Causes of Low-Grade, Pleuritic, Left-Sided Chest Pain in Pulmonary Hypertension

Pulmonary Embolism

Pulmonary embolism can present with pleuritic chest pain, which is typically due to distal emboli causing pleural irritation, in patients with pulmonary hypertension 1
In patients with pulmonary hypertension, recurrent pulmonary embolism can lead to chronic thromboembolic pulmonary hypertension, which requires specific management, as recommended by the European Respiratory Society 2, 1
Pulmonary embolism should be suspected in any patient with pulmonary hypertension who develops new or worsening pleuritic chest pain, especially if accompanied by hypoxemia, according to the European Heart Journal 1

PVOD is a rare but serious cause of pulmonary hypertension that can present with pleuritic chest pain, characterized by progressive obstruction of pulmonary veins leading to pulmonary congestion and edema, as described in the European Respiratory Review 3
Radiographic findings in PVOD include patchy areas of ground-glass opacification, septal lines, and mediastinal lymph node enlargement, which can be diagnosed using CT imaging, as recommended by the European Respiratory Review 3
PVOD patients may experience pleuritic chest pain due to pleural inflammation from adjacent pulmonary congestion and microinfarcts, according to the European Respiratory Review 3, 4

Patients with pulmonary hypertension due to left heart disease may experience pleuritic chest pain from myocardial ischemia due to compression of the left main coronary artery by an enlarged pulmonary artery, as reported in the European Respiratory Journal 5
Pericardial inflammation secondary to right ventricular strain can also cause pleuritic chest pain in patients with left heart disease, according to the European Respiratory Journal 5
Pleural effusion resulting from heart failure can cause pleuritic chest pain in patients with pulmonary hypertension, as described in the European Heart Journal 1

Pleural effusions are common in patients with advanced pulmonary hypertension, especially those with left heart disease, and can cause pleuritic chest pain, according to the European Heart Journal 1

Infections should be promptly identified and treated to prevent worsening of pulmonary hypertension, as recommended by the European Respiratory Journal 2

Echocardiography is indicated in patients with unexplained dyspnea to detect cardiovascular complications, such as those recommended by the European Respiratory Journal 7
CT imaging may be necessary to evaluate for PVOD, which shows characteristic patterns of ground-glass opacities and septal lines, as described in the European Respiratory Review 3
Ventilation/perfusion scanning is preferred for evaluating suspected pulmonary embolism in patients with pulmonary hypertension, as recommended by the European Respiratory Journal 2

Treatment should target the underlying cause of pleuritic chest pain while continuing management of pulmonary hypertension, as recommended by the European Respiratory Journal 2
For patients with PVOD, early referral to a transplant center is indicated as soon as the diagnosis is established, according to the European Respiratory Journal 7
Patients with pulmonary hypertension should be managed in centers with experience in this condition, particularly when complications arise, as recommended by the European Respiratory Journal 7