Differential Diagnosis for Sudden-Onset Chest Pain in a 16-Year-Old Boy
Single Most Likely Diagnosis
- Aortic dissection or related aortic pathology: The patient's symptoms of sudden-onset chest pain radiating to the neck and jaw, along with a murmur and physical examination findings of mild scoliosis and pectus carinatum, suggest a possible underlying connective tissue disorder such as Marfan syndrome. This condition increases the risk of aortic dissection.
Other Likely Diagnoses
- Acute pericarditis: The patient's chest pain and shortness of breath could be indicative of pericarditis, especially if there's an associated pericardial friction rub, which is not mentioned but should be considered.
- Myocardial infarction: Although less common in teenagers, myocardial infarction should be considered, especially if there are risk factors such as hypercoagulable states or severe hypertension.
Do Not Miss Diagnoses
- Dissecting aortic aneurysm: This is a life-threatening condition that requires immediate diagnosis and treatment. The patient's symptoms and physical findings make this a critical diagnosis not to miss.
- Pulmonary embolism: Although less likely given the patient's age and presentation, pulmonary embolism is a potentially fatal condition that must be considered, especially if there are underlying risk factors for thromboembolism.
- Spontaneous pneumothorax: Given the patient's physical characteristics (tall and thin), spontaneous pneumothorax is a possibility, especially if the patient has underlying lung disease.
Rare Diagnoses
- Spontaneous coronary artery dissection: This is a rare cause of myocardial infarction that could present with sudden chest pain.
- Mitral valve prolapse with associated complications: While mitral valve prolapse is not uncommon, complications such as severe mitral regurgitation or chordae tendineae rupture could present acutely and require urgent attention.