Douleurs thoraciques d’origine viscérale

Abstract

Although chest pain can be ascribed to a rheumatologic condition in every three cases, rheumatologists should not miss life-threatening disorders like myocardial ischaemia, pulmonar embolism, aortic dissection, aortic aneurysm, cardiac tamponade, severe pericarditis or myocarditis. In rare event, chest pain can herald the dissection of pulmonary artery. The diagnosis of pneumonia, pleuresia, mesothelioma and pneumothorax can be tricky. Drepanocytosis can also manifest as severe pain in the chest. Diaphragm has been proposed as the origin of pain in shrinking lung syndromes from lupus patients. Hernia through the anterior diaphragmatic foramen (Morgagni's herniation) can also induce retrosternal pain. Mediastinal tumors, mediastinal fat necrosis, and thymic disorders, from hemorragiae to infarctus, can be disclosed by chest pain, as well as the even more severe infections, pneumo-mediastins and mediastinal bleedings within mediastin (sometimes linked to the breakage of a parathyroid adenoma). Regurgitations, spasms, and functional disorders of esophagus can manifest as angina-like chest pain, as well as some esophageal ulcers and cancers. Spontaneous esophageal rupture following forced vomiting (Boerhave syndrome) leads to death in 20 to 40% of patients. Pancreas and biliary duct disorders can present as low chest pain, as well as some colitis, especially when associated with colonic interposition between the liver and the diaphragm, the so-called Chilaiditi syndrome.