Differential Diagnosis for Shortness of Breath with Back Pain
Single Most Likely Diagnosis
- Musculoskeletal strain: This is often the most common cause of back pain and can be associated with shortness of breath if the pain is severe enough to cause anxiety or if the strain affects the thoracic spine, potentially irritating the nerves that control breathing.
Other Likely Diagnoses
- Pulmonary embolism with referred pain: While the primary symptom of a pulmonary embolism is shortness of breath, it can sometimes cause referred pain in the back, especially if the embolism is large and affects the upper parts of the lungs.
- Pneumonia: Inflammation of the lung tissue can cause both shortness of breath and back pain, especially if the pneumonia is located near the spine or if there is associated pleurisy (inflammation of the lining surrounding the lungs).
- Chronic obstructive pulmonary disease (COPD) exacerbation: Patients with COPD can experience shortness of breath and may also have back pain due to chronic coughing or musculoskeletal strain from using accessory muscles for breathing.
Do Not Miss Diagnoses
- Aortic dissection: A life-threatening condition where the inner layer of the aorta tears, causing severe back pain that can radiate to the chest and shortness of breath if the dissection involves the aortic arch or affects blood flow to the lungs.
- Pneumothorax: Air in the pleural space can cause the lung to collapse, leading to shortness of breath and sharp chest pain that can be referred to the back.
- Myocardial infarction (heart attack): While typically presenting with chest pain, some myocardial infarctions can cause back pain and shortness of breath, especially if the inferior wall of the heart is involved.
Rare Diagnoses
- Spinal cord compression or tumor: Although rare, spinal cord compression or a tumor in the spine can cause back pain and, if it affects the nerves controlling breathing, can lead to shortness of breath.
- Osteoporotic vertebral fracture: In patients with osteoporosis, a vertebral fracture can cause sudden back pain and, if the fracture is in the upper thoracic spine, can potentially irritate nerves affecting breathing, leading to shortness of breath.
- Epidural abscess: A collection of pus in the epidural space surrounding the spinal cord can cause back pain, fever, and shortness of breath if it compresses the spinal cord or nerves controlling respiration.