TürkçeChest pain is a clinical symptom that can develop due to cardiac, pulmonary, musculoskeletal, digestive system, and psychogenic causes and may range from mild discomfort to life-threatening conditions. The duration, severity, radiation of the pain, and accompanying findings are key criteria in determining the underlying cause.
Cardiac-origin chest pain is mostly associated with coronary artery disease and myocardial infarction and typically presents as pressure that may radiate to the arm, neck, or jaw. Accompanying symptoms such as worsening with exertion, shortness of breath, and sweating may indicate serious conditions requiring urgent medical evaluation.
Musculoskeletal-origin chest pain usually worsens with movement and becomes more evident with localized tenderness. Trauma, muscle strain, and costochondritis are among the common causes. This type of pain often increases or decreases with changes in position and is not accompanied by systemic findings.
The treatment of chest pain is planned according to the underlying cause, and emergency intervention is prioritized in cardiac conditions, while anti-inflammatory treatment and rest are prominent in musculoskeletal problems. Acid-suppressive treatments are used for pain related to reflux, and advanced examinations with a multidisciplinary approach are essential in high-risk cases.
What causes chest pain and which organs can it originate from?
This area located in the upper part of our body should not be considered only as the home of the heart. The rib cage is a dynamic structure; it expands with every breath we take, narrows with every breath we exhale, and is a mechanism that is constantly in motion. Any damage, inflammation, or compression occurring within or on the walls of this moving structure stimulates pain receptors.
When viewed in general, the organs and tissues that may be the source of chest pain are quite diverse. Sometimes muscle stiffness related to a simple cold and sometimes a tumor requiring much more serious surgical intervention may be the cause of this pain. In thoracic surgery, our area of interest mainly includes the lungs, the pleura, which we call the lung membrane, the chest wall (ribs and muscles), the diaphragm, and the mediastinum, which is the space between the two lungs. The nerve endings in these regions send any damage that occurs to the brain as a pain signal.
Common causes of pain in this region include:
- Inflammation of the lung membrane
- Collapsed lung
- Pneumonia
- Rib fractures
- Muscle contusions
- Reflux disease
- Esophageal spasms
- Shingles
- Panic attack
- Pulmonary embolism
How can heart attack pain be distinguished from lung-related chest pain?
This is the issue our patients are most curious about and most afraid of. A heart attack is life-threatening and requires intervention within minutes. However, pain originating from the lungs or chest wall can also be extremely severe and may make the patient feel as though “my heart is being squeezed.” To distinguish these two conditions from each other, it is necessary to focus on the character of the pain, in other words, “how it feels.”
Pain originating from the heart is usually a feeling of tightness felt in the exact center of the chest, behind the sternum, and spreading over a very wide area. Patients usually describe it as “an elephant is sitting on my chest” or “it feels like it is being squeezed in a vise.” This pain increases with exertion, such as walking or climbing stairs, and decreases with rest.
Pain originating from the lungs and the lung membrane, which are within our field, is called “pleuritic pain.” This type of pain is much sharper. It is stabbing, piercing, and sudden. Its most important distinguishing feature is that it is related to breathing. The pain becomes more severe when the patient takes a deep breath, coughs, sneezes, or laughs. This is because the lung membranes move and rub against each other when we breathe; if there is a problem there, this friction creates a severe stabbing sensation. For this reason, patients with lung-related pain avoid taking deep breaths and try to keep that area still by taking short and shallow breaths.
The characteristics of non-cardiac chest pain include:
- Stabbing character
- Worsening with breathing
- Triggered by coughing
- Localized tenderness
- Changes with movement
- Radiation to the back
- Burning sensation
Why does a collapsed lung (Pneumothorax) cause severe chest pain?
Pneumothorax, commonly known as a “collapsed lung,” is one of the conditions we most frequently encounter in thoracic surgery clinics and causes sudden and severe pain. Under normal conditions, our lungs remain attached to the chest wall inside the rib cage through negative pressure, almost like a vacuum effect. In this way, when the rib cage expands, the lung expands with it and we breathe.
In pneumothorax, a small air bubble on the surface of the lung bursts or the lung membrane is perforated due to an external impact. The air leaking through this opening fills the vacuum space between the lung and the chest wall. As air fills this area, the vacuum effect is disrupted and the lung contracts and collapses inward like a deflated balloon.
At the moment this event occurs, the patient feels a very sharp, sudden, stabbing pain. The pain is so severe that the person has to stop what they are doing. This condition usually develops spontaneously in young, thin, tall, and smoking men, sometimes even while simply sitting on a couch. The most important symptom accompanying the pain is shortness of breath. This is because the collapsed lung can no longer be ventilated and the body begins to suffer from oxygen deprivation.
The risk factors for pneumothorax include:
Smoking
- Genetic predisposition
- COPD
- Tall body structure
- Thin body structure
- Diving
- Pressure changes
- Chest trauma
How does chest pain caused by a collapsed lung resolve and what are the treatment methods?
The only way for chest pain caused by a collapsed lung to resolve is to evacuate the air that has filled that space and allow the lung to reinflate and adhere to the chest wall again. Painkillers provide only temporary relief in this situation, and the pain does not completely resolve until the mechanical problem is corrected.
Treatment varies according to the degree of collapse. If only a very small portion of the lung has collapsed, for example around 10-15%, we may sometimes keep the patient under observation with oxygen therapy alone. The body may absorb that small amount of air on its own over time. However, if the amount of collapse is large or the patient has severe shortness of breath, intervention is necessary.
The method we most frequently use is “tube thoracostomy,” meaning the placement of a chest tube. Under local anesthesia, we insert a tube about the thickness of a little finger into the chest cavity between the patient’s ribs. The other end of this tube is connected to a special container filled with water. The air inside exits through this tube and is evacuated by bubbling through the water. As the air is removed, the lung reinflates. When the lung expands again, the pain decreases dramatically and the patient feels relief.
In some cases, especially if the air leak does not stop or the condition recurs, surgical intervention is required. During these operations, the ruptured blebs on the lung are removed and the lung membrane is adhered to the chest wall to prevent the lung from collapsing again.
The treatment methods applied include:
- Oxygen support
- Observation
- Needle aspiration
- Chest tube
- VATS surgery
- Pleurodesis procedure
Is chest pain among the symptoms of lung cancer?
Unfortunately, lung cancer is a disease that progresses very insidiously, and “pain” may not always be the first symptom. The main reason for this is that there are no pain nerves within the lung tissue itself, known as the parenchyma. In other words, a tumor growing in the center of the lung may not cause pain even if it reaches a very large size. This is one of the main reasons why the disease is sometimes detected at advanced stages.
However, when the tumor grows outward from the lung and comes into contact with the lung membrane, known as the pleura, the chest wall, the ribs, or the spine, very severe and persistent chest pain begins. Unlike the sudden pain seen in a collapsed lung, this pain gradually increases, is gnawing in character, constant, and may wake the patient from sleep at night. It may not respond to standard painkillers.
Tumors located especially at the apex of the lung, known as Pancoast tumors, may cause very severe pain in the shoulder and arm. Sometimes patients may mistake this for shoulder stiffness or a cervical disc herniation and seek physical therapy. Therefore, the lungs should always be imaged in cases of unexplained and persistent shoulder and back pain.
Other symptoms of lung cancer include:
- Persistent cough
- Bloody sputum
- Hoarseness
- Shortness of breath
- Wheezing
- Weight loss
- Loss of appetite
- Difficulty swallowing
How effective are minimally invasive surgery (VATS) methods in the treatment of chest pain?
In the past, thoracic surgery brought to mind a large incision extending from the patient’s back toward the chest, called a “thoracotomy,” along with cut muscles and ribs forcibly separated with the help of an instrument. Although this method provided the surgeon with a wide field of view, it was a serious source of postoperative pain for the patient. The recovery period was prolonged, and it could take months for patients to return to their normal lives.
Today, with the development of technology, minimally invasive methods called “VATS” (Video-Assisted Thoracoscopic Surgery) have become the gold standard. In this method, instead of opening the entire rib cage, the operation is performed through only 1, 2, or 3 small openings called ports. A thin rod with a high-resolution camera at its tip and special surgical instruments are used.
The greatest advantage of the VATS method is that the ribs are not separated and large muscle groups are not cut. As a result, postoperative pain is remarkably less compared with open surgery. Our patients can get up and walk in the corridor the day after surgery, take deep breaths, and cough. Less pain shortens the hospital stay, usually to 2-4 days, and accelerates the patient’s return to work and social life. This method is used safely and with high success in both cancer surgeries and benign diseases such as pneumothorax.
The advantages of the VATS method include:
- Less pain
- Small incisions
- Rapid recovery
- Early discharge
- Aesthetic appearance
- Low complication rate
- Safe surgery
- Comfortable process
Is chest pain less after operations performed with robotic surgery?
Robotic surgery is the most advanced point reached by minimally invasive surgery. These operations are performed with robotic arms positioned beside the patient and controlled by the surgeon while seated at a console, providing major convenience especially in narrow and difficult-to-reach areas. In a risky area such as the chest cavity, where the heart and major vessels are located, the robot’s three-dimensional and 10-15 times magnified image allows the surgeon to see tissues with millimetric precision.
In terms of pain, the principle of robotic surgery is similar to VATS; large incisions are not made and the ribs are not strained. The robotic arms have a range of motion that the human hand cannot achieve, and these arms work while causing minimal damage to tissues. Tissue trauma at the entry openings, which we call “port sites,” is much lower.
This precision keeps postoperative pain at a minimal level. Patients who undergo robotic surgery generally require much less pain medication. The recovery process is extremely fast. Robotic surgery provides excellent results in terms of both oncological clearance and patient comfort, especially in thymus gland tumors or delicate lung resections.
The benefits provided by robotic surgery include:
- High precision
- Three-dimensional imaging
- Tremor-free arms
- Maximum range of motion
- Tissue preservation
- Minimal bleeding
- Rapid recovery
- Less pain
Do chest wall deformities cause chest pain?
The inward depression of the chest, commonly known as “funnel chest” (Pectus Excavatum), or the outward protrusion known as “pigeon chest” (Pectus Carinatum), is often perceived as only an aesthetic problem. However, these structural deformities may also cause physical complaints and pain.
Especially in an inward chest deformity, the sternum is pressed inward. This bone applies physical pressure to the heart located directly behind it and sometimes to the lungs. The patient may not feel a problem while at rest, but may experience tightness, pain, and fatigue more quickly than normal while exercising, climbing stairs, or running. This is because the heart cannot expand and fill at full capacity due to this pressure.
In addition, postural disorders such as kyphosis and scoliosis are also common in people with this deformity, and this may lead to chronic muscle pain in the back, shoulders, and side walls of the chest. The “Nuss procedure,” which we use in the treatment of this condition and involves placing a bar through a minimally invasive method, lifts the rib cage and completely removes the pressure on the heart. Once the pressure is relieved, the patient’s exercise capacity increases and the chest pain caused by compression resolves.
Problems caused by deformities include:
- Pressure on the heart
- Rapid fatigue
- Shortness of breath
- Feeling of palpitations
- Chest pain
- Loss of self-confidence
- Postural disorder
- Social withdrawal
Do masses behind the sternum and mediastinal diseases cause chest pain?
We call the area located in the exact center of the rib cage, between the two lungs, the “mediastinum.” This is the body’s most strategic junction point; the heart, major arteries, trachea, esophagus, thymus gland, and lymph nodes are located here. Cysts and benign or malignant tumors that may develop in this narrow and crowded area, such as thymoma, lymphoma, hydatid cyst, schwannoma, and others, begin to press on the surrounding tissues as they grow.
The pain caused by mediastinal masses is usually what we call “retrosternal pain,” a dull, pressure-like pain felt behind the sternum whose exact location cannot be clearly identified. If the mass is close to the back, it may cause an aching pain between the shoulder blades.
Apart from pain, if these masses press on the trachea, they cause shortness of breath; if they press on the esophagus, they cause difficulty swallowing; and if they press on the nerve of the vocal cords, they cause hoarseness. Needle biopsy methods such as EBUS (Endobronchial Ultrasound) or mediastinoscopy are used in the diagnosis of masses in this region. In treatment, removal of the mass through minimally invasive methods such as VATS or robotic surgery eliminates the pressure and pain.
Symptoms of compression include:
- Fullness in the chest
- Difficulty swallowing
- Persistent cough
- Voice changes
- Facial swelling
- Fullness in the neck veins
- Drooping eyelid
- Back pain
What kind of chest pain do chest wall tumors and rib diseases cause?
Sometimes the source of the pain is not the internal organs but directly the “wall” forming the rib cage itself. Tumors originating from the ribs, cartilage tissue, or chest muscles, such as chondrosarcoma and osteosarcoma, or the spread of cancers from other organs to the bone, known as metastasis, cause very pronounced and severe pain.
This type of pain is usually localized, meaning that the patient can clearly point to the painful area with a finger. There may be a hard swelling that can be felt in the painful region. The pain tends to increase at night and does not resolve with simple painkillers. In addition, benign inflammations of the rib cartilage called Tietze syndrome or costochondritis may also cause severe anterior chest pain that mimics a heart attack. However, in these conditions, pressing the painful area with a finger increases the patient’s pain enough to make them cry out; this is an important finding that guides us toward the diagnosis.
Surgical treatment of chest wall tumors requires the wide removal of the affected bone or tissue. In place of the removed area, a new wall is constructed to protect the lungs by using synthetic patches, titanium plates, or the patient’s own muscle tissues, a process called reconstruction.
Symptoms of chest wall problems include:
- Palpable mass
- Tenderness to touch
- Night pain
- Swelling
- Redness
- Limited movement
- Persistent aching
- Deformity
Which modern methods are used in the diagnosis of chest pain?
Making the correct diagnosis in a patient presenting with chest pain is the first and most important step for treatment success. First, we listen to the patient’s history: when did the pain begin, what type of pain is it, and where does it radiate? The physical examination performed afterward tells us a great deal. However, we need modern imaging technologies to clearly see the internal organs:
The first step is usually a simple chest X-ray. Rib fractures, large pneumothoraces, or large masses may be seen on this image. However, in thoracic surgery, we create our main roadmap with “Computed Tomography” (CT). Tomography scans the rib cage in thin slices and reveals millimetric lesions, vascular structures, and bone details in three dimensions.
If cancer is suspected, a nuclear medicine examination called “PET-CT” comes into play. This method shows the extent of the disease by making active cancer cells in the body light up. We use methods such as “EBUS,” which is ultrasound at the tip of a bronchoscope, to examine the lymph nodes in the mediastinum, and “fiberoptic bronchoscopy” to obtain tissue samples from the lung. All these technological possibilities are vital for preventing unnecessary operations and planning highly targeted treatment.
The methods used in diagnosis include:
- Chest X-ray
- Computed tomography
- PET-CT scan
- Magnetic resonance imaging (MRI)
- Bronchoscopy
- EBUS procedure
- Mediastinoscopy
- Needle biopsy
How is postoperative chest pain managed?
The greatest concern of patients who decide to undergo surgery is usually the question, “Will I be in a lot of pain after the operation?” This is a very human and understandable fear. However, in modern medicine, “suffering from pain” is no longer considered an inevitable part of surgery. On the contrary, for us, a “pain-free patient” is the patient who recovers best. This is because a patient without pain can breathe comfortably, cough and clear sputum effectively, and begin walking early.
For this reason, we apply a “multimodal,” meaning multi-faceted, approach to postoperative pain management. Instead of giving an injection only after pain starts, we take preventive measures before the pain even begins. Intercostal blocks performed by the surgeon during the operation, which numb the nerves between the ribs, epidural catheters inserted by anesthesiologists, and intravenous controlled pain-relief devices called PCA, meaning Patient-Controlled Analgesia, allow our patients to go through the process very comfortably. Our aim is to keep the patient’s pain score at a level that allows them to breathe comfortably and turn in bed.
Methods used in pain management include:
- Epidural catheter
- Nerve blocks
- Intravenous painkillers
- Oral medications
- Cold application
- Respiratory support
- Early mobilization
- Physical therapy
What should be done to prevent chest pain from recurring during the recovery period?
After a successful operation and discharge, the process is not considered complete. The recovery period at home is just as important as the hospital period. The patient must take good care of themselves to prevent chest pain from becoming chronic and to preserve lung capacity.
The first and most definite rule is that smoking must never be resumed. Smoking impairs wound healing, increases the risk of infection, and brings the risk of cancer back into consideration.
The second important point is breathing exercises. The multi-ball breathing devices called “Triflo” that we provide to our patients help expand the lungs all the way to their outermost regions. These exercises preserve the flexibility of the chest wall and prevent adhesions that may cause pain.
It is also necessary to stay active. Going home and remaining in bed constantly causes the muscles to weaken and the pain to increase. Regular walking both accelerates blood circulation and reduces general body pain. Consuming protein-rich foods is essential for tissue repair. Avoiding constipation is also important because excessive straining may increase intrathoracic pressure and cause pain.
Recovery recommendations include:
- Quitting smoking
- Triflo exercises
- Regular walking
- Protein-rich nutrition
- Drinking plenty of water
- Avoiding heavy lifting
- Preventing constipation
- Attending follow-up appointments
In which situations should a doctor be consulted for chest pain?
Chest pain is the body’s way of saying that “something is not right” and should never be ignored. Sometimes it may be a simple muscle pain, but at other times it may be the first sign of a life-threatening condition. Consulting a specialist instead of trying to diagnose yourself is always the safest approach.
If your chest pain begins suddenly and is severe, is accompanied by shortness of breath, if you cough up blood, or if the pain spreads to your back or shoulder, you should seek medical attention immediately. Pain developing after trauma, such as a fall or impact, must also be evaluated. In addition, unexplained and progressively worsening pain in smokers over the age of 40 should be evaluated for lung tumors, especially when accompanied by symptoms such as weight loss and hoarseness.
Early diagnosis saves lives in thoracic surgery. A collapsed lung can be relieved within seconds with early intervention, and early-stage lung cancer can be completely treated with minimally invasive surgery. Value your health and pay attention to the signals coming from your chest.
Emergency warning signs include:
- Sudden-onset pain
- Severe shortness of breath
- Bloody sputum
- Bluish discoloration of the lips
- Confusion
- Cold sweating
- Persistent palpitations
- High fever
Frequently Asked Questions
Prof. Dr. Alper Fındıkcıoğlu graduated from Istanbul University Faculty of Medicine and completed his thoracic surgery residency at Dr. Siyami Ersek Hospital. He began his academic career at Başkent University in 2005; he received the title of associate professor in 2014 and professor in 2022. He has extensive experience in lung cancer, chest wall diseases, and minimally invasive surgery. Since 2024, he has been continuing his professional work at Acıbadem Hospital.
