Differential Diagnosis for Sharp Pleuritic Chest Pain
Single Most Likely Diagnosis
- Pulmonary Embolism (PE) with a low probability score: Although the d-dimer is negative, which has a high sensitivity for PE, it is not 100% specific, especially in patients with a low pre-test probability. However, given the clinical presentation of sharp pleuritic chest pain, it remains a consideration, albeit less likely.
Other Likely Diagnoses
- Costochondritis: Inflammation of the cartilage that connects the ribs to the sternum, which can cause sharp pleuritic chest pain, especially with deep breathing.
- Pleurisy: Inflammation of the pleura, which can cause sharp chest pain that worsens with deep breathing, and can be due to various causes such as viral infections.
- Musculoskeletal strain: Strain or injury to the muscles or ribs, which can cause sharp chest pain, especially with movement or deep breathing.
Do Not Miss Diagnoses
- Aortic Dissection: A life-threatening condition where the inner layer of the aorta tears, which can cause severe, sharp chest pain. Although the ECG is normal, and the chest X-ray is clear, it's crucial to consider this diagnosis due to its high mortality rate if missed.
- Pneumothorax: A collapsed lung, which can cause sharp pleuritic chest pain and can be life-threatening if not promptly treated. A normal chest X-ray does not entirely rule out a small pneumothorax.
- Pericarditis: Inflammation of the pericardium, which can cause sharp chest pain that may improve with sitting up and leaning forward. Although the ECG is normal, pericarditis can sometimes present with a normal ECG early in the course.
Rare Diagnoses
- Pulmonary Laceration: A tear in the lung tissue, which can cause sharp chest pain, especially with deep breathing.
- Diaphragmatic Injury: An injury to the diaphragm, which can cause sharp chest pain, especially with deep breathing or movement.
- Esophageal Rupture: A tear in the esophagus, which can cause severe, sharp chest pain, especially with swallowing or deep breathing.