Retrosternal: Meaning, Causes and Symptoms
Retrosternal refers to the area located behind the sternum (breastbone). The term describes an anatomical position or pain felt behind the breastbone.
Things worth knowing about "Retrosternal"
Retrosternal refers to the area located behind the sternum (breastbone). The term describes an anatomical position or pain felt behind the breastbone.
What does retrosternal mean?
Retrosternal is a medical term derived from Latin: retro (behind) and sternum (breastbone). It describes an anatomical location or the site of symptoms situated behind the breastbone. In clinical practice, the term is most commonly used in reference to pain or pressure felt in this area.
Anatomical Background
The sternum (breastbone) is a flat bone located at the center of the chest. Behind it lies the mediastinum, a region that contains several vital structures, including:
- The heart and major blood vessels (e.g., the aorta and vena cava)
- The trachea (windpipe) and main bronchi
- The esophagus (food pipe)
- Lymph nodes and the thymus gland
Diseases or changes affecting these structures can manifest as retrosternal symptoms.
Causes of Retrosternal Symptoms
Retrosternal pain or a sensation of pressure behind the breastbone can arise from a wide range of causes, varying from benign conditions to life-threatening emergencies.
Cardiac Causes
- Angina pectoris: Chest pain due to temporary reduced blood flow to the heart
- Myocardial infarction (heart attack): Persistent retrosternal pain, often radiating to the left arm, jaw, or back
- Pericarditis: Inflammation of the pericardium (the sac surrounding the heart)
Esophageal Causes
- Gastroesophageal reflux disease (GERD): Stomach acid rising into the esophagus causing heartburn and retrosternal burning
- Esophagitis: Inflammation of the esophagus
- Esophageal spasms: Cramp-like contractions of the esophageal muscles
Respiratory Causes
- Tracheitis: Inflammation of the trachea
- Pulmonary embolism: A blood clot in the lungs that can cause retrosternal pressure
- Pleuritis: Inflammation of the pleura (lining of the lungs)
Other Causes
- Mediastinitis (inflammation of the mediastinum)
- Mediastinal masses (e.g., tumors or cysts)
- Musculoskeletal conditions (e.g., costochondritis)
Symptoms and Clinical Presentation
Retrosternal symptoms can vary depending on the underlying cause:
- Pressure, tightness, or pain behind the breastbone
- Burning sensation (typical of heartburn or GERD)
- Stabbing or persistent pain (more typical of cardiac conditions)
- Radiation to the shoulder, arm, jaw, or back
- Difficulty swallowing (in esophageal disorders)
Diagnosis
Several diagnostic tests may be used to evaluate retrosternal symptoms:
- ECG (electrocardiogram): To assess heart activity and rule out cardiac events
- Blood tests: e.g., troponin levels when a heart attack is suspected
- Chest X-ray: To evaluate the lungs and mediastinum
- Endoscopy (gastroscopy): Direct visualization of the esophagus and stomach
- CT scan of the chest: Detailed imaging of thoracic structures
- Echocardiography: Ultrasound examination of the heart
When to Seek Medical Attention
Retrosternal pain should always be taken seriously. Call emergency services immediately (911 or local emergency number) if you experience:
- Sudden, severe pressure or tightness behind the breastbone
- Pain radiating to the arm, jaw, or back
- Shortness of breath, sweating, or nausea accompanying the pain
- Symptoms lasting more than a few minutes
Even recurring, less acute retrosternal discomfort warrants prompt medical evaluation to rule out serious underlying conditions.
References
- Fauci, A.S. et al. - Harrison's Principles of Internal Medicine. 21st edition. McGraw-Hill, 2022.
- World Health Organization (WHO) - Cardiovascular Diseases: www.who.int/health-topics/cardiovascular-diseases
- Kahrilas, P.J. - Gastroesophageal Reflux Disease. New England Journal of Medicine, 2008; 359:1700-1707.
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