4 Possible Causes of Stabbing Pain When Breathing

It might happen out of nowhere — you're just going about your day when suddenly it hits you: You feel a stabbing pain when breathing.

Since breathing is essential, having pain when you're trying to breathe can be very frightening. In some cases, it's a harmless circumstance that will pass, but in others, it's a very serious symptom that warrants immediate medical condition.

Medically speaking, stabbing pain when breathing describes a symptom known medically as pleuritic pain, explains Kamran Boka, MD, a pulmonary medicine specialist with McGovern Medical School at UTHealth and UT Physicians in Houston.

Dr. Boka describes this type of pain as chest or rib pain that develops sharply or gradually when you breathe in. The pain can occur whether you're breathing deeply or shallowly, and during rest or activity. He notes that some people experience the pain radiating across the chest, into the back and/or in one particular area of the ribs. "Some patients describe the sensation as discomfort and even occasionally say it has the ability to abruptly interrupt the breath itself," he adds.

‌Read more‌: Causes of Burning Pain in the Chest & Back

According to Dr. Boka, anything that irritates the lining of the lungs can cause pleuritic pain. There are many different things that may cause this type of irritation, including:

• Prolonged coughing
• Early signs of lung infection (including pneumonia or empyema)
• Pulmonary embolism, aka a blood clot in the veins of the lung
• Chest or rib injury or trauma (such as a seat belt injury during a motor vehicle accident)
• Irritation to the lining of the heart

Here is a closer look at some of the causes of stabbing pain when breathing.

Viral infections are the most common cause of pleuritic pain, Dr. Boka says.

Infections that can irritate the lungs include influenza, RSV (respiratory syncytial virus) and the common cold viruses that lead to pneumonias. Another lung irritant is COVID-19, per Johns Hopkins Medicine. Dr. Boka adds that the risk for these types of viruses is the highest during flu season (November through March) and in individuals who have weakened immune systems. Vaccinations are available for the flu, COVID-19 and RSV, and can help you avoid these viral infections (or reduce the severity of the infection if you do catch them).

Infection with other less-common viruses — such as cytomegalovirus (CMV), Epstein-Barr virus (EBV) and parainfluenza virus — can also lead to pleuritic pain. Tuberculosis and bacterial or viral pneumonia also sometimes cause stabbing chest pain.

Treatment for these conditions typically includes nonsteroidal anti-inflammatory medications, such as ibuprofen (Advil, Motrin), and antibiotics for bacterial pneumonia and tuberculosis.

Pulmonary embolism (PE) refers to a sudden blockage of a lung artery caused by a blood clot that traveled from elsewhere in the circulatory system. Most PEs occur due to blood clots that formed in the deep veins of the legs.

A PE is a potentially life-threatening condition, as large clots can block oxygen to your body. According to Dr. Boka, signs that you may have a PE include:

• fever
• hemoptysis (coughing up blood)
• increased heart rate
• rapid breathing
• sudden/abrupt chest pain
• shallow or deep pain while breathing in
• in extreme cases, loss of consciousness, lightheadedness, dizziness, vision changes and headache

Pain or crampy pain in the legs may signal a deep venous thrombus (DVT), which is usually a blood clot in the leg that has a risk of coming loose and traveling to the lungs to become a PE. If you're experiencing any of these symptoms, see your doctor as soon as possible.

As Dr. Boka explains, a pneumothorax is an air leak from the lungs into the chest wall cavity. Often known as a "collapsed lung," this condition can allow air bubbles to leak into the layers of skin around the neck and upper chest and back, which can be painful. In severe cases, he also adds that a pneumothorax may lower blood pressure and may stop the heart.

A pneumothorax can occur spontaneously (particularly in tall, thin young men) as a result of an injury or chronic lung condition and, in rare cases, within 48 hours of beginning menstruation before menopause or estrogen therapy after menopause. Smoking increases the risk for a spontaneous pneumothorax.

Symptoms of a pneumothorax depend on the extent of lung collapse and may include:

• Sudden pleuritic chest pain that might radiate to the shoulder or back, and often transitions to more constant, aching pain
• Shortness of breath, which might be mild to severe
  
• Rapid heart rate

A large pneumothorax can quickly become life-threatening. Treatment typically involves removal of the accumulated air in the chest through a needle or tube. In the case of small amounts of air leakage, treatment might not be needed, although observation is needed to ensure the condition doesn't worsen. See your doctor immediately if you suspect you might have a collapsed lung.

A number of other conditions can cause pleuritic pain, some minor and others more serious. Examples of these conditions include:

• ‌Musculoskeletal:‌ Rib fracture, sore chest muscles
  
• ‌Inflammatory:‌ Lupus, rheumatoid arthritis, pericarditis (inflammation of the sac around the heart)
• ‌Cardiovascular:‌ Heart attack (although most people do not feel pain while breathing in with a heart attack), aortic dissection (tear of the large artery that carries blood from the heart to the rest of the body)
• ‌Cancer:‌ Lung cancer, mesothelioma

Although some causes of pleuritic pain pose no long-term health threat, this symptom also occurs with life-threatening conditions. "Unexplained pain during breathing should be reason for seeking prompt medical attention," Dr. Boka says.

You should seek immediate medical care if you suddenly develop stabbing chest pain, especially if it's accompanied by shortness of breath or any of the following symptoms:

• A cough that lasts more than 1 week
• A cough that produces blood
• Fever with cough
• Sharp chest pains
• Deep chest pains
• Confusion
• Unusually sweaty or dry, pale skin