massive mediastinal lymph node sarcoidosis (large lymphadenopathy that exerts mechanical compression on the tracheobronchial structures and the anterior pericardium, perceptible when expanding the chest)
• Submassive pulmonary embolism of subacute evolution (vascular congestion and mild right ventricular overload).

Initial workup

12-lead electrocardiogram and determination of cardiac enzymes (troponins) to rule out acute ischemic heart disease; Chest x-ray; Computed tomography (CT) of the chest with contrast; Respiratory function tests with determination of lung volumes; Systemic inflammatory markers (CRP, sedimentation rate).

Standard management

• Paracetamol — 500-1000 mg orally or intravenously every 8 hours for symptomatic control of the tracheobronchial inflammatory component
• Ibuprofen — 400 mg orally every 8 hours with food if there is an associated musculoskeletal or pleural component
• Budesonide (inhaled, 200 micrograms every 12 hours if bronchial hyperreactivity is documented).