Differential Diagnosis for Right Rib Pain in the Back
Single most likely diagnosis
- Costochondritis: This condition, characterized by inflammation of the cartilage that connects the ribs to the breastbone, is a common cause of rib pain that worsens with deep breathing. The consistent and months-long duration of the pain, along with its exacerbation by breathing in, supports this diagnosis.
Other Likely diagnoses
- Musculoskeletal strain: Strain or injury to the muscles or ligaments in the back or around the ribs could cause pain, especially if it involves the area where the ribs meet the spine or the muscles between the ribs.
- Rib fracture: Although less likely without a history of trauma, a stress fracture or an occult fracture could cause persistent pain that worsens with movement or deep breathing.
- Precordial catch syndrome: This condition involves sharp, stabbing pains in the chest or back that can be exacerbated by breathing and can be recurrent.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Pulmonary embolism: While less common, pulmonary embolism can present with sudden onset of chest or back pain that worsens with deep breathing. It's crucial to consider this diagnosis due to its high mortality rate if untreated.
- Pneumonia or pleuritis: Infections involving the lung or the lining around the lung (pleura) can cause pain that worsens with breathing. These conditions require prompt diagnosis and treatment.
- Aortic dissection: A tear in the aorta's inner layer can cause severe, tearing chest or back pain that can radiate to the back and worsen with movement or breathing.
Rare diagnoses
- Tietze's syndrome: Similar to costochondritis but involves swelling of the cartilage, this condition can cause chest pain that radiates to the back and worsens with breathing.
- Sickle cell crisis: In individuals with sickle cell disease, a crisis can cause severe pain episodes, including pain in the chest or back, due to sickling of red blood cells.
- Osteoporotic vertebral fracture: Although more common in the elderly or those with known osteoporosis, a vertebral fracture could cause back pain that worsens with movement or breathing.