A pulmonary embolism (PE) is a blockage in one of the pulmonary arteries in your lungs. In most cases, pulmonary embolisms are caused by blood clots that travel from the legs or arms and lodge in the lungs. Some of the common symptoms of a PE include:
- Shortness of breath
- Chest pain that may feel sharp or stabbing
- Coughing up blood
- Rapid heart rate
- Lightheadedness or dizziness
While chest pain is a common symptom, some people wonder if rib pain can also occur with a PE. Let’s take a closer look at the connection between pulmonary embolisms and rib pain.
Can a pulmonary embolism cause rib pain?
Yes, it is possible for a pulmonary embolism to cause pain in the ribs or chest wall. Here are some key points about rib pain and PEs:
– Pleuritic chest pain — Chest pain that feels sharp and stabbing with breathing or coughing is a classic symptom of pulmonary embolism. This type of pain occurs when the embolus causes inflammation of the pleura (the lining around the lungs). The inflamed pleura rubbing against the inner chest wall can cause pain with breathing.
– Referred pain — A pulmonary embolism in the lung can irritate the phrenic nerve, which provides sensation to the diaphragm and ribs. This can cause pain that is referred to the ribcage or upper abdomen, even though the cause is actually a PE in the lung tissue.
– Coughing — The coughing caused by a PE can also lead to soreness or pain in the ribs or chest wall. Forceful coughing engages the intercostal muscles between the ribs, which can lead to muscle soreness or rib pain.
– Risk factors — Some risk factors for pulmonary embolism, like trauma, recent surgery, and cancer also increase the likelihood of pain in the chest wall or ribs.
So in summary, while a sharp or stabbing chest pain is more common, it is certainly possible for a pulmonary embolism to cause pain that is perceived in the ribs or side of the chest. Any unexplained chest or rib pain should be evaluated quickly to rule out a potentially life-threatening PE.
Other causes of rib pain
While rib pain can be a symptom of pulmonary embolism, there are many other potential causes of rib pain to consider:
- Pleurisy — Inflammation of the pleura from infection, inflammation, trauma, or tumor can cause sharp rib pain, especially with breathing.
- Pneumonia — The lung inflammation from pneumonia can irritate the pleura and cause pleuritic type rib pain.
- Muscle strain — Overuse or injury of the intercostal muscles between the ribs is a common cause of rib pain.
- Fractured rib — Rib fractures from trauma will cause pain at the fracture site that is worse with breathing and movement.
- Shingles — Shingles infection affecting the intercostal nerves can cause rib and chest wall pain before the rash appears.
- Pancreatitis — Inflammation of the pancreas can cause pain that radiates to the left ribcage or upper abdomen.
- Liver issues — Enlargement, inflammation, or distension of the liver from hepatitis or other conditions can cause right-sided rib pain.
The timing, location, triggers, and other associated symptoms can help differentiate rib pain from a pulmonary embolism vs. another condition. If the cause is unclear, imaging tests may be needed to confirm the diagnosis.
How is a pulmonary embolism diagnosed?
If a pulmonary embolism is suspected based on risk factors and symptoms, diagnostic imaging tests are needed to confirm the diagnosis:
- CT pulmonary angiogram — This is the standard diagnostic test for pulmonary embolism. It uses an intravenous contrast dye and CT scan to visualize the blood vessels of the lungs.
- Ventilation-perfusion (V/Q) scan — This nuclear imaging test looks for areas of reduced blood flow and air delivery in the lungs.
- Pulmonary angiogram — A dye is injected into the pulmonary arteries and x-rays visualize its flow. Not used as often due to its invasive nature.
- Ultrasound — Portable ultrasound of the legs can detect blood clots (deep vein thrombosis) as a cause of a PE.
- D-dimer blood test — This blood test indirectly measures blood clot formation. A negative D-dimer makes a PE very unlikely.
Once a PE is confirmed, treatment with anticoagulant medications can begin to prevent further clot enlargement and new clots from forming. Prompt diagnosis and treatment of pulmonary embolism is critical, as it can be fatal if left untreated.
Treatment for pulmonary embolism and rib pain
Treatment for a pulmonary embolism is aimed at preventing clot enlargement and future clot formation. Medications include:
- Heparin or enoxaparin (Lovenox)
- Direct oral anticoagulants like apixaban (Eliquis), rivaroxaban (Xarelto), or dabigatran (Pradaxa)
- Warfarin (Coumadin)
These medications don’t actively dissolve the clot – they prevent it from getting bigger. The existing clot will slowly dissolve over time.
For rib pain associated with a PE, over-the-counter anti-inflammatories can provide relief:
- Ibuprofen (Advil)
- Naproxen (Aleve)
- Acetaminophen (Tylenol)
Applying heat or ice packs to the painful rib area may also help. Getting plenty of rest allows the ribs to heal. Cough suppressants can ease discomfort from coughing.
If rib pain persists beyond a few days, see your doctor to ensure no complications like pleural effusion, pneumonia, or fracture. They may order imaging tests to further evaluate the cause of ongoing pain.
Complications
Some potential complications to watch for with pulmonary embolism and associated rib pain include:
- Pleural effusion — Fluid buildup around the lungs that causes shortness of breath.
- Pneumonia — Lung infection can develop from reduced blood flow.
- Pulmonary hypertension — High blood pressure in the arteries of the lungs.
- Heart strain — A large PE overloads the right ventricle of the heart.
- Paradoxical embolism — Part of the clot breaks off and travels to the brain, causing a stroke.
Prompt medical care can often prevent complications of pulmonary embolism. Being aware of concerning symptoms like fever, trouble breathing, fainting, or leg swelling should prompt urgent evaluation.
Pulmonary embolism prevention
For those at increased risk of pulmonary embolism, prevention is key. Some preventive measures include:
- Early mobilization after surgery
- Pneumatic compression devices during hospitalization
- Anticoagulants after some types of surgery
- Compression stockings
- Avoiding long periods of immobility
- Treating underlying blood clotting disorders
- Maintaining a healthy weight
Lowering modifiable risk factors and following prevention strategies can reduce the likelihood of developing a problematic blood clot.
When to see a doctor
See your doctor or go to the emergency room right away if you have any symptoms of a pulmonary embolism, including:
- Unexplained shortness of breath
- Rapid breathing
- Chest pain, especially with breathing
- Coughing up blood
- Rapid heart rate or palpitations
- Feeling faint or passing out
- Leg pain, swelling, warmth, or redness
Many of the symptoms of PE are not specific and could be caused by other conditions. However, it’s important to rule out a potentially life-threatening pulmonary embolism when these symptoms are present. Prompt treatment is vital.
Conclusion
In summary, rib pain can sometimes occur as a symptom of a pulmonary embolism. The pain is often pleuritic in nature, meaning it worsens with breathing, coughing, or movement. However, there are many other potential causes of rib discomfort to consider. Imaging tests like a CT angiogram are needed to conclusively diagnose a PE.
Treatment focuses on anticoagulant medications to stop clot enlargement and complications. Seeking prompt medical care for symptoms is critical, as pulmonary embolism can be fatal if not treated rapidly. Preventive measures may also be warranted in those at increased risk. Being aware of the signs and symptoms of pulmonary embolism allows early recognition and treatment of this serious condition.