Differential Diagnosis for 30-year-old Female with Intermittent Chest Pain and Bilateral Breast Burning Sensation

• Single most likely diagnosis:
  • Costochondritis: This condition, also known as Tietze's syndrome, is characterized by inflammation of the cartilage that connects the ribs to the breastbone, leading to chest pain and tenderness. The patient's symptoms of intermittent chest pain and bilateral breast burning sensation, along with her daily gym workouts, make this diagnosis plausible as costochondritis can be exacerbated by physical activity.
• Other Likely diagnoses:
  • Precordial Catch Syndrome: A condition that causes sharp, stabbing chest pain, often related to the muscles and bones in the chest wall. It can be triggered by deep breathing, movement, or even anxiety, which might align with the patient's symptoms and lifestyle.
  • Gastroesophageal Reflux Disease (GERD): Although more commonly associated with heartburn and regurgitation, GERD can sometimes present with chest pain. The patient's consumption of pre-workout and creatine daily might influence her digestive system, potentially leading to GERD symptoms.
  • Breast Conditions (e.g., Mastitis, Fibrocystic Changes): Given the bilateral breast burning sensation and the ordered ultrasound, it's essential to consider breast-related conditions. Mastitis or fibrocystic breast changes could explain the breast symptoms, though they might not fully account for the chest pain.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Acute Coronary Syndrome (ACS): Although less common in young females, ACS, including myocardial infarction, must be considered due to the potential for fatal outcomes. Risk factors such as family history, smoking, or other cardiovascular risk factors would increase the likelihood, but even without them, it's crucial not to miss this diagnosis.
  • Pulmonary Embolism (PE): A life-threatening condition that can present with chest pain. While the patient's age and presentation might make this less likely, any history of recent immobilization, family history of clotting disorders, or other risk factors would necessitate a thorough evaluation for PE.
  • Aortic Dissection: A rare but critical condition where the inner layer of the aorta tears. It often presents with severe, tearing chest pain but can sometimes have a more subtle onset. Given the potential for catastrophic outcomes, it must be considered in the differential diagnosis.
• Rare diagnoses:
  • Spontaneous Coronary Artery Dissection (SCAD): A rare cause of myocardial infarction, more common in young women without traditional cardiovascular risk factors. It could explain the chest pain but would be less likely to cause bilateral breast burning sensations.
  • Tietze's Syndrome with an atypical presentation: While costochondritis is considered the single most likely diagnosis, an atypical presentation affecting the lower ribs or with unusual symptomatology could be classified under rare diagnoses if it doesn't fit the typical pattern of costochondritis.