pleurisy or inflammation

hi all i am new here and a really frustrated mum! My daughter who is 12 is asthmatic but only gets affected when has a cold or cough. to cut a long story short, a week last monday she had an attack and i took her to fairfield hospital in bury, where they gave her two bouts of nebuliser and a short course of steroids. we then went home, during the afternoon she developed a very bad pain in her chest between the breast bones but slightly more to the left and round. she described it as very painful especially when taking deep breaths. anyway her gp said its costochondritis or inflammation of the rib cage and to try anti inflammatories. it got worse so two days ago i took her to a and e at booth hall childrens hospital where they did an x ray. they were uncertain of the diagnosis as their could have been some pleurisy and some inflammation explaining why she has both symptoms. they wanted to admit her for further tests but had no beds so we were transferred to fairfield by emergency ambulance. the next morning the doctor said why did booth hall say pleurisy as they see only inflammation!!!! and discharged her without doing the tests booth hall had wanted to. so here we are back home, danielle still in pain with no improvement at all, she is breahing and talking normally but has this terrible pain to touch on her chest and on the inside. where do i go from here?????????? also surely would a scan not be more accurate and why have they not advised that???

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Hi Dominique,

sorry to hear your daughter isn't so well just now.

Both costochondritis and pleurisy are inflammation - costochondritis is inflammation of the rib joints with the cartilage, and pleurisy is inflammation of the pleura, which is the lining of the chest cavity, between the ribs and the lungs. Both can cause chest pain which is worse when you breathe - typically a sharp pain.

There are several causes for both of these conditions, but commonly they are viral in someone of your daughter's age, so will settle on their own. Antiinflammatories such as ibuprofen will help the pain and get them to settle a bit faster - sometimes antiinflam drugs can be a problem in asthmatics but it sounds like your daughter is ok on them - they can in some people make wheeze worse, but the doctors will have considered this before starting them.

It would be possible to do a scan which might make it clearer which of these conditions it is, but as it would not alter the treatment, there is no need. Things should settle down over the next week or two - unfortunately there are no instant cures!

Hope she feels better soon

S

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thank you

s, thank you you have made it a lot clearer for me to understand that what ever it is the anti inflammatories are the only thing than can help. she has had this ten days or so now but i gather will settle alone. i had heard that if drags on and on a cortisone injection may be beneficial.? although she has had to have many steroid courses in her life so far and long term the effects are pretty dismal so lets say if this drags on.... what would be the next plan of action. dom. x

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Hi Dominique,

Welcome to the boards, as always I am sorry that you had to find your way here but hopefully you will find us a supportive and useful bunch!

I'm so sorry to read that your daughter is suffering at the moment - it must be so hard to see her in pain and struggling. I have asthma myself but don't have any children so can't really imagine what you're going through, but you have my sympathy.

I wonder if anyone has properly explained to you what these terms mean that they are banding about? Often doctors tend to use these terms and don't really fully explain themselves! I hope I am not repeating what you have already been told but I thought it might be useful to understand a little more about it.

Costochondritis is, as your GP told you, inflammation of the rib cage, or more specifically the joints where the ribs join onto the breast bone. It's very common in children aged 12 - 14, it's not really known what causes it, and it usually causes sharp intense central chest pain that is often worse on breathing in, moving (particularly when twisting the torso) and when the breast bone is pushed. It's not dangerous and it normally settles down in a few days to weeks. The standard treatment is painkillers, preferably of the anti-inflammatory kind (Non Steroidal Anti Inflammatory Drugs such as ibuprofen and diclofenac) although it should be noted that these drugs can cause worsening of asthma in about 10% of asthmatics.

Pleurisy is a form of inflammation as well - it is inflammation of the pleura, two thin membranes, one of which covers the whole of the outside of the lungs and the other of which covers the inside of the ribcage. Normally when you breath, the two linings produce a lubricant so that they can slide over each other easily and painlessly. If the pleura become inflammed, then their rubbing together during breathing can become extremely painful. Again, it's usually a sharp, stabbing pain, made worse by breathing and coughing. It can be anywhere in the rib cage. It can again be sore to press.

There are many many causes of pleurisy but by far the most common and relevent one in a young child would be infection. This can be a simple 'chest infection' or a pneumonia, which is basically a slightly more severe chest infection that causes infected fluid to build up in the affected area of the lung. In either case, the symptoms are usually fever, coughing up brown/yellow/greeny coloured sputum, shortness of breath and feeling generally unwell.

Pneumonia can be seen on an X-ray; a simple chest infection usually doesn't. Pleurisy in itself also doesn't usually show up on an X-ray unless there is very significant inflammation which has caused fluid to develop in the space between the two membranes. Costochrondritis also would not usually show up on an X-ray. If by a 'scan' you mean a CT scan, then I can understand why they wouldn't want to do one - it is a huge dose of radiation (equivalent to 50 to 100 chest X rays) which is never a good idea unless unavoidable in a child, and it probably wouldn't actually give any more information, as most of the potential diagnoses probably wouldn't be particularly obvious on a CT scan either.

It's hard with the information you've given and without actually seeing the X rays and so on to say exactly what *is* going on, but I hope that the information above gives you some idea of why the medics might have said and did the things that they did. I know it must be really hard to see your daughter in pain and not be able to do anything about it, but I guess from the doctors' point of view, the main priority will be to exclude anything serious going on. The main thing I would be keen to exclude would be a raging pneumonia-type infection, which definately would have shown up in your daughter's general condition, on her X-ray, and on any blood tests that she had done. Since the doctors haven't said anything like this to you, and haven't kept her in, I am guessing that there wasn't any barn door pneumonia that they felt needed antibiotic treatment.

However, if you aren't happy and she is in pain and not improving, I wouldn't hesitate to trust your mothering instinct and take her back to see the GP, or to hospital if you feel her condition is serious enough. I have to say that really, as it's impossible to safely advise you over a website that it would be safe to ignore the symptoms.

I do hope this helps a little and that she feels a lot better soon,

Take care

Em H

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Ooops Owl, cross posting!

Good to know we concur anyway - although you managed to be a lot more succinct than I was!

Em

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Bumped up for 1_winged_angel.

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Bump for Philomela.

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Thanks Ginny. This sounds nastier than what I have but after reading think maybe is worth going to GP to see if they can give me anything.