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- Sun May 06, 2007 4:37 pm
First, thank you so much in advance for your time in answering my questions.
I am a 39 year old female, former 20 year, pack a day smoker. I quit in the middle of January of this year. I have been extremely healthy my whole life. I rarely get a cold.
Anyway, the end of January my ribs started hurting. The right side, front, side and back. For the most part the pain moved around. Went to my doctor. He took x-rays(which were clear) and diagnosed me with Cosochondritis.
A few weeks later I still had the pain so I decided to see my Orhopedic Doctor(I have arthritis in my lower spine). He took an x-ray(which was clear) and also said I had Costochondritis. Prescribed steroids which actually cleared it up for a few weeks.
Two weeks ago I started having severe middle of the chest pains plus burning in the chest and upper back. Went to my doctor and he said I had GERD. I also have a hiatal hernia which was diagnosed by a barium x-ray 10 years ago. He took a chest x-ray(which was still clear) and did an EKG. He gave me Nexium and told me what foods to stay away from.
For the most part the burning and chest pains have gone away. Occasionally I still have it happen. But my ribs still hurt, mainly on the side and back, sometimes in the front. The pain is not constant but it is daily. Also, this past week I have developed pain behind my right shoulder blade. It also is not constant but it is daily. At times, movement makes it worse. Sometimes the shoulder blade pain is stabbing and severe. The rib pain is also stabbing and severe at times.
My question is, could I still have lung cancer with three clear chest x-rays in 4 months? Is all of this really caused by GERD and Costochondritis? I am so scared. I cry everyday thinking I am dying. My husband started a new job so we will not have insurance again for 90 days. I can't go all that time without another opinion.
I am sorry for the long post and again I am extremely grateful for your services.
| Dr. A. De la Guerra
- Thu May 17, 2007 10:24 pm
First of all congratulations for quitting smoking.
I will answer your second question first. You were diagnosed with a hiatal hernia, a very common cause of GERD; both conditions can explain all your symptoms, particularly the burning sensation in your chest. Besides, the back pain, the stabbing sensation behind your shoulder blade, and the fact that movement makes it worse, is very consistent with your diagnosis of spinal osteoarthritis.
Also, in healthy people, chest pain frequently is caused by musculoskeletal problems of the chest wall (ribs, breastbone, articulations, and muscles). The most common cause of chest pain originating in the chest wall is costochondritis, which is consistent with the symptoms you described too.
Sometimes, the symptoms of the conditions described above may overlap.
Is all of this really caused by GERD and Costochondritis? Due to the nature of the pain and your previous diagnoses, the answer is yes.
About your first question on the possibility that lung cancer could be missed by chest x-rays (CXRs), the simple answer is yes. CXRs detect lung tumors when they reach 1 cm in size. Also, small nodules may overlap with ribs, clavicles, the spine, and the heart silhouette, making detection very hard. There is a 30% of lung nodules not recognized by radiologists in CXRs. At present, low dose computerized tomography (LDCT) is the method of choice for lung cancer screening (for tumor detection), and high resolution CT (HRCT) is superior differentiating between benign and malignant lung tumors. Anyhow, a lung tumor that generates the kind of pain you describe must be seen on the CXRs.
If the pain gets worse or is accompanied by other symptoms, you should call your doctor.