What is the cause of intermittent left-sided chest pain, rated 1/10, with tenderness over the sternochondral junction of ribs 3-4, in a 48-year-old male, 220 pounds, 5 feet 7.6 inches, with no pain on deep breathing?

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Last updated: February 24, 2025 • View editorial policy

Differential Diagnosis for 48-year-old Male with Chest Pain

Single Most Likely Diagnosis

  • Costochondritis: This condition is characterized by inflammation of the cartilage that connects the ribs to the sternum, which can cause chest pain and tenderness, especially over the sternochondral joints. The patient's symptoms of dull, intermittent pain and tenderness over the sternochondral rib 3-4 area are consistent with costochondritis.

Other Likely Diagnoses

  • Musculoskeletal strain: Given the patient's weight and potential for strain on the chest wall, musculoskeletal strain could be a contributing factor to his pain.
  • Gastroesophageal reflux disease (GERD): Although the patient does not report pain on deep breathing, GERD can cause chest pain that is often described as dull and intermittent.
  • Anxiety or stress-related chest pain: The patient's pain is described as a 1/10, which could suggest a non-cardiac, stress-related etiology.

Do Not Miss Diagnoses

  • Acute coronary syndrome (ACS): Although the patient's pain is not typical for ACS (dull, intermittent, and low severity), it is essential to consider this diagnosis due to the potential for catastrophic consequences if missed.
  • Pulmonary embolism (PE): The absence of pain on deep breathing makes PE less likely, but it should still be considered, especially if the patient has risk factors such as obesity or recent immobility.
  • Aortic dissection: This is a rare but life-threatening condition that can cause chest pain, often described as severe and tearing.

Rare Diagnoses

  • Tietze's syndrome: This is a rare condition characterized by inflammation of the cartilage of the ribs, similar to costochondritis, but it can cause more severe pain and swelling.
  • Sternocostal joint infection: This is a rare condition that can cause chest pain and tenderness, often accompanied by fever and swelling.
  • Rib fracture: Although the patient does not report any trauma, a stress fracture or osteoporotic fracture could cause chest pain and tenderness.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.