Differential Diagnosis
Given the impression that no cause for pain was identified, the following differential diagnoses can be considered:
- Single most likely diagnosis
- Musculoskeletal strain or injury: This is a common cause of pain that may not be visible on radiographs, especially if the injury is soft tissue-related or not severe enough to cause significant bone or joint abnormalities.
- Other Likely diagnoses
- Gastrointestinal issues (e.g., gastritis, gastroesophageal reflux disease): These conditions can cause chest or abdominal pain and may not be evident on a radiograph focused on the lungs and skeletal system.
- Pulmonary embolism (with a normal chest radiograph): While the lungs are described as clear, a pulmonary embolism can sometimes present with a normal chest X-ray, especially if it's small or peripheral.
- Costochondritis or Tietze's syndrome: Inflammation of the cartilage that connects the ribs to the breastbone can cause chest pain and may not be visible on radiographs.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Aortic dissection: Although the mediastinum is described as unremarkable, a small or early dissection might not be visible on a standard chest X-ray. This condition is life-threatening and requires immediate attention.
- Pneumothorax (small or anterior): A small pneumothorax, especially if it's anterior, might not be evident on a standard upright chest X-ray.
- Cardiac conditions (e.g., myocardial infarction, pericarditis): These can cause chest pain and may not always have radiographic findings, especially early in the course of the disease.
- Rare diagnoses
- Pneumomediastinum: Air in the mediastinum can cause chest pain and might not always be visible if the amount of air is small.
- Esophageal rupture or perforation: A rare but serious condition that can cause severe chest pain and may not have obvious radiographic signs, especially if the perforation is small.
- Spinal or neurologic causes of pain (e.g., spinal cord injury, multiple sclerosis): These conditions can cause pain and may not be evident on a chest or abdominal radiograph, requiring further imaging or clinical evaluation for diagnosis.