Differential Diagnosis for 88y Female with Rib Pain Post Fall
- Single most likely diagnosis
- Musculoskeletal strain or bruising: Given the history of a fall and the absence of visible fractures on the X-ray, musculoskeletal strain or bruising of the chest wall is a plausible cause for the rib pain. The mildly coarse interstitial reticular changes could be incidental or related to another process but do not directly suggest an acute cause for the pain.
- Other Likely diagnoses
- Costochondritis: This condition, which involves inflammation of the cartilage that connects the ribs to the breastbone, could be exacerbated by a fall and cause rib pain.
- Pulmonary contusion: Although the X-ray does not show an acute cardiopulmonary process, a pulmonary contusion could present with delayed symptoms and might not be immediately visible on an X-ray.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Aortic dissection: Although less likely given the X-ray findings, aortic dissection is a life-threatening condition that can present with chest pain after trauma. It requires immediate diagnosis and treatment.
- Pulmonary embolism: This condition can be difficult to diagnose based on X-ray alone and requires consideration in any patient with chest pain, especially after a fall which could lead to immobilization and increased risk of thromboembolism.
- Pneumothorax: A small pneumothorax might not be visible on an initial X-ray, especially if the patient is not in a perfect position or if the pneumothorax is small. It's crucial to consider this diagnosis, especially in the context of trauma.
- Rare diagnoses
- Osteoporotic vertebral fracture: While the X-ray focused on the chest, osteoporotic fractures can occur in the spine and might refer pain to the chest area.
- Rib stress fracture: More common in athletes but possible in anyone with repetitive stress or a fall, especially in osteoporotic bones.
- Sickle cell crisis: If the patient has sickle cell disease, a crisis could be triggered by the stress of a fall, leading to chest pain.