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Why do I have chest pain while breathing?

Q: I am a 22 years old student suffering from shortness of breath. When I breathe pain occurs in the left chest and it has started four months back for five days. The chest X-ray report shows pleural fluid occurrence, monocytes - high, lymphocytes - low, WBC - normal and sputum analysis - no microorganism is found. Am I suffering from tuberculosis? I have undergone laparoscopy cystectomy four years back. Since then I am suffering from cough every year in the months of December, January, February and March.

A:I understand from the above description that your main complaints are as follows ---Shortness of breath and pleuritic chest pain. The pain that occurs whenever you breath sounds like pleuritic chest pain. It refers to inflammation of "pleura" , the membranous coverings of the lungs. They normally move along with the lung with every breath and you are unaware of the sensation due to the lubricating action of pleural fluid. However, when there is inflammation in the pleural space, the movement with each breath is longer painless. The acute onset of fever , pleuritic chest pain is indicative of pleuritis. Whether, this is bacterial or viral , is difficult to tell from the supplied information. I am not sure which side of your belly the surgery was done,it is very unlikely the above mentioned surgery is related to your present pleural effusion after a long gap of 4 years. TB pleuritis is unlikely given the presence of "low lymphocytes" though it would be good to know the absolute number of WBC's and the distribution of monocytes, lymphocytes, eosinophils . It would be good to know the other chemistries also ( Total protein, Albumin, RBC's etc . It would be good to know whether it was a small, moderate or a large effusion. I am assuming that you do not have any other major medical conditions like lupus, rheumatoid arthritis etc. With the limited information supplied, it would be good to obtain a repeat chest x ray in a month from now ( to look for the resolution of the pleural effusion) coupled with a PPD ( known as Mantoux in India ). If the symptoms resolve and the pleural effusion resolves in a month from now, it would be safe to assume it was a self limiting process like viral pleuritis . Follow up is the key here.


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