Suggest Treatment For Pain Under Right Rib Cage

Posted on Fri, 8 May 2015

Question: It started with a pain in my right rib just below breast. I was coughing and the pain got worse. It felt like a broken rib. It has been x-rayed and I've been informed that there is no fracture. This has been going on for 2 months. Then the pain in the lung and rib intensified. Sneezes, coughing and blowing of the nose intensifies this pain. I have also been experiencing, low grade fever off and on, dizziness, blurred vision, fogginess in my head, general verbal confusion (inability to say words that are even simple), headaches, heaviness, and constant pain in my right lung. and lack of balance. Today, I was driving and did not have the ability to stay in my XXXXXXX without severe concentration. Even with that it was difficult. I am a farmer and rancher and very fit and athletic. I work around cattle and pigs, dust in hay, manure, and mouse droppings, and bird droppings. These symptoms have intensified in the last two weeks with today being the worse. I am currently taking lyrica 50 mg, citalopram 20 mg, singulair 10 mg, and losartin 25 mg. I also have two leaking heart valves, which haven't caused any problems.

Answered by Dr. Ram Choudhary (1 hour later)

Brief Answer:
get advised investigations

Detailed Answer:
Hi
Welcome to Healthcare magic.
Fever and right lower chest pain may be due to a problem in gall bladder may be infection or gall bladder stones.
Another possibility is of congestive hepatomegaly if the heart valve function has worsened in which case you will also have some swelling in the feet.
Still other possibilities of some chronic infections also there like tuberculosis, fungal infections etc.
You should get investigations for further assessment. Complete blood count, CRP, ESR, liver function test, Ultrasound of whole abdomen are highly advisable for you. Also get a physical clinical examination by a local physician after investigations.
I hope the advise will be helpful for you.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ram Choudhary (15 hours later)

I should have reported that my gallbladder removed 7 years ago. I have not had any swelling in my feet. I am concerned about the possibility of having a fungal infection called cryptococcois. Approximately a year ago, a friend offered to sell 10 of her sheep to me. It sounded like a good deal. Little did I know they were infected with coccidiosis. I lost about 10 of my ewes and several lambs before I realized what was happening. I treated their water numerous times with corid, but still had problems. I got rid of all my sheep three weeks ago. I immediately, started cleaning the pen. ( I had cleaned this pen before selling the sheep also.) Dust was flying everywhere. I did wear a paper mask and safety goggles but the dust still got into my lungs and eyes. Would you still suggest the same tests or something different since you have this information. Thanks, XXXX

Answered by Dr. Ram Choudhary (8 hours later)

Brief Answer:
update investigation

Detailed Answer:
Hi
Welcome back.
If gall bladder has been removed then no question of gall bladder stones but duct stones and stricture still possible.
In view of possibilities of severe of exposure you may be having some difficult to detect infection.
Histoplasmosis, coccidiomycosis, cryptococcosis or tuberculosis are pretty high probabilities.
Please get Complete blood counts, blood cultures, ESR, CRP, LFT, ECHO and Contrast CT chest and abdomen and a consult with Infectious disease specialist.
I hope the advise will be helpful for you.

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Above answer was peer-reviewed by : Dr. Shanthi.E