Upper Abdominal Pain After Pneumothorax: Is It Normal?

Q: Upper Abdominal Pain After Pneumothorax: Is It Normal?

Hello： The letter mentions that you previously underwent chest tube insertion for pneumothorax, and now, six months later, you are experiencing twitching sensations in the upper right abdomen. <br>It is possible that discomfort in the area where the chest tube was inserted may be

Upper abdominal cramping pain?

Hello Doctor: About a year ago, I experienced a pneumothorax, and after chest tube drainage, I noticed that about six months later, I began to feel a sharp pain in my right upper abdomen (approximately below the right chest).
To this day, I have undergone numerous X-rays, and there is no indication of a recurrence of pneumothorax.
Is this sharp pain normal (sometimes it hurts when I press on it)?

wetin, 30~39 year old female. Ask Date: 2012/06/07

Dr. Chen Bozhang reply Family Medicine

Hello: The letter mentions that you previously underwent chest tube insertion for pneumothorax, and now, six months later, you are experiencing twitching sensations in the upper right abdomen.
It is possible that discomfort in the area where the chest tube was inserted may be due to nerve irritation following the pneumothorax.
If the chest X-ray shows no issues, more serious thoracic diseases can be ruled out.
However, the diaphragm and organs such as the liver and gallbladder in the lower chest may require abdominal ultrasound examination to exclude related conditions.
It is advisable to discuss this with your original treating physician or to consult with specialists in thoracic or gastroenterology for clinical differential diagnosis.

Reply Date: 2012/06/07

More Info

Experiencing upper abdominal pain after a pneumothorax can be concerning, especially if it persists over time. While it is not uncommon for individuals who have had a pneumothorax to experience some residual discomfort, it is essential to understand the potential causes and implications of this pain.

First, let's clarify what a pneumothorax is. It occurs when air leaks into the space between the lung and the chest wall, causing the lung to collapse partially or completely. Treatment often involves the insertion of a chest tube to remove the air and allow the lung to re-expand. After the resolution of a pneumothorax, some patients may experience lingering discomfort or pain in the chest or upper abdomen due to several factors.

One possible explanation for your right upper abdominal pain could be related to the healing process of the pleura (the membrane surrounding the lungs) or the chest wall. After a pneumothorax, the body undergoes a healing process that can sometimes lead to scar tissue formation or changes in the sensitivity of the nerves in the area. This can result in sensations of pain or discomfort, especially when pressure is applied.

Another consideration is the possibility of referred pain. The diaphragm, which separates the chest cavity from the abdominal cavity, is innervated by the phrenic nerve. Irritation or injury to the diaphragm can lead to pain that is felt in the upper abdomen or shoulder, even if there is no direct issue in those areas. If there was any trauma or irritation during the pneumothorax treatment, it could potentially lead to such referred pain.

Additionally, it is essential to rule out other potential causes of upper abdominal pain. Conditions such as gallbladder disease, peptic ulcers, or even musculoskeletal issues can manifest as pain in the upper abdomen. Since you mentioned that pressing on the area can elicit pain, this could suggest a musculoskeletal origin, such as muscle strain or inflammation in the chest wall.

Given that you have undergone multiple X-rays without evidence of pneumothorax recurrence, it is reassuring that there is no immediate concern for a collapsed lung. However, if the pain persists or worsens, further evaluation may be warranted. This could include imaging studies such as a CT scan, which can provide a more detailed view of the chest and abdomen, or an ultrasound to assess for any abdominal organ issues.

In conclusion, while some discomfort after a pneumothorax can be normal due to the healing process, it is crucial to monitor the symptoms closely. If the pain is persistent, worsening, or accompanied by other symptoms such as shortness of breath, fever, or significant changes in your health, it is advisable to consult with your healthcare provider for a thorough evaluation. They may recommend additional tests or referrals to specialists, such as a pulmonologist or gastroenterologist, to ensure that all potential causes of your pain are adequately addressed.

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