Differential Diagnosis for Pleuritic Chest Pain with Pain on Palpation in an 18-year-old Female
- Single most likely diagnosis:
- Pneumonia: This is a common cause of pleuritic chest pain, especially in young adults. The pain on palpation could be due to the inflammation of the pleura.
- Other Likely diagnoses:
- Pulmonary embolism (less likely in this age group but possible): Although less common in young adults, pulmonary embolism can cause pleuritic chest pain and should be considered, especially if there are risk factors such as recent travel, immobility, or family history.
- Costochondritis: This condition, which involves inflammation of the cartilage that connects the ribs to the breastbone, can cause chest pain that worsens with palpation.
- Pneumothorax: A collapsed lung can cause pleuritic chest pain and could be considered, especially if there's a history of trauma or lung disease.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
- Cardiac causes (e.g., myocardial infarction, pericarditis): Although rare in young adults, cardiac causes of chest pain can be life-threatening and must be ruled out.
- Aortic dissection: This is a rare but potentially fatal condition that requires immediate medical attention.
- Pulmonary embolism (again, due to its potential severity): Despite being less likely, the potential severity of pulmonary embolism warrants its inclusion in this category.
- Rare diagnoses:
- Pleuritic pain due to autoimmune diseases (e.g., lupus, rheumatoid arthritis): These conditions can cause pleuritic chest pain but are less common in this age group without other systemic symptoms.
- Diaphragmatic rupture or eventration: These are rare conditions that could cause pleuritic chest pain, especially if there's a history of trauma.
- Mediastinitis: Inflammation of the tissues in the mediastinum can cause chest pain, including pleuritic pain, but this is a rare condition.