Chest pain

The majority of patients with chest pain referred for a respiratory opinion have either acute pleuritic pain or persistent, well-localized pain. Within the respiratory system, pain may arise from the parietal pleura, major airways, chest wall, diaphragm, and mediastinum; the lung parenchyma and visceral pleura are insensitive to pain. Processes involving the upper parietal pleura cause a pain localized to that part of the chest. The lower parietal pleura and outer region of the diaphragmatic pleura are innervated by the lower six intercostal nerves, and pain here may be referred to the abdomen. The central region of the diaphragm is supplied by the phrenic nerve, and pain may be referred to the ipsilateral shoulder tip. Tracheobronchitis tends to be associated with retrosternal pain.