wall. In Tietze’s syndrome, inflammation
at the junctions of the rib cartilages caus-
es pain on the front of the chest wall.
Pain within the chest may be caused by
pleurisy, as a result of bronchitis, pneu-
monia,or, rarely, pulmonary embolism.
Cancerous tumours of the lung (see lung
cancer; mesothelioma) may cause pain
as they grow and press on the pleura
and ribs. Acid refluxmay lead to heart-
burn, a burning pain behind the sternum.
The common heart disorder angina
pectoriscauses pain in the centre of the
chest that may spread outwards to the
throat, jaw, or arms. Myocardial infarc-
tion (heart attack) and acute pericarditis
both also produce severe pain in the
centre of the chest. Mitral valve prolapse
may cause sharp chest pain, usually on
the left side. Chest pain may also be a
result of anxietyand emotional stress
(see hyperventilation; panic attack).
chest thrustA first aidtechnique to
unblock the airway in cases of choking.
when abdominal thrusts would be dan-
gerous (such as in infants) or impossible
(such as in pregnant women). In a chest
thrust, the first-aider places a fist in the
other hand, and, pressing against the
victim’s lower breastbone, thrusts the
chest wall inwards
up to 5 times. The
pressure simulates
the coughing reflex
and may expel the
obstruction.
chest X-rayOne
of the most fre-
quently performed
medical tests, usu-
ally carried out to
examine the heart
or lungs to confirm
diagnoses of heart
disorders and lung
diseases. (See also
X-rays.)
Cheyne–Stokes respirationAn abnor-
mal pattern of breathing in which the
rate and depth of respiration varies.
Cheyne–Stokes respiration is character-
ized by repeated cycles, lasting a few
minutes, of deep, rapid breathing that
becomes slower and shallower and then
stops for 10–20 seconds. The patternmay be due to malfunction of the part
of the brain that controls breathing (as
occurs in some cases of strokeand head
injury). It may also occur as a result of
heart failureor in healthy people at high
altitudes, especially during sleep.
chickenpoxA common, mild infectious
disease (also called varicella) occurring
in childhood and characterized by a
rash and slight fever. In adults, chicken-
pox is rare but usually more severe. An
attack gives lifelong immunity, but the
virus remains dormant in nerves and
may reappear later in life to cause her-
pes zoster (shingles). The cause of
chickenpox is the varicella-zoster virus,
which is spread in airborne droplets. A
widespread rash develops 2–3 weeks
after infection, consisting of clusters of
small, red, itchy spots that become
fluid-filled blisters within a few hours.
After several days the blisters dry out to
form scabs. Scratching the blisters can
lead to secondary infection and scar-
ring. Paracetamolhelps reduce fever and
calaminelotion may be used to relieve
itching. In severe cases, aciclovir(an
antiviral drug) may be prescribed.
chigoeA painful, itchy, pea-sized swelling
caused by a sand flea that lives in sandy
soil in Africa and tropical America. The
flea penetrates the skin of the feet and
lays eggs. Chigoe fleas should be re-
moved with a sterile needle, and the
wounds treated with an antiseptic.
chilblainAn itchy, purple-red swelling,
usually on a toe or finger, caused by
excessive constriction of small blood
vessels below the surface of the skin in
cold weather. Chilblains are most com-
mon in the young and the elderly, and
women are more susceptible to them.
They generally heal without treatment
child abuseThe maltreatment of chil-
dren. Child abuse may take the form of
physical injury, sexual abuse, emotional
mistreatment, and/or neglect; it occurs
at all levels of society. Being deprived or
ill-treated in childhood may predispose
people to repeat the pattern of abuse
with their own children. Children who are
abused or at risk of abuse may be placed
in care while the health and social ser-
vices decide on the best course of action.
childbed feverSee puerperal fever.CHEST THRUST CHILDBED FEVERC
CHEST X-RAY
Spine Heart RibDiaphragm Lung