Differential Diagnosis for Left Sided Chest Tightness
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. The symptoms include sharp pains or aching in the chest, which can radiate to the arms, and are often reproducible with palpation. Given the location and nature of the pain described, costochondritis is a plausible explanation.
Other Likely Diagnoses
- Musculoskeletal strain: Strains or pulls in the muscles between the ribs or in the chest wall can cause pain that feels like it's coming from the chest and can radiate to the axilla. This type of injury could be due to overuse, trauma, or sudden movement.
- Intercostal neuralgia: This condition involves irritation of the nerves that run between the ribs, which can cause sharp, stabbing pains in the chest that may radiate to the axilla. The pain can be exacerbated by movement or pressure on the affected area.
Do Not Miss Diagnoses
- Myocardial infarction (MI): Although less likely given the reproducibility with palpation, it's crucial not to miss an MI, especially if the patient has risk factors. Chest pain that radiates to the arm can be a symptom of a heart attack.
- Pulmonary embolism (PE): While the description doesn't classically fit a PE, which often presents with sudden onset dyspnea and possibly chest pain that worsens with deep breathing, it's a condition that could be deadly if missed. The radiation to the axilla is less common but can occur.
- Pneumothorax: Spontaneous pneumothorax can cause sudden chest pain that may radiate and can be exacerbated by deep breathing or movement. It's less likely given the specific radiation pattern but is a critical diagnosis not to overlook.
Rare Diagnoses
- Tietze's syndrome variant involving the sternocostal joints: Similar to costochondritis but specifically involves inflammation of the sternocostal joints, which could cause localized pain and tenderness.
- Slipping rib syndrome: A condition where the ribs slip out of place, causing pain in the chest or upper abdomen that can radiate to the back or arms. It's less common and might not perfectly fit the described radiation pattern but is a rare cause of chest pain.
- Thoracic outlet syndrome: Involves compression of the nerves or blood vessels that pass into the thoracic outlet (the space between your collarbone and first rib). It can cause pain in the chest that radiates to the arm, but the specific pattern and palpation reproducibility might not perfectly align with this diagnosis.