Differential Diagnosis for Chest Pain
The patient presents with sharp chest pain that radiates to the neck, worsens with deep breathing, and improves when sitting up. Considering the patient's history and symptoms, the differential diagnosis can be categorized as follows:
Single most likely diagnosis
- D. pericarditis: The patient's symptoms of sharp chest pain that worsens with deep breathing and improves when sitting up are classic for pericarditis. The recent history of a sinus infection could be a precipitating factor, as viral infections are a common cause of pericarditis.
Other Likely diagnoses
- A. costochondritis: The patient's sharp chest pain could be consistent with costochondritis, especially given the recent history of a respiratory infection. However, the radiation of pain to the neck and worsening with deep breathing are more suggestive of pericarditis.
- E. pneumonia: Although the patient's sinus infection has resolved, it's possible that he has developed pneumonia, which could cause pleuritic chest pain. However, the lack of other respiratory symptoms such as cough or shortness of breath makes this less likely.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- B. myocardial infarction: Although the patient's symptoms are not typical for myocardial infarction, his family history of coronary artery disease and significant smoking history make it essential to consider and rule out this diagnosis. Myocardial infarction can present atypically, especially in younger patients or those with fewer risk factors.
- C. peptic ulcer disease: The patient's worsening pain when lying down could be consistent with peptic ulcer disease, although the sharp and pleuritic nature of the pain is less typical. However, a perforated peptic ulcer can be life-threatening and should be considered in the differential diagnosis.
Rare diagnoses
- Pulmonary embolism: Although not directly suggested by the patient's symptoms, pulmonary embolism can present with pleuritic chest pain and should be considered in the differential diagnosis, especially given the patient's recent history of immobility (e.g., recovering from a sinus infection).
- Aortic dissection: This is a rare but life-threatening condition that can present with sharp chest pain. Although the patient's symptoms are not typical for aortic dissection, it should be considered in the differential diagnosis, especially given the patient's history of hypertension.