Differential Diagnosis for Left Sided Breast Pain
Given the clinical history and imaging findings, the following differential diagnoses are considered:
- Single most likely diagnosis
- Musculoskeletal strain or costochondritis: This is a common cause of breast pain, especially if the pain is reproducible with movement or pressure on the chest wall. The normal imaging findings support this diagnosis, as musculoskeletal issues may not be visible on radiographs.
- Other Likely diagnoses
- Hormonal fluctuations or fibrocystic breast changes: These conditions are common in women and can cause cyclic or non-cyclic breast pain. The absence of abnormal findings on imaging does not rule out these diagnoses.
- Breast cysts or fibroadenomas: Although the imaging study did not identify any masses, small cysts or fibroadenomas may not be visible, especially if they are not causing significant distortion or are located in a subtle area.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Cardiac ischemia or myocardial infarction: Although the heart size is normal and the mediastinum is unremarkable, cardiac ischemia can present with atypical symptoms, including chest pain that may be referred to the breast area. This diagnosis is critical to consider, especially in patients with risk factors for cardiovascular disease.
- Pulmonary embolism: While the lungs are clear on the imaging study, a pulmonary embolism can cause sudden onset of chest pain, which may be referred to the breast area. This diagnosis requires prompt consideration and evaluation.
- Rare diagnoses
- Tietze's syndrome: This is a rare condition characterized by inflammation of the cartilages and surrounding tissues of the chest wall, which can cause chest pain that may be referred to the breast area.
- Sickle cell disease or other hematologic disorders: These conditions can cause chest pain due to vaso-occlusive crises or other mechanisms, although they are less common causes of breast pain.