Differential Diagnosis
The provided radiology report indicates a normal heart size, unremarkable mediastinum, clear lungs, and no acute skeletal abnormalities, with no cause for pain identified. Based on this information, the following differential diagnoses can be considered:
- Single most likely diagnosis
- Musculoskeletal strain or sprain: This is a common cause of pain that may not be visible on radiologic imaging, especially if the injury is not severe enough to cause significant bone or soft tissue abnormalities.
- Other Likely diagnoses
- Overuse injury or repetitive strain: Similar to musculoskeletal strain, overuse injuries might not have radiologic correlates, especially in the early stages.
- Stress fracture: Although the report mentions no acute skeletal abnormality, stress fractures can be subtle and might not be immediately visible on standard radiographs.
- Soft tissue injury (e.g., muscle or tendon injury): These types of injuries often do not show up on plain radiographs but can cause significant pain.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pulmonary embolism: Although the lungs are reported as clear, pulmonary embolism can sometimes present with minimal or no findings on plain chest radiographs. It's a critical diagnosis to consider due to its high mortality rate if untreated.
- Aortic dissection: The mediastinum is described as unremarkable, but aortic dissection can be a subtle finding, especially if it's not extensive. This condition is life-threatening and requires immediate intervention.
- Spinal cord injury or compression: Even though no acute skeletal abnormality is noted, spinal injuries can sometimes be radiographically occult, especially if they involve soft tissues or are not associated with significant bony displacement.
- Rare diagnoses
- Osteonecrosis: This condition can cause pain and might not be immediately visible on standard radiographs, especially in early stages.
- Bone tumors: Although rare, bone tumors can cause pain and might not have distinctive radiographic features, especially if they are small or of a type that does not significantly alter bone architecture.
- Inflammatory or autoimmune conditions (e.g., rheumatoid arthritis, lupus): These conditions can cause musculoskeletal pain and might not have specific radiologic findings in early stages or between flare-ups.