Chest Pain: Differentiating Between Costochondritis and Other Conditions - Pulmonology

Mediastinal tumor? Lung cancer? Costochondritis?

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I was born in 1984 and have been working in an office for six years.
I have been troubled by chronic nasal allergies, but I generally do not have any major health issues.
I play basketball regularly, averaging about 3-4 times a week for about 2 hours each time, sweating profusely.
I do not smoke or drink alcohol, and I eat plenty of fruits and vegetables, with a moderate amount of meat.
Most of the vegetables are homegrown, and I rarely eat out, as my hardworking mother prepares our meals.
This lifestyle should be considered healthy.
Summary of my condition:
1.
Since early June 2017, I have experienced a persistent urge to cough, which comes and goes.
I have had nasal allergies for over 20 years, and looking back, it feels somewhat like chest tightness causing difficulty in breathing.
Even when I cough, it does not provide relief, so I eventually stopped coughing.
However, sometimes I feel a significant discomfort.
During this period, I had three colds by mid-September, and the urge to cough noticeably decreased during these times.
2.
I mention mid-September because that is when I first experienced sharp pain in my left chest, right in front of the heart.
This occurred several times a day, lasting only 1-2 seconds each time, and I did not think much of it.
Once, I tried doing push-ups to see if it would alleviate the sensation, and I also performed chest expansion exercises and tapped my left chest.
I am not sure if this caused it, but about a week later, the same sharp pain returned, lasting longer (over 10 seconds).
However, this sharp pain eventually disappeared, but I began to feel a different sensation in the left chest, described as "aching or pulling pain." I can clearly distinguish between the sharp pain and the aching/pulling pain, and they have coexisted at times.
3.
I later reflected on the aching and pulling sensations, describing them as follows:
(1) Aching pain: Most notably, while waxing my car, I felt an ache when pushing the wax with my left hand.
I also felt it when bending over to put on socks or when getting into a car.
This sensation developed gradually, initially occurring once a day, sometimes not at all.
The day I waxed the car was particularly memorable, but this sensation has since diminished significantly.
(2) Pulling pain: This is most pronounced when turning my head or body (only when turning to the right), in positions requiring significant extension (with certain body parts fixed, the pain is similar to turning right), and when rolling over in bed (sometimes I feel pain while sleeping, but not always).
It has also occurred when looking at my phone and suddenly needing to dodge something, or when I accidentally drop something and reach to catch it.
The pulling pain, apart from turning right, usually lasts only 1-2 seconds.
4.
Due to these pain sensations and my regular basketball practice, I am certain I have not experienced any collisions or severe strains.
I decided to stop high-impact activities and switch to running or swimming.
My physical condition is still good, as I can run 5-6 kilometers.
After visiting the thoracic surgery department at Guangtian Hospital, the doctor suggested it might be costochondritis.
Starting in early December, I reduced my exercise and tried to avoid using my chest, even holding back sneezes or coughs, but when I couldn't resist, I would feel pain.
I later heard that rehabilitation was necessary, so I resumed normal sneezing and coughing, but thankfully, I did not feel any significant discomfort, although sometimes I felt a slight pain.
On the night of December 24, I wanted to test if turning to the right would cause pain; it was intermittent, but still painful.
After sleeping on my side, I woke up with chest tightness and pain, feeling constricted and wanting to cough (but coughing did not relieve the urge).
It felt strange, and I recalled that this sensation was similar to how I felt after playing basketball, running, or swimming, leading me to suspect it was caused by side sleeping or pulling movements.
5.
I have experienced chest tightness and a desire to cough, even feeling slightly breathless, often taking deep breaths.
This occurs almost exclusively when sleeping on my side, and I feel more comfortable when sucking on throat lozenges or after showering.
Because of this, I am hesitant to move when sleeping on my back, as my hands tend to go numb, resulting in poor sleep.
The urge to cough rarely occurs during sleep, and I have never woken up due to the urge to cough.
Currently, I face two difficulties: discomfort while sleeping at night (numb hands) and daytime discomfort (chest tightness and the urge to cough).
6.
On October 30, 2017, I visited the internal medicine department at Guangtian Hospital, and my X-ray results were normal.
On November 17, I saw a cardiologist at Guangtian Hospital for an ECG, exercise ECG, echocardiogram, and blood tests, all of which were normal.
I was selected for a community health check at Chung Shan Medical University on November 18, where I underwent a basic health check and lung function tests, both of which were normal.
On November 28, I visited a family medicine clinic and took anti-inflammatory medication for three days.
On November 29, I had a consultation with the thoracic surgery department at Guangtian Hospital, which was only a consultation.
I have had a long-standing issue with triglycerides being over 200, along with nasal allergies, but my overall health is relatively good.
7.
I am unsure if my reluctance to cough is due to chest tightness.
The cause of my chest tightness and shortness of breath may be related to long hours of sitting in an office.
Additionally, since mid-June, I have been preparing for exams, and while my posture is not terrible, I began experiencing pain in mid-September.
By October 20, I discovered a cervical spine issue and have been gradually expanding my chest, but I have not fully recovered.
I suspect that poor posture has led to chest tightness and costochondritis, and I wonder if I might be experiencing what traditional Chinese medicine refers to as internal injury.
(I have been exercising regularly until December, so I question whether my poor posture could have contributed to this situation.)
8.
However, for a diagnosis of costochondritis, there should be tenderness and swelling.
I do not believe I have swelling, and I can hardly find any tender points, although I have found some tender points that only hurt when pressed with a large area of my palm.
Pressing with my fingers does not cause pain.
The tenderness feels like bruising when pressed.
My aching and pulling pain sensations are in the same area, but I cannot pinpoint the discomfort after exercising; it feels uncomfortable, cool, tight, and empty, but I cannot specify where the pain is.
This sensation has lasted the longest for an entire day, but it does not occur frequently, usually happening after exercise.
9.
In early June, during the late stage of a cold, I coughed up blood-tinged phlegm, particularly in the mornings or shortly after waking.
This did not recur.
In October, I experienced increased phlegm while eating, which did not require much effort to cough up and was slightly thick and yellow-green.
Based on past experiences, I tend to catch colds when my wife or child has one, usually presenting with sore throat and nasal issues.
However, since August 20, I have had very few colds, so I am unsure if the phlegm in October was due to a cold or chronic pharyngitis.
On December 15, I had a mild cold with a sore throat and nasal issues, but I noticed that when I woke up, I could use my tongue to remove nasal mucus from my mouth, which sometimes appeared red.
I remember experiencing this since childhood.
I can usually use my mouth to expel nasal mucus, but I am unsure if this is what is referred to as post-nasal drip.
Since early June, I have not had a fever or night sweats, and when I cough, I cannot produce much, and a hard cough produces a low-frequency sound, which I wonder if it is what is referred to as a metallic sound.
10.
The pulling pain when turning to the right (left chest) leads to a strange feeling in the chest afterward.
The location of the pulling pain is very specific, but the strange feeling is more vague.
I have had over ten years of nasal allergies, and side sleeping causes chest tightness, with the urge to cough sometimes alleviated by sneezing or taking deep breaths.
11.
The chest pain seems to occur after pulling; chest tightness occurs after side sleeping—if I do not test it, it almost never happens, or I do not feel anything significant, but I am always cautious about making large movements.
The urge to cough is not constant; I can suppress it, but it becomes particularly uncomfortable.
When I do cough, it is often forceful, with little phlegm, and sometimes I go 2-3 days without coughing.
The urge to cough does not affect my sleep.
I suspect that my prolonged desk work and poor posture (though I have been mindful since late October) have caused chest tightness leading to costochondritis.
However, costochondritis typically presents with tenderness and swelling; I occasionally experience tenderness but not often, and I have no swelling.
I do experience a strange feeling in my chest after pulling or exercising (this pain is quite vague), which does not align well with a diagnosis of costochondritis.
12.
On January 11, 2018, I particularly wanted to soak in a hot bath at the swimming pool, which made my heart race.
After returning home, I did some stretching exercises, which made the pain worse.
The stretching involved turning to the right and pulling my right arm outward, which caused pain.
I felt like I returned to an acute phase, waking up with chest tightness, and sometimes experiencing pain in my right arm when changing positions (for example, resting my arm on someone’s shoulder for about two minutes, then letting go, which would trigger pain, whereas previously it was my left arm when putting on socks).
For instance, when driving and turning to talk to family, I must turn my entire body; if only my head turns, the pain occurs.
This pain feels like a tearing sensation, and if I pull in a certain way, I can maintain this tearing pain, similar to pulling my fingers.
I have been using this movement as a measure of my recovery.
Additionally, a previous doctor (a traditional Chinese medicine practitioner) advised me to avoid movement, but I still check in weekly to see if I have improved.
Consequently, I have become so cautious that I am afraid to turn over at night, resulting in pain in both upper back areas.
Sometimes I wake up feeling like I am consciously pressing my weight down on my back to avoid turning over, which I know is a self-imposed restriction.
13.
Finally, I would like to ask the doctor what is wrong with me.
I know that lung cancer can be detected with low-dose scans; can mediastinal tumors be seen on X-rays? What is the likelihood that they cannot be detected? (I am somewhat avoiding a CT scan.) What tests are needed to rule out pulmonary diseases before confirming costochondritis? Can a chest ultrasound be used for diagnosis? Thank you.

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Dong, 30~39 year old female. Ask Date: 2018/01/15