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What could be the cause of deep burning pains in sternum area and left rib cage ?

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Internal Medicine Specialist
Practicing since : 1998
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Once or twice a year for 2-3 month duration, I have severe intermittent site pain under left ribcage and it extends to my back and then up my left shoulder. It feels as if my individual nerve endings are shooting pains and my blood vessels alongside the left rib cage are burning, very painful and distended to the touch. After 2 weeks of this pain, I noted 2 small blisters in that area of my back that dried and went away in 5 days but they were very tender to touch. Additionally, there feels like a massive swelling inside, pushing towards ribs and up against stomach. During this stage, after eating, I am having severe XXXXXXX burning pain in my sternum area, feeling full very quickly. I am to the point of eating as little as possible and trying to manage pain with Tylenol, etc which takes just the edge off the pain. Dr. ran ESR last week and said all within normal range albeit I always post a chronic low white cell count. Dr. did not do physical exam and dismissed me last week. It is escalating in severity and I have no idea how to get help for this as I have been labeled Chronic Abdominal pain, although it only happens 1 -2 times a year... I can literally pinpoint the spot on my left back, midaxillary line inside my ribs, where the pain is most severe, radiating.
Posted Tue, 8 May 2012 in Abdominal Pain
Answered by Dr. Jasvinder Singh 36 minutes later

Thanks for posting your query.

First of all, since you have a history of Herpes and Shingles, the blisters on the side of the trunk are typical site for Shingles or Herpes sores. It can be Atypical Shingles as well. In this there is pain and sensitivity in a particular dermatome especially under the armpits and on the trunk and there is little or no appearance of any rash or blisters. The sensitivity can be due to touch of clothes also.

Although recurrence of Shingles is rare but in some cases it may occur. Herpes sores also present with painful blisters when the herpes virus reactivates and this may be responsible for these blisters.

Get a viral culture of the fluid from the blisters, IgM antibodies done when the blisters appear.

For the severe pain under the left rib cage, three possibilities are coming to my mind, these include:

1)     The first possibility is of Peptic ulcer disease or Hiatal hernia. Diagnosis can be confirmed by upper GI endoscopy. Try raising the head of your bed about four inches with blocks. It also might help to avoid eating or drinking for two hours before you lie down. To help control the stomach acid, one should not drink alcohol or drinks with caffeine in them, or eat chocolate or spicy or greasy foods. Also take some antacid but if the symptoms are severe, then you may need drugs like proton pump inhibitors.

2)     The second possibility is of pancreatitis as it may cause upper left abdominal pain which is worse when bending over or sitting. Pancreatic enzymes like serum amylase and lipase should be measured to rule out any pancreatic cause.

3)     The last possibility is of any kidney stones which may present as such sharp pain radiating to the back. For this purpose you need to get an ultrasound abdomen and kidneys done.

I suggest you to consult a physician and get an ultrasound upper left abdomen, pancreatic enzymes, upper GI endoscopy to rule out any peptic ulcers and a chest x-ray done to rule out these causes.

Hope this answers your query. If you have additional questions or follow up queries then please do not hesitate in writing to us. I will be happy to answer your queries.

Wishing you good health.


Above answer was peer-reviewed by
Follow-up: What could be the cause of deep burning pains in sternum area and left rib cage ? 14 hours later
Thank you for your reply to my query. Would the tests for Pancreatitis be included in the panels traditionally run by a Doctor when looking for an inflammatory condition or are they specific tests that go beyond the traditional panel?
Answered by Dr. Jasvinder Singh 15 hours later

Thanks for writing back.

The test for pancreatitis like serum lipase and serum amylase are generally done when you have symptoms of pain under the left rib cage. They are not done traditionally but are done when your doctor suspects and wants to rule out pancreatitis as the cause of inflammation.

Hope this answers your query.

Wishing you good health.
Above answer was peer-reviewed by
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