Differential Diagnosis for Sharp Rib Pain

• Single most likely diagnosis
  • Costochondritis: This is the most common cause of sharp rib pain, characterized by inflammation of the cartilage that connects the ribs to the breastbone. It is often related to strain or overuse and can be exacerbated by movements that involve the chest wall.
• Other Likely diagnoses
  • Rib fracture: A fracture of one or more ribs can cause sharp pain, especially with deep breathing or movement. This is often due to trauma but can also occur from coughing or severe osteoporosis.
  • Precordial catch syndrome: This condition involves sharp, stabbing pain in the chest that can radiate to the ribs, often related to a specific position or movement.
  • Intercostal muscle strain: Strain of the muscles between the ribs can cause sharp pain, especially with movement or deep breathing.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
  • Pulmonary embolism: Although less common, a pulmonary embolism can cause sharp chest pain that may radiate to the ribs, especially if the embolism is located peripherally. It is crucial to consider this diagnosis due to its high mortality rate if untreated.
  • Pneumothorax: A collapsed lung can cause sharp, stabbing chest pain that may be referred to the ribs, worsened by deep breathing. This condition requires immediate medical attention.
  • Myocardial infarction: In some cases, a heart attack can present with sharp pain that may be perceived as coming from the ribs, especially if the inferior wall of the heart is involved.
• Rare diagnoses
  • Tietze's syndrome: Similar to costochondritis but involves swelling of the cartilage, which can cause sharp pain.
  • Sickle cell crisis: In patients with sickle cell disease, a crisis can cause sharp pain due to vaso-occlusive episodes affecting the chest.
  • Osteonecrosis of the ribs: Although rare, this condition can cause sharp pain due to the death of bone tissue in the ribs.