Differential Diagnosis for Teenage Girl with Shortness of Breath and Chest Pain

Given the symptoms of shortness of breath and chest pain in a teenage girl that have been intermittent for the last 5 months, with negative troponin and D-dimer, the following differential diagnoses are considered:

• Single Most Likely Diagnosis

  • Anxiety or Panic Disorder: This is a common cause of intermittent chest pain and shortness of breath in adolescents, especially in the absence of other significant findings like positive troponin or D-dimer. The chronic nature of the symptoms over 5 months also supports a diagnosis that is more related to psychological factors rather than an acute cardiac or pulmonary issue.

• Other Likely Diagnoses

  • Asthma: Although not immediately life-threatening, asthma can cause recurring episodes of shortness of breath and chest tightness. The intermittent nature of the symptoms could align with asthma, especially if triggered by specific allergens or irritants.
  • Gastroesophageal Reflux Disease (GERD): GERD can cause chest pain that may be mistaken for cardiac issues. The pain can be intermittent and may worsen with certain foods or positions.
  • Costochondritis: Inflammation of the cartilage that connects the ribs to the breastbone can cause sharp chest pain, which can be intermittent and may be exacerbated by movement or deep breathing.

• Do Not Miss Diagnoses

  • Pulmonary Embolism (PE): Although the D-dimer is negative, which makes PE less likely, it's crucial not to miss this diagnosis due to its high mortality rate. A negative D-dimer does not entirely rule out PE, especially if there are other risk factors or clinical suspicions.
  • Pericarditis: Inflammation of the pericardium can cause chest pain that may be sharp and can change with position. It's a condition that needs prompt recognition and treatment to prevent complications like cardiac tamponade.
  • Myocarditis: Inflammation of the heart muscle can cause chest pain and shortness of breath. It's a serious condition that requires early diagnosis and treatment to prevent long-term cardiac damage.

• Rare Diagnoses

  • Pneumothorax: A collapsed lung can cause sudden and severe shortness of breath and chest pain. It's less common in the absence of trauma but can occur spontaneously, especially in tall, thin individuals.
  • Mitral Valve Prolapse: A condition where the two valve flaps of the mitral valve do not close smoothly or evenly but instead bulge (prolapse) upward into the left atrium when the heart contracts. It can cause chest pain, shortness of breath, and palpitations, though it's often asymptomatic.
  • Ehlers-Danlos Syndrome: A group of disorders that affect connective tissues supporting the skin, bones, blood vessels, and many other organs and tissues. It can lead to aortic root dilatation and increased risk of aortic dissection, presenting with chest pain.