Differential Diagnosis for Pain Around Rib Cage, Sweaty, Nausea with Vomiting

Single Most Likely Diagnosis

• Acute Coronary Syndrome (ACS): This condition, which includes myocardial infarction (heart attack), is a leading cause of chest pain and can radiate to the rib cage area. Symptoms such as sweating, nausea, and vomiting are common, especially in women or individuals with diabetes. The pain is often described as a pressure or tightness.

Other Likely Diagnoses

• Gastroesophageal Reflux Disease (GERD): GERD can cause chest pain that may be perceived around the rib cage, especially after eating. It can also lead to nausea and vomiting. The pain is typically burning in nature and can worsen with lying down.
• Pulmonary Embolism (PE): While less common, PE can present with sudden onset of chest pain, sweating, nausea, and vomiting. The pain is often sharp and worsens with deep breathing.
• Costochondritis: Inflammation of the cartilage that connects the ribs to the breastbone can cause sharp pains in the chest that may feel like they are coming from around the rib cage. It can be accompanied by nausea and vomiting if the pain is severe.
• Panic Attack: Panic attacks can cause chest pain or discomfort that may be perceived around the rib cage, along with sweating, nausea, and vomiting due to the intense anxiety.

Do Not Miss Diagnoses

• Aortic Dissection: A life-threatening condition where the inner layer of the aorta tears. It can cause severe, tearing chest pain that radiates to the back and can be associated with sweating, nausea, and vomiting. Immediate diagnosis and treatment are crucial.
• Esophageal Rupture: A rare but dangerous condition that can cause severe chest pain, vomiting, and can lead to shock if not promptly treated.
• Pneumonia: Especially if the pain is pleuritic (worsens with deep breathing), pneumonia should be considered, as it can lead to severe complications if not treated.

Rare Diagnoses

• Herpes Zoster (Shingles): Can cause pain around the rib cage due to the involvement of the intercostal nerves. It is usually accompanied by a rash but can occur without (zoster sine herpete).
• Tietze's Syndrome: A rare inflammatory condition affecting the cartilages of the ribs, causing chest pain and swelling.
• Sickle Cell Crisis: In individuals with sickle cell disease, a crisis can cause severe pain episodes, including around the rib cage, due to vaso-occlusion.

Each of these diagnoses requires careful consideration of the patient's history, physical examination, and diagnostic tests to determine the underlying cause of their symptoms.