Pain under the rib case, either left or right, is not an uncommon symptom. However, the are many causes for pain in this location and the underlying problem can sometimes be difficult to diagnose. It is important to understand that the rib cage does not only lie over the thoracic (chest) cavity. It also covers the upper part of the abdomen. Therefore pain under the rib cage may be due to problems with the chest and abdominal organs.
Causes of Pain Under Left Rib Cage
Pain under the left rib cage can be either left-sided chest pain or left upper quadrant (LUQ) abdominal pain. The chest cavity ends a short distance under the nipple (in men) where the diaphragm divides the chest and abdominal cavities. Therefore the organs in this area may be the cause of the pain. This includes:
- Lung and bronchus
- Heart and great blood vessels
There are a number of conditions of the chest wall that can cause superficial pain over the left ribcage. This may sometimes extend deeper under the left ribcage. Broken ribs, shingles, trauma and breast pain are some of the possible causes of chest wall pain.
Heart and Blood Vessels
The heart lies in the center of the chest and extends more to the left. It therefore causes central to left-sided chest pain and the pain with certain cardiac conditions may extend down the left arm.
- Angina pectoris: Cardiac pain when the blood supply to the heart muscle is insufficient for its needs.
- Heart attack: Death of a portion of the the heart muscle due to obstruction of blood flow to the heart.
- Aortic dissection: Tearing of the inner lining of the aorta with pooling of blood in the aortic wall.
- Pericarditis: Inflammation of the lining around the heart.
Lungs and Airways
The left lung and left bronchi may also be the cause of pain under the left rib cage. The pain is usually exacerbated during breathing and some conditions may be accompanied by a cough.
- Bronchitis: Inflammation of the bronchi often caused by an infection or in chronic cases it is due to cigarette smoking.
- Pneumonia: Inflammation of the lung usually due to an infection.
- Pleuritis: Inflammation of the lining around the lungs (pleura).
The esophagus (food pipe) runs from the throat to the stomach. Food and fluid passes down it and into the stomach when the lower esophageal sphincter (LES) opens. The esophagus runs down the chest almost in the center but slightly to the left.
- GERD: Gastroesophageal reflux disease is where the stomach acid flows backward into the esophagus.
- Esophagitis: Inflammation of the esophagus often due to GERD.
- Esophageal Ulcers: Open sores that form in the esophagus wall.
Most of the stomach lies just under the lower part of the left ribcage within the abdominal cavity. It shifts position when standing up or lying down. The stomach extends below the lower border of the rib cage.
- Gastritis: Inflammation of the stomach mainly caused by H.pylori bacteria infection and the excessive use of NSAIDs.
- Stomach Ulcers: Open sores that form in the stomach wall often due to severe gastritis.
- Hiatal Hernia: Portion of the upper stomach protrudes into the chest cavity through the esophageal opening in the diaphragm.
The spleen serves as a reservoir for blood and filters out harmful microbes from it. Almost the entire spleen is tucked under the lower part of the left rib cage.
- Ruptured spleen: Break in the surface of the spleen which can allow for blood to leak out of it.
- Splenitis: Inflammation of the spleen that can arise with trauma or infections and the latter may cause a spleen abscess.
- Splenomegaly: Enlargement of the spleen which may only cause pain when very severely enlarged and inflamed.
The left kidney is almost entirely shielded under the left ribcage towards the side (flank) and back. Unlike the other organs in the left upper quadrant of the abdomen, the kidney does not usually move significantly with a change in position.
- Pyelonephritis: Infection of the kidney mainly due to bacteria.
- Kidney stones: Hard masses that form in the kidney usually formed from the precipitates of urine.
- Nephropathy: A number of different kidney conditions that may be caused by drugs, alcohol, diabetes and other diseases.
- Kidney infarct: Death of a portion of the kidney tissue usually due to a blockage in the renal artery.
The splenic flexure, the bend in the colon where the transverse colon becomes the descending colon, is usually tucked under the left rib cage. It shifts to some extent when standing or lying down.
- Trapped Gas: A common site where intestinal gas is trapped within the colon.
- Inflammatory Bowel Disease (IBD): Inflammation of the bowel due to an autoimmune defect.
- Diverticulitis: Inflammation of outpouchings that form in the colon.
- Fecal Impaction: Hardened stool that blocks the colon.
Although many of the conditions discussed above can be serious and even fatal, the main concern is with cardiac conditions and a heart attack in particular. For this reason it is important to differentiate cardiac pain from non-cardiac pain.
- Cardiac pain is central in the chest but may be felt slightly towards the left.
- The pain can radiate down the left arm, up to the left jaw or down to the middle of the upper abdomen.
- Dizziness, shortness of breath, excessive sweating and paleness are common symptoms that are seen in a heart attack.
- Heart attack pain is usually described as crushing or constricting in nature.
- Angina pectoris may occur as episodes for weeks, months or even years before the heart attack.
Due to the serious nature of cardiac pain, any indication that pain under the left rib cage may be due to the heart should be treated as a medical emergency. Even if there is uncertainty about the source of the pain, it should be considered as cardiac pain until it can be otherwise proven. Sometimes cardiac pain is atypical and may be mistaken for acid reflux, stomach pain and breastbone pain.