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, often worsened by movement or deep breathing, which aligns with the patient's symptoms. The absence of significant family history of heart disease, negative X-ray and EKG, and the nature of the pain (sharp and anterior) support this diagnosis.
- Other Likely diagnoses:
- Panic Attack: Given the patient's history of drug abuse and current residence in a detention center, which could be a source of stress, a panic attack is a plausible explanation for her symptoms, including shortness of breath and sharp chest pain.
- Gastroesophageal Reflux Disease (GERD): The sharp chest pain and episode of vomiting could be indicative of GERD, especially if the patient has been experiencing stress or has a history of irregular eating habits.
- Musculoskeletal Pain: The sharp nature of the pain and its location could also suggest musculoskeletal pain, possibly due to strain or overuse, although the patient denies any injury or trauma.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
- Pulmonary Embolism (PE): Although less common in younger patients, PE is a critical diagnosis to consider, especially given the patient's history of drug abuse, which increases the risk of thromboembolic events. The presence of shortness of breath and sharp chest pain warrants consideration of this diagnosis.
- Myocardial Infarction: While rare in teenagers, myocardial infarction should not be entirely ruled out, especially with a history of drug abuse that could affect cardiovascular health.
- Pneumothorax: The patient's symptoms of sharp chest pain and shortness of breath, combined with a history of drug abuse (which could potentially lead to lung damage), make pneumothorax a critical diagnosis to consider, despite the negative X-ray.
- Rare diagnoses:
- Spontaneous Coronary Artery Dissection (SCAD): This is a rare condition that could present with sharp chest pain and is more common in young women, although it is less likely given the negative EKG and lack of family history of heart disease.
- Pericarditis: Inflammation of the pericardium could cause sharp chest pain, but the absence of fever, cough, or radiation of pain makes this less likely. However, it remains a consideration in the differential diagnosis due to its potential severity.