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What causes shortness of breath and pain under right rib cage?

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Posted on Mon, 14 Sep 2015
Question: Hi, I would like your opinion on the following, when my husband was advised to go to hospital for shortness of breath and pain on breathing on his right lower ribs. One doctor said it looked like a lower respiratory infection whilst another said atelectasis caused by musculoskeletal pain, it was decided it was musculaskeletal and he was discharged but within an hour he was back in with worse pain and more shortness of breath, within 24 hours he was sent to intensive care and severe pnuemonia was diagnosed and a large pleural effuson, he was sedated and put on a ventilator for 3 days. This was XXXXXXX 2014, more than a year on he has been diagnosed with eventration of the right diaphragm as his breathing has never returned to normal, is it likely that the pnuemonia has damaged his lungs? They have ruled out problems below the diaphragm from a CT scan and said the diaphragm is moving normally to 2-3 intercostal spaces on deep inspiration, there has been no mention of fibrosis in his lung or any neoplasms. Thank you
doctor
Answered by Dr. Indu Kumar (1 hour later)
Brief Answer:
Raised diaphragm on 13/06/2014 may be due to sub-pulmonic pleural effusion

Detailed Answer:
Hello

I have gone through your husband's history and findings in detail.
I have also gone through uploaded chest X-rays.
Chest X-ray done on 12/06/2014 shows normal diaphragm whereas X-ray done on 13/06/2014 shows raised right dome of diaphragm.
Raised right dome of diaphragm on 13/06/2014 may be due to sub-pulmonic pleural effusion in right side.Collection below right lung raises right dome.
If possible please upload recent chest X-ray and CT report so that I can interpret in a better way.

Get well soon.
Hope I have answered your question.
Further queries are most welcome.

Take Care
Dr.Indu XXXXXXX
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indu Kumar (1 hour later)
Hi, we do not have more recent xray but I have uploaded some of the CT images of the right lung from the 13.06.14 Can you kindly interpret what you can see on the images. Many thanks.
doctor
Answered by Dr. Indu Kumar (19 hours later)
Brief Answer:
It shows atelectasis and consolidation of right lung,

Detailed Answer:
Hello

Uploaded images shows atelectasis(loss of normal aeration in small segments)and consolidation of right lung(basal part)with upward pull of liver.

Get well soon.
Hope I have answered your question.
Further queries are most welcome.

Take Care
Dr.Indu XXXXXXX
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indu Kumar (11 minutes later)
Hello thank you for your interpretation. What would be the likely cause of the atelectasis/consolidation if symptoms were shortness of breath and pain whilst breathing in, raised crp levels and d dimer? Many thanks.
doctor
Answered by Dr. Indu Kumar (17 hours later)
Brief Answer:
Consolidation is generally due to pneumonia.

Detailed Answer:
Hello

Consolidation is generally due to pneumonia.
Atelectasis is due to small segmental collapse and it is generally due to retained secretions.
Pneumonia may cause shortness of breath and pain.

Get well soon.
Hope I have answered your question.
Further queries are most welcome.

Take Care
Dr.Indu XXXXXXX
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Indu Kumar (26 hours later)
Hi, given my husband had a large right-sided pleural effusion and severe pneumonia (right lung) and type 1 respiratory failure needing mechanical ventilation and sedation would the fact he now has eventration/raised right hemidiaphragm be due to this? They have done a CT scan and said nothing is untoward below the diaphragm and there are no bronchial neoplasms so does he likely have this elevation as the result of the pneumonia/pleural effusion?
I have uploaded the xray from the 13.06.14 in which you think it may be a subpulmonc effusion and his xray from the 14.06.14 in which it shows clearly a large pleural effusion, do you think looking at both of these xrays that the xray taken on the 13.06.14 is more likely to have been a subpulmonic effusion given the fact that that the effusion was much larger on the 14th?
doctor
Answered by Dr. Indu Kumar (21 hours later)
Brief Answer:
Initially there may besub-pulmonic effusion which may progress laterally.

Detailed Answer:
Hello
Sorry for replying late

Initially there may be sub-pulmonic effusion then it may be extended laterally with more effusion.

Get well soon.
Hope I have answered your question.
Further queries are most welcome.

Take Care
Dr.Indu XXXXXXX
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indu Kumar (9 minutes later)
Thank you very much for all your help and interpretation you have been most helpful.
doctor
Answered by Dr. Indu Kumar (1 hour later)
Brief Answer:
Thanks for your comments.

Detailed Answer:
Hello

Thanks for your comments.

Get well soon.
Further queries are most welcome.

Take Care
Dr.Indu XXXXXXX
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Dr. Indu Kumar

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What causes shortness of breath and pain under right rib cage?

Brief Answer: Raised diaphragm on 13/06/2014 may be due to sub-pulmonic pleural effusion Detailed Answer: Hello I have gone through your husband's history and findings in detail. I have also gone through uploaded chest X-rays. Chest X-ray done on 12/06/2014 shows normal diaphragm whereas X-ray done on 13/06/2014 shows raised right dome of diaphragm. Raised right dome of diaphragm on 13/06/2014 may be due to sub-pulmonic pleural effusion in right side.Collection below right lung raises right dome. If possible please upload recent chest X-ray and CT report so that I can interpret in a better way. Get well soon. Hope I have answered your question. Further queries are most welcome. Take Care Dr.Indu XXXXXXX