Right Lower Chest Pain and Night Sweats: When to Seek Help

Q: Right Lower Chest Pain and Night Sweats: When to Seek Help

Hello： You can first visit the pulmonology department for evaluation by a physician.

Localized sharp pain in the lower right side of the chest (bone) with occasional body fever?

Approximately four to five years ago, around 2018/2019, I started experiencing a dull sensation in a fixed point on the lower right side of my chest (bone), which would occur occasionally but quickly dissipate, about once every few months.
This was also accompanied by unexplained fevers, especially at night during sleep (night sweats).
Over the past few years, I have undergone various examinations including X-rays, breast ultrasounds, consultations with family medicine, hematology, infectious disease, and rheumatology specialists, but no cause has been identified.
In the last two years, all these symptoms have disappeared, leaving only the occasional dull pain and tenderness at the same fixed point in my chest.
Last night, during sleep, I experienced a noticeable sharp pain at that same fixed point for the first time, lasting only 2-3 seconds each time, occurring four to five times during the night.
Upon waking, I still felt this sensation, accompanied by intermittent feelings of warmth in my body.
I usually have an irregular schedule, going to bed late and waking up late, and I have been experiencing sleep deprivation recently.
Before the sharp pain occurred, I sometimes felt the need to take deep breaths, and my chest felt heavy and fatigued.
However, there is no pain when I breathe or stretch.
What could this condition be? Which specialist should I see? Should I consider getting a low-dose chest CT scan? Thank you, doctor.

Jamie, 40~49 year old female. Ask Date: 2023/06/21

Dr. Zhou Ziguang reply Pulmonology

Hello: You can first visit the pulmonology department for evaluation by a physician.

Reply Date: 2023/06/21

More Info

When it comes to right lower chest pain accompanied by night sweats, it’s essential to consider a variety of potential causes, especially given your history of intermittent symptoms and previous medical evaluations. The fact that you have experienced this discomfort for several years, with varying intensity and frequency, suggests that it may not be a straightforward issue.
Your symptoms, particularly the localized chest pain, can arise from several sources. Musculoskeletal issues, such as costochondritis (inflammation of the cartilage connecting a rib to the sternum), are common and can cause sharp, localized pain that may be exacerbated by certain movements or positions. This type of pain is often benign and can be managed with rest and over-the-counter pain relievers.

However, the presence of night sweats and episodes of unexplained fever raises additional concerns. Night sweats can be associated with a range of conditions, including infections, autoimmune disorders, and even certain malignancies. Given that you have undergone extensive testing in various specialties without a definitive diagnosis, it’s important to consider whether these symptoms could be related to a systemic issue rather than a localized one.

The fact that you mentioned feeling a need to take deep breaths and experiencing a sensation of heaviness in your chest could also indicate anxiety or stress, which can manifest physically. Anxiety can lead to hyperventilation, which may cause chest discomfort and a feeling of tightness. However, it’s crucial not to overlook the physical aspects of your symptoms, especially since they have changed recently.

Given your history and the recent onset of more pronounced symptoms, it would be prudent to consult a healthcare provider who specializes in pulmonary medicine or cardiology. They can perform a thorough evaluation, including a physical examination and possibly recommend imaging studies such as a low-dose chest CT scan if deemed necessary. This imaging can help rule out any structural issues in the lungs or chest cavity that might not have been visible on previous X-rays.

Additionally, if you have not already done so, consider discussing your sleep patterns and lifestyle with your healthcare provider. Irregular sleep schedules and insufficient rest can significantly impact your overall health and may contribute to both physical and psychological symptoms. Improving your sleep hygiene and establishing a more regular sleep routine could potentially alleviate some of your symptoms.

In summary, while your symptoms may stem from benign causes, the combination of right lower chest pain, night sweats, and the need for deep breaths warrants further investigation. Consulting with a specialist in pulmonary or cardiac health, along with a review of your lifestyle factors, will be essential in determining the underlying cause and appropriate treatment. Remember, it’s always better to err on the side of caution when it comes to chest pain and systemic symptoms.

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