History of Present Illness (HPI)
The patient is a 22-year-old female presenting with a primary complaint of persistent breastbone pain, which has been ongoing for the last year. The pain is localized to the chest wall, sharp in nature, and occurs only with movement, with a pain rating of 0/10 at rest and increasing to 10/10 at its worst. The pain is bilateral and temporal, with an onset 7 years ago, characterized as throbbing. She denies radiation of pain, nausea, double vision, and sensitivity to light and sound. The pain is worse in the afternoon and is exacerbated by activity, with rest providing relief. The pain scale ranges from 0/10 currently to 10/10 at its worst.
Differential Diagnosis
- Single Most Likely Diagnosis
- Costochondritis: This condition is characterized by inflammation of the cartilage that connects the ribs to the breastbone, leading to sharp pains in the chest wall that worsen with movement and improve with rest. The patient's symptoms of sharp, movement-induced pain localized to the chest wall are consistent with costochondritis.
- Other Likely Diagnoses
- Tietze's Syndrome: Similar to costochondritis but involves the inflammation of the cartilage and surrounding tissues, leading to swelling and tenderness. The patient's symptoms could fit this diagnosis, especially given the bilateral and temporal nature of the pain.
- Musculoskeletal Strain: Given the exacerbation of pain with activity and relief with rest, a musculoskeletal strain in the chest wall muscles could be a plausible diagnosis.
- Do Not Miss Diagnoses
- Acute Coronary Syndrome: Although less likely in a young female without risk factors, it is crucial not to miss this diagnosis. The presentation can sometimes be atypical, and the consequences of missing it are severe.
- Pulmonary Embolism: Sudden onset of chest pain, especially if it worsens with movement, could suggest a pulmonary embolism, which is a medical emergency.
- Pneumothorax: Spontaneous pneumothorax can cause sharp chest pain that worsens with movement, and it requires immediate medical attention.
- Rare Diagnoses
- Sickle Cell Crisis: If the patient has sickle cell disease, a crisis could cause severe chest pain due to vaso-occlusion in the chest wall.
- Hypertrophic Cardiomyopathy: This condition can cause chest pain, especially with exertion, due to the thickened heart muscle obstructing blood flow.
- Mitral Valve Prolapse: While often asymptomatic, mitral valve prolapse can cause chest pain, usually due to mitral regurgitation or associated conditions like mitral annular disjunction.