Differential Diagnosis for Chest Pain
The patient presents with sharp chest pain and sensitivity in the skin of the armpit, left chest, back, and left neck. The pain is intermittent and described as sharp. Here is a categorized differential diagnosis:
Single Most Likely Diagnosis
- Costochondritis: This condition, also known as Tietze's syndrome, is characterized by sharp pains in the chest and is often accompanied by tenderness in the costochondral junctions. The patient's description of sharp chest pain and sensitivity in areas that could correspond to the distribution of intercostal nerves or costochondral junctions makes this a plausible diagnosis.
Other Likely Diagnoses
- Musculoskeletal Pain: Given the sharp nature of the pain and its location, musculoskeletal issues such as strained muscles in the chest wall or between the ribs could be a cause.
- Gastroesophageal Reflux Disease (GERD): Although the patient denies nausea, GERD can cause sharp chest pain, especially if it occurs at night and is related to eating or lying down.
- Precordial Catch Syndrome: This condition is characterized by sharp, stabbing pains in the chest that can be exacerbated by deep breathing or movement and can be related to the patient's description of sharp pain.
Do Not Miss Diagnoses
- Myocardial Infarction (MI): Although the patient's age and the nature of the pain (sharp and intermittent) are less typical for MI, it is crucial to consider this diagnosis due to its high morbidity and mortality. The absence of numbness, anxiety, or nausea does not rule out MI.
- Pulmonary Embolism (PE): This is another critical diagnosis to consider, as it can present with sharp chest pain, especially if it worsens with deep breathing. The patient's denial of symptoms at the time of encounter does not exclude this diagnosis.
- Aortic Dissection: A sharp, tearing chest pain that radiates to the back could indicate an aortic dissection, a life-threatening condition.
Rare Diagnoses
- Pneumothorax: Although less likely without a history of trauma or underlying lung disease, a spontaneous pneumothorax could cause sharp chest pain and should be considered, especially if the patient experiences shortness of breath or if physical examination reveals decreased breath sounds on one side.
- Herpes Zoster (Shingles): This condition can cause sharp pain and skin sensitivity before the rash appears, which could fit the patient's description of sensitivity in the skin. However, the absence of a clear dermatomal distribution and the lack of a rash make this less likely.