Differential Diagnosis for 16-year-old Female with Chest Pain
- Single most likely diagnosis
- Costochondritis: This condition is characterized by sharp pains in the chest, worse with palpation, and is often seen in adolescents. The patient's symptoms of sharp anterior left-sided chest pain, reproducible with palpation, and absence of other alarming features make this a plausible diagnosis.
- Other Likely diagnoses
- Musculoskeletal strain: Given the patient's history of residing in a detention center and potential for physical activity or altercations, musculoskeletal strain is a possible cause of her chest pain.
- Gastroesophageal reflux disease (GERD): The patient's episode of vomiting and sharp chest pain could be related to GERD, especially if she has been experiencing stress or eating spicy foods.
- Anxiety or panic disorder: The patient's history of drug abuse and current living situation may contribute to anxiety or panic disorders, which can manifest as sharp chest pain and shortness of breath.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pulmonary embolism (PE): Although the patient denies any recent trauma or immobility, her history of drug abuse increases her risk for PE. The presence of shortness of breath and sharp chest pain warrants consideration of this potentially life-threatening condition.
- Myocardial infarction (MI): Despite the patient's young age and lack of family history, her history of cocaine use increases her risk for MI. The normal EKG does not entirely rule out MI, and further evaluation may be necessary.
- Pneumothorax: The patient's sharp chest pain and shortness of breath could be indicative of a pneumothorax, especially if she has experienced any trauma or has a history of lung disease.
- Rare diagnoses
- Pneumomediastinum: This condition, characterized by air in the mediastinum, can cause sharp chest pain and is often seen in young adults. However, it is a rare condition and would require further imaging to diagnose.
- Spontaneous coronary artery dissection (SCAD): This rare condition can cause myocardial infarction and is often seen in young women. However, it is a rare diagnosis and would require further evaluation, including coronary angiography, to confirm.