Right Lateral Chest Pain When Coughing

Primary Musculoskeletal Causes

Right lateral chest pain triggered by coughing is most commonly caused by musculoskeletal injury to the chest wall, including intercostal muscle strain, costochondritis, or rib fractures, which occur in up to 82.4% of patients presenting with post-tussive chest pain 1
Cough-induced rib fractures occur in approximately 82.4% of patients with post-tussive chest pain 1
The 10th rib is most frequently affected 1
Severe coughing fits cause widening of rib spaces, with 44% developing associated fractures 1
Point-of-care ultrasound detects rib fractures in 29% of cases after negative chest radiography 1

Postinfectious cough is most common for acute cough (<3 weeks) 2
Upper respiratory tract infections are a common cause of acute cough (<3 weeks) 2
Upper airway cough syndrome/postnasal drip syndrome (33.2%) is a common cause of chronic cough (>8 weeks) 2
Asthma (15.8%) is a common cause of chronic cough (>8 weeks) 2
Gastroesophageal reflux disease is a common cause of chronic cough (>8 weeks) 2
Nonasthmatic eosinophilic bronchitis (5.4%) is a common cause of chronic cough (>8 weeks) 2
ACE inhibitor-induced cough should be considered if the patient takes these medications 3, 4

The American College of Chest Physicians recommends that the initial evaluation should focus on red flags requiring immediate attention: hemoptysis, severe dyspnea, or life-threatening symptoms 2
The American College of Radiology recommends that chest radiography is the appropriate initial imaging for chronic cough with chest pain 5, 6
Radiographic rib series are more sensitive than standard chest X-rays for detecting rib fractures 1
Point-of-care ultrasound can identify rib fractures missed on plain films 1
The physical examination should include palpation of the lateral chest wall for point tenderness over ribs or intercostal spaces 1
The physical examination should evaluate for signs of underlying respiratory disease 2

The American College of Chest Physicians recommends addressing the underlying cough cause as the first step in management 1, 2
The American College of Chest Physicians recommends following a systematic evaluation per CHEST guidelines for cough duration 2
The American College of Chest Physicians recommends considering empiric treatment trials for common causes (postnasal drip, asthma, GERD) 2
Pain control with NSAIDs or acetaminophen is recommended for musculoskeletal pain 4
Chest wall support/binding may provide symptomatic relief for musculoskeletal pain 4

Pulmonary embolism causes cough in nearly half of cases and can present with lateral chest pain 3, 4
Mediastinal lesions can impinge on airways causing both cough and chest pain 3, 4
ACE inhibitors cause chronic dry cough in 5-50% of patients depending on ethnicity 7
Beta-blockers, inhaled medications, and other drugs can trigger cough 3, 4
Therapeutic withdrawal trial should be considered if drug-induced cough is suspected 3, 4
Patients with chronic cough frequently report musculoskeletal chest pains as part of the disease burden 8, 9
Quality of life can be significantly impaired and warrants formal assessment 8, 9