Download PDF
Int J Sports Med 2009; 30(11): 834-838
DOI: 10.1055/s-0029-1233468
Clinical Sciences

© Georg Thieme Verlag KG Stuttgart · New York

Exercise Dependent Pleurisy in a Soccer Athlete

R. Best1 , A. Niess2 , H. Schlemmer3 , H. Striegel2
  • 1Department of Orthopaedic Sports Medicine, Medical Clinic, University of Tuebingen
  • 2Department of Sports Medicine, Medical Clinic, University of Tuebingen
  • 3Department of Radiology, University Clinic Tuebingen
Further Information

Publication History

accepted after revision June 22, 2009

Publication Date:
29 October 2009 (online)

Also available at
    Permissions and Reprints

Abstract

Except for traumatic or spontaneous pneumothorax, little information is known about exercise associated pleural pathologies. We present the case of a 22-year-old athlete with symptoms of musculoskeletal disorders of his upper back after a first league soccer match. Clinical examination initially showed a blockage of the costotransversal joints six and seven with subsequent muscular tension representing an interscapulovertebral pain syndrom. Temporary complete pain relief with following severe reoccurrence of symptomes led to further diagnostic procedures after 3 days. Contrast Enhanced Magnetic Resonance Images (CE-MRI) surprisingly revealed an intrathoracic tumenescence in front of the cardiac apex with surrounding pleural effusion. After excluding all alternative diagnosis for unclear pleurisy we assumed an exercise dependent local pleurisy with subsequent pleural effusion due to local friction by a posttraumatic intrathoracic hematoma. Several invasive and non-invasive therapeutical options were discussed in this rare case with a final decision for a conservative strategy. Seven weeks after injury the player was able to return to play. Even if musculoskeletal problems are most likely in high impact athletes, referred pain due to less common disorders has always to be kept in mind.

Key words

pleuritic pain - intrathoracic hematoma - pleural effusion - interscapulovertebral syndrom - sports

References

  • 1 Chang SC, Perng RP. The role of fiberoptic bronchoscopy in evaluating the causes of pleural effusions.  Arch Intern Med. 1989;  149 855-857
    CrossrefPubMedGoogle Scholar
  • 2 Diaz-Guzman E, Dweik RA. Diagnosis and management of pleural effusions: a practical approach.  Compr Ther. 2007;  33 237-246
    CrossrefPubMedGoogle Scholar
  • 3 Duysinx B, Nguyen D, Louis R, Cataldo D, Belhocine T, Bartsch P. Evaluation of pleural disease with 18-fluorodeoxglucose positron emission tomography imaging.  Chest. 2004;  125 489-4993
    CrossrefPubMedGoogle Scholar
  • 4 Frank W. Current diagnostic approach to pleural effusion.  Pneumonologie. 2004;  58 777-790
    PubMedGoogle Scholar
  • 5 Fromm B. Often an orthopaedic problem can manifest as chest pain. Cervical vertebrae syndrome mimics myocardial infarct.  MMW Fortschr Med. 2002;  144 31-33
    PubMedGoogle Scholar
  • 6 Goyle K, Walling AD. Diagnosing pericarditis.  Am Fam Physician. 2002;  66 1695-1702
    PubMedGoogle Scholar
  • 7 Gregory PL, Biswas AC, Batt ME. Musculuskeletal problems of the chest wall in athletes.  Sports Med. 2002;  32 235-250
    CrossrefPubMedGoogle Scholar
  • 8 Griffith JF, Rainer TH, Ching ASC, Law KL, Cocks RA, Metreweli C. Sonography compared with radiography in revealing acute rib fracture.  Am J Rad. 1999;  173 1603-1609
    PubMedGoogle Scholar
  • 9 Hogg K, Dawson DD, Mackway-Jones K. The emergency department utility of Simplify D-dimer to exclude pulmonary embolism in patients with pleuritic chest pain.  Ann Emerg Med. 2005;  46 305-310
    CrossrefPubMedGoogle Scholar
  • 10 Hull RD, Raskob GE, Carter CJ, Coates G, Gill GJ, Sackett DL. Pulmonary embolism in outpatients with pleuritic chest pain.  Arch Intern Med. 1988;  148 838-844
    CrossrefPubMedGoogle Scholar
  • 11 Karlson KA. Thoracic region pain in athletes.  Curr Sports Med. 2004;  3 53-74
    PubMedGoogle Scholar
  • 12 Kass S, Williams P, Reamy B. Pleurisy.  Am Fam Physician. 2007;  75 1357-1364
    PubMedGoogle Scholar
  • 13 Kramer U, Nael K, Fenchel M, Miller S. Magnetic Resonance Angiography of chest and abdomen.  Top Magn Reson Imaging. 2007;  18 105-115
    CrossrefPubMedGoogle Scholar
  • 14 Light RW. Diagnostic principles in pleural disease.  Eur Respir J. 1997;  10 476-481
    CrossrefPubMedGoogle Scholar
  • 15 Light RW. The undiagnosed pleural effusion.  Clin Chest Med. 2006;  27 309-319
    CrossrefPubMedGoogle Scholar
  • 16 Light RW. Management of pleural effusions.  J Formos Med Assoc. 2000;  99 523-531
    PubMedGoogle Scholar
  • 17 Liman ST, Kuzucu A, Tastepe AI, Ulasan GN, Topcu S. Chest injury due to blunt trauma.  Eur J Cardiothoracic Surg. 2003;  23 374-378
    CrossrefPubMedGoogle Scholar
  • 18 Loddenkemper R. Thorcoscopy – state of the art.  Eur Respir J. 1998;  11 213-221
    CrossrefPubMedGoogle Scholar
  • 19 Mallawathantri S, Lim WS, Kinnear W. Setting up a medical thoracoscopy service: safety and efficacy.  Thorax. 2004;  59 ((Suppl II)) 40-41
    PubMedGoogle Scholar
  • 20 Maskell NA, Gleeson FV, Davies RJ. Standard pleural biopsy versus CT-guided cutting needle biopsy for diagnosis of malignant disease in pleural effusions: a randomised controlled trial.  Lancet. 2003;  361 1326-1330
    CrossrefPubMedGoogle Scholar
  • 21 Medford A, Maskell N. Pleural effusion.  Postgrad Med J. 2005;  81 702-710
    CrossrefPubMedGoogle Scholar
  • 22 Metlay JP, Kapoor WN, Fine MJ. Does this patient have community acquired pneumonia? Diagnosing pneumonia by history and physical examination.  JAMA. 1997;  278 1440-1145
    CrossrefPubMedGoogle Scholar
  • 23 Miranda JC, Borges Rau C, Barros JA, Torrejais MM. Spontaneous chylothorax associated with light physical activity.  J Bras Pneumol. 2006;  32 599-602
    PubMedGoogle Scholar
  • 24 Partridge RA, Coley A, Bowie R, Woolard RH. Sports-related pneumothorax.  Ann Emerg Med. 1997;  30 539-541
    CrossrefPubMedGoogle Scholar
  • 25 Porcel JM, Light RW. Diagnostic approach to pleural effusion in adults.  Am Fam Physician. 2006;  73 1211-1220
    PubMedGoogle Scholar
  • 26 Soundappan SV, Holland AJ, Brown G. Sports-related pneumothorax in children.  Pediatr Emerg Care. 2005;  21 259-260
    CrossrefPubMedGoogle Scholar

Correspondence

Dr. R. Best

Orthopedic Clinic

University Clinic Tuebingen

Silcherstr. 5

72076 Tuebingen

Germany

Phone: +49/707/1298 64 61

Fax: +49/707/129 46 26

Email: raymond.best@med.uni-tuebingen.de

      >