Chronic Left Chest Pain and Persistent Cough: Possible Causes and Solutions

Q: Chronic Left Chest Pain and Persistent Cough: Possible Causes and Solutions

Hello： Your friend is suffering from a difficult-to-treat illness. <br>It is advisable to avoid multiple hospital visits and instead find a single medical center to focus on. <br>After all, the physicians at the same hospital will have access to the same diagnostic information, w

Pain below the left chest, sputum production, and difficulty breathing?

I have a female friend who has been experiencing pain below her left chest for several years.
She almost constantly produces phlegm, which is often yellow and sometimes white.
She feels numbness, and deep breathing causes pain, sometimes to the point of difficulty breathing.
In the last two days, she has also developed a cough, and her body sometimes feels very hot, while at other times she feels weak and cold.
She has visited various hospitals for X-rays, electrocardiograms, and blood tests, all of which have returned normal results.
She has seen numerous pulmonologists and recently consulted a pain specialist, who suggested it might be costochondritis, a back issue, or psychological stress.
However, the medications prescribed have been ineffective, including pain relievers.
She has previously undergone bilateral nipple reduction surgery.
I would like to ask the doctor what this condition might be.
I have searched online extensively, and she has frequently visited major hospitals, undergoing so many X-rays and electrocardiograms that she is questioning everything.
This situation is truly distressing for her; she produces phlegm all day and cannot work.
I feel very sorry for her as she presses on the painful area to the point of bruising.
This has been going on for many years without improvement.
I sincerely request a diagnosis or advice from the doctor.
Thank you.

Li Sir, 30~39 year old female. Ask Date: 2019/04/09

Dr. Jiang Junyi reply Neurology

Hello: Your friend is suffering from a difficult-to-treat illness.
It is advisable to avoid multiple hospital visits and instead find a single medical center to focus on.
After all, the physicians at the same hospital will have access to the same diagnostic information, which can guide their treatment decisions, including whether a medication has reached its maximum efficacy.
If there is an increase in sputum production, it is essential to consult with a pulmonologist and an infectious disease specialist.
Regarding pain management, a neurologist can be consulted, and if a regional nerve block is necessary, a pain management specialist may be required.
The physicians will prescribe medications based on her condition, allowing specialists to collaborate on her issues.
Wishing you good health, peace, and happiness.
Dr.
Jiang from Taoyuan Medical Center cares about you.

Reply Date: 2019/04/09

More Info

Chronic left chest pain accompanied by persistent cough and phlegm production can be a complex clinical scenario that requires careful evaluation. Based on your friend's symptoms, there are several potential causes to consider, and I will outline these along with possible solutions.

Possible Causes
1. Respiratory Conditions: Given the persistent cough and production of yellowish phlegm, it is essential to consider chronic respiratory conditions such as chronic bronchitis or even asthma. Chronic bronchitis, often associated with long-term smoking or exposure to irritants, can lead to inflammation of the airways, resulting in cough and phlegm. Asthma can also cause similar symptoms, particularly if there is a history of wheezing or shortness of breath.

2. Musculoskeletal Issues: The description of pain that worsens with deep breathing suggests a possible musculoskeletal origin, such as costochondritis or rib inflammation. Costochondritis is inflammation of the cartilage connecting the ribs to the sternum, which can cause localized pain that may mimic cardiac pain.
3. Gastroesophageal Reflux Disease (GERD): GERD can also present with chest pain, particularly if the acid reflux irritates the esophagus. This condition can lead to a sensation of chest tightness and may be accompanied by cough due to aspiration of gastric contents.

4. Cardiac Issues: Although previous tests like ECG and X-rays have ruled out significant cardiac problems, it is crucial to remain vigilant. Conditions like pericarditis or even atypical presentations of angina could still be considered, especially if there are risk factors present.

5. Psychogenic Factors: Chronic pain can sometimes have a psychological component. Stress and anxiety can exacerbate physical symptoms, leading to a cycle of pain and emotional distress.

Suggested Solutions
1. Further Evaluation: Since your friend has undergone various tests without a definitive diagnosis, it may be beneficial to seek a second opinion from a specialist, such as a pulmonologist or a rheumatologist. They may consider additional imaging studies, such as a CT scan of the chest, or pulmonary function tests to assess lung function more thoroughly.

2. Physical Therapy: If musculoskeletal issues are suspected, physical therapy may help alleviate pain through targeted exercises and stretching. A physical therapist can provide guidance on posture and body mechanics that may reduce strain on the chest wall.

3. Medication Review: If your friend has been prescribed medications that have not been effective, it may be worth discussing alternative treatments with her healthcare provider. This could include different classes of medications for pain management or anti-inflammatory drugs.

4. Lifestyle Modifications: Encouraging your friend to avoid known irritants (such as smoke or strong odors) and to maintain a healthy lifestyle can be beneficial. If GERD is a concern, dietary changes and avoiding late meals may help reduce symptoms.

5. Psychological Support: If stress or anxiety is contributing to her symptoms, seeking support from a mental health professional could be beneficial. Cognitive-behavioral therapy (CBT) has been shown to help individuals manage chronic pain.

6. Follow-Up: Continuous follow-up with healthcare providers is essential. If symptoms persist or worsen, further investigations may be warranted, including referrals to specialists who can provide a fresh perspective on her condition.

In conclusion, chronic left chest pain and persistent cough can arise from various underlying conditions, and a multidisciplinary approach may be necessary to address the symptoms effectively. Your friend's situation is undoubtedly challenging, and it is essential to remain proactive in seeking the appropriate care and support.

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