Epidemic Pleurodynia is characterized by intense, excruciating chest pain of acute onset, sometimes radiating into the back, shoulders, and abdomen. Attacks of pain last for seconds to 1 minute, and episodes may be separated by minutes to hours. The illness is sometimes preceded by a few days of headache, muscle ache, sore throat, fatigue, and loss of appetite. However, these associated symptoms may not occur until after the onset of the chest pain. GI symptoms such as nausea, vomiting, and diarrhea are common. About 10% of males with pleurodynia have testicular pain (orchitis) (Petrache).
Localized tenderness may be revealed upon physical examination. During episodes of severe pain, the individual may sweat profusely and appear acutely ill and apprehensive. Fever is present in most of the affected individuals, and often with associated tachycardia. Some of affected individuals may have dermatitis (Petrache).
The diagnosis is made clinically on the basis of the classical symptom complex and a normal chest x-ray study. Ventilation-perfusion (V/Q) lung scanning and D-dimer testing are usually ordered to rule out pulmonary embolism. To rule out cardiac causes of chest pain, an electrocardiogram (ECG) and cardiac isoenzymes may also be ordered.
Other tests such as:
- stool or pleural fluid
- muscle biopsy
- complete blood count
- viral cultures of throat swabs
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