Chest Pain After Trauma: When to Seek Medical Attention

Q: Chest Pain After Trauma: When to Seek Medical Attention

Hello： You should consult a surgeon for your question.

My boyfriend physically assaulted my chest?

My boyfriend struck me forcefully in the area just below my chest, around the rib cage (slightly to the left of the center below the left breast) during an argument.
I experienced about one to two seconds of inability to breathe, followed by severe chest pain.
I initially thought my rib was broken.
I went to the emergency department at Kaohsiung Medical University Hospital, where I had an X-ray, and it showed no fractures, so the emergency visit ended rather quickly.
However, after returning home, I continued to experience pain that made it difficult to breathe, lift heavy objects, or lie flat, with a tearing sensation.
The next day, I went to Sheng Kung Hospital to check for internal bleeding, but the doctor arranged for another X-ray.
I don’t understand why the area where I was struck and where I feel pain is in the middle of the rib cage, near the heart, yet the doctor focused the ultrasound on my left flank.
They only prescribed pain relief medication.
Today is the fifth day, and I still have pain that prevents me from taking deep breaths.
Breathing or coughing sometimes causes a tearing pain, and if I stay in one position for too long, I feel a sensation as if my internal organs are sticking together.
I have been breathing heavily these past few days, and I’m unsure if this is hyperventilation.
Additionally, I sometimes experience palpitations.
I am very concerned about whether coughing or sneezing could worsen my condition.

I would like to ask the doctor:
1.
If there was a strong impact and the X-ray shows no issues and there are no obvious external injuries, could there still be internal organ damage? What is the possibility of organ injury, and how long should I observe for symptoms?
2.
What symptoms should prompt an immediate return to the hospital?
3.
If a strong man struck me in the area I described, what organs, such as the heart or arteries, could potentially be injured?
4.
Is it possible for serious complications to arise several days after the injury?

Xiao Yu, 30~39 year old female. Ask Date: 2016/01/08

Dr. Li Zhiyao reply Internal Medicine

Hello: You should consult a surgeon for your question.

Reply Date: 2016/01/08

More Info

After experiencing trauma to the chest, especially from a significant impact like a punch, it's crucial to understand the potential implications and when to seek further medical attention. Your symptoms of severe chest pain, difficulty breathing, and feelings of tightness or "sticking" sensations in the chest area are concerning and warrant careful consideration.

1. Internal Injuries and X-ray Limitations: While X-rays are excellent for identifying fractures, they are not as effective in detecting soft tissue injuries or internal organ damage. Even if the X-ray shows no rib fractures, it does not rule out the possibility of internal injuries such as contusions to the lungs, spleen, or liver, or even damage to blood vessels. Given the mechanism of injury (a strong punch), there is a risk of such injuries, particularly if you are experiencing significant pain and difficulty breathing. If you continue to have severe symptoms, it may be necessary to pursue further imaging, such as a CT scan, which can provide a more comprehensive view of the chest and abdominal organs.

2. Symptoms to Watch For: You should seek immediate medical attention if you experience any of the following:
- Increasing chest pain or pain that worsens with breathing or movement.

- Shortness of breath that is not improving or is worsening.

- Symptoms of a possible pneumothorax (collapsed lung), such as sudden sharp chest pain and difficulty breathing.

- Signs of internal bleeding, such as coughing up blood or experiencing severe abdominal pain.

- Any new symptoms, such as dizziness, fainting, or rapid heart rate.

3. Potential Organ Damage: The area you described (lower rib cage, near the heart) is indeed close to several vital organs, including the heart, lungs, and major blood vessels. A strong impact could potentially cause:
- Cardiac contusion (bruising of the heart muscle).

- Pulmonary contusion (bruising of lung tissue), which can lead to respiratory issues.

- Damage to the spleen or liver, which could result in internal bleeding.

- Injury to the diaphragm, which can affect breathing.

4. Delayed Complications: It is possible for complications to arise days after the initial injury. For example, a hematoma (a localized collection of blood outside of blood vessels) can develop and cause pressure on surrounding structures, leading to delayed symptoms. Additionally, if there is any internal bleeding, it may not be immediately apparent and can lead to significant complications if not addressed.

In conclusion, given your ongoing symptoms and the nature of your injury, it is advisable to follow up with a healthcare provider who can perform a thorough evaluation. If your symptoms persist or worsen, do not hesitate to return to the emergency department or seek a specialist in trauma or internal medicine. Your health and safety are paramount, and it’s better to err on the side of caution when dealing with potential internal injuries.

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