Chest pain in patients with COPD: the fascia's subtle silence

Abstract

COPD is a progressive condition that leads to a pathological degeneration of the respiratory system. It represents one of the most important causes of mortality and morbidity in the world, and it is characterized by the presence of many associated comorbidities. Recent studies emphasize the thoracic area as one of the areas of the body concerned by the presence of pain with percentages between 22% and 54% in patients with COPD. This article analyzes the possible causes of mediastinal pain, including those less frequently taken into consideration, which concern the role of the fascial system of the mediastinum. The latter can be a source of pain especially when a chronic pathology is altering the structure of the connective tissue. We conclude that to consider the fascia in daily clinical activity may improve the therapeutic approach toward the patient.

Keywords: COPD; diaphragm; fascia; muscle pain; thoracic pain.

Figure 1

Chest CT on axial planes. Chest CT usually shows emphysema which can be centrilobular, panlobular or paraseptal; the first one is the most common type of emphysema (A), usually related to smoking status and more marked in the upper lobes; the parenchymal destruction is centered around the terminal bronchiole, representing the center of the secondary pulmonary lobule. Other findings include bronchial wall thickening (B), air trapping and narrowing of the trachea in the coronal plane. Abbreviation: CT, computed tomography.

Figure 2

Chest X-ray in PA (A) and LL (B) projections. Chest X-ray has poor sensitivity to detect COPD; possible findings include prominence of the hilar vessels and decreased peripheral bronchovascular markings, flattened diaphragm due to hyperexpansion and hyperkyphosis and increased lung lucency (especially seen in the retrosternal region in LL projection) and bullae (round focal lucency over 1 cm). Abbreviations: PA, posterior–anterior; LL, latero-lateral.