Dear All,
I observed a 58 yo female patient in deep pain and was diagnosed as having a left-sided atypical chest pain. And she was sent for a chest X-Ray. It was found that she has a 1.0 cm x 0.8 cm lower left lung nodule. A repeat X-Ray is warranted but the result is still unknown.
My question is -
1. Could the atypical chest pain be the result of the lung nodule?
2. Her previous mammogram showed no abnormality, and she conducts her BSE monthly NOS. Could it be that there is some abnormality in the breast instead?
3. What could best explain her condition(s)?
Best regards - Mariam
Dear Dr. Ahmad:
If the nodule was closely associated with the pleura then the chest pain can be explained. If the nodule is close to the bronchioles, then there may be pain but more likely would produce a cough or hemoptysis. Otherwise, if the nodule resides in the parenchyma of the lung there should not be any pain especially at the size you reported.
Dear Wayne.
Unfortunately, I am not a Dr. yet. But thanks for your great input.
I was looking at the same direction too.
Best regards - Mariam
Dr. Schmedel elegantly explained the options and the reasons for atypical pain. In any case, it is desirable to observe medical professional. Only in this case can be timely assistance.
Although the pain may be caused by the nodule, given the many possible causes of atypical chest pain it will be unlikely.
The main and most urgent issue here is to rule-out coronary disease with a clinical work-up.
Dear Dr Ahmad:
Atypical chest pain can occur due to any of a variety of reasons. Although an atypical chest pain can be the result of:
a)Costochondritis, musculoskeletal, b)acid reflux, c)stress or psychogenic, d)lung problems (pulmonary embolism, pneumothorax, pneumonia, pleurisy), etc, the atypical chest pain is:
Pleuritic
Pricking
Sharp and pulsating or choking, knife like
Involving chest wall
Tender to touch, affected area tender to palpation
Positional
Inflammatory
Such that it might not be felt under the sternum but may radiate to other areas
Present as radiating to other areas beside left side of chest with different symptoms
Occurring at any time with the duration of about 3-15 minutes
Getting relieved or not with nitroglycerin
Similar to pain seen in musculoskeletal, respiratory or GIT disorders
Other symptoms of excessive fatigue, profuse sweating, lightheadedness, and breathing difficulties occur due to atypical chest pain.
If the pain is caused by costochondritis then the subject will be prescribed pain medications and NSAIDs for controlling the pain and inflammation.
In case the nodule was closely associated with the pleura then the possibility of atypical chest pain can be explained. This and the other options given by Dr. Schmedel differentiate very well. It is still necessary to consult a physician, and perform detailed check up of the patient, since considering the mentioned options, there might be other possible cause, or more than one cause for explaining the atypical chest pain with lower left lung nodule.
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