Differential Diagnosis for 70-year-old Female with Right Anterior Rib Pain
Single Most Likely Diagnosis
- Costochondritis: This condition, also known as Tietze's syndrome, is characterized by inflammation of the cartilage that connects the ribs to the breastbone, leading to pain in the chest wall. The patient's symptoms of pain with movement and worsening with palpation, without any history of trauma, make this a plausible diagnosis. The absence of systemic symptoms such as fever or rash also supports this diagnosis.
Other Likely Diagnoses
- Musculoskeletal Strain: Given the patient's age and history of osteoarthritis, a musculoskeletal strain could be a possible cause of her rib pain, especially if she has been engaging in unusual physical activity.
- Gastroesophageal Reflux Disease (GERD) Exacerbation: Although the patient denies abdominal pain, an exacerbation of GERD could potentially cause chest pain that might be referred to the rib area.
- Osteoarthritis: The patient's known history of osteoarthritis could contribute to her rib pain, especially if the joints involved are those that connect the ribs to the vertebrae or sternum.
Do Not Miss Diagnoses
- Pulmonary Embolism: Although the patient does not report shortness of breath or other typical symptoms, pulmonary embolism can sometimes present atypically, especially in the elderly. The sudden onset of pain without a clear cause warrants consideration of this potentially life-threatening condition.
- Myocardial Infarction: Chest pain, even if localized to the rib area, should always prompt consideration of myocardial infarction, especially in a patient with a history of hypertension and hyperlipidemia.
- Pneumonia: The patient denies fever and recent illness, but pneumonia can sometimes present without typical symptoms, especially in the elderly.
Rare Diagnoses
- Tietze's Syndrome with Involvement of the Xiphoid Process: A rare condition where the xiphoid process becomes inflamed, causing chest pain.
- Sickle Cell Crisis: If the patient has sickle cell disease (not mentioned in the history), a crisis could cause rib pain due to vaso-occlusive episodes affecting the bones.
- Multiple Myeloma: A rare condition where cancer of the plasma cells in the bone marrow could lead to bone pain, including rib pain, though this would typically be accompanied by other systemic symptoms.