Differential Diagnosis for 70-year-old Female with Right Anterior Rib Pain
- Single most likely diagnosis: + Costochondritis: This condition, characterized by inflammation of the cartilage that connects the ribs to the breastbone, is a common cause of rib pain, especially in older adults. The patient's symptoms of pain with movement and worsening with palpation are consistent with costochondritis. The absence of trauma or injury and the gradual onset of symptoms also support this diagnosis.
- Other Likely diagnoses: + Musculoskeletal strain: Given the patient's history of osteoarthritis and the fact that she woke up with the discomfort, a musculoskeletal strain is a plausible explanation for her symptoms. The pain with movement and palpation could be indicative of a strain in the muscles or ligaments surrounding the ribs. + Rib fracture (stress or insufficiency fracture): Although the patient denies any trauma, stress or insufficiency fractures can occur without a significant traumatic event, especially in older adults with osteoporosis or osteopenia. The patient's history of osteoarthritis may increase her risk for these types of fractures.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed): + Pulmonary embolism: Although the patient does not have typical symptoms such as shortness of breath or chest pain, pulmonary embolism can present atypically, especially in older adults. The recent episode of dysuria could be a sign of a recent immobilization or infection, increasing the risk for pulmonary embolism. + Myocardial infarction: The patient's history of hypertension and hyperlipidemia increases her risk for cardiovascular disease. Atypical presentations of myocardial infarction, such as rib pain, can occur, especially in women and older adults. + Pneumonia: The patient denies any recent illnesses, but pneumonia can present with atypical symptoms, such as rib pain, especially in older adults.
- Rare diagnoses: + Tietze's syndrome: This is a rare condition characterized by inflammation of the cartilage and surrounding tissues of the ribs. It can present with symptoms similar to costochondritis, but it is less common. + Sickle cell crisis: Although the patient does not have a known history of sickle cell disease, it is essential to consider this diagnosis, especially if she has not been previously screened. Sickle cell crisis can present with rib pain due to vaso-occlusive crises affecting the bones. + Metastatic disease: The patient's age and history of multiple medical conditions increase her risk for cancer. Metastatic disease to the ribs can cause pain, although it is a less common cause of rib pain in this scenario.