Differential Diagnosis for Unilateral Chest Pain

• Single most likely diagnosis
  • Musculoskeletal strain: This is often the most common cause of unilateral chest pain, resulting from overuse or injury to the muscles and bones of the chest wall.
• Other Likely diagnoses
  • Pneumonia: Infection of the lung can cause unilateral chest pain, especially if it involves the pleura.
  • Pulmonary embolism: A blood clot in the lungs can cause sudden, severe unilateral chest pain, often accompanied by shortness of breath.
  • Pleurisy: Inflammation of the pleura, the lining surrounding the lungs, can cause sharp, unilateral chest pain that worsens with breathing.
  • Costochondritis: Inflammation of the cartilage that connects the ribs to the breastbone can cause unilateral chest pain, often reproducible with palpation.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Myocardial infarction (heart attack): Although more commonly associated with central chest pain, myocardial infarction can occasionally present with unilateral chest pain, especially in women or diabetic patients.
  • Aortic dissection: A tear in the aorta can cause severe, tearing unilateral chest pain that radiates to the back.
  • Pneumothorax: Collapse of the lung can cause sudden, severe unilateral chest pain and shortness of breath.
  • Esophageal rupture: A tear in the esophagus can cause severe, unilateral chest pain that worsens with swallowing.
• Rare diagnoses
  • Pneumomediastinum: Air in the mediastinum can cause unilateral chest pain, often accompanied by a feeling of chest fullness.
  • Diaphragmatic rupture: A tear in the diaphragm can cause unilateral chest pain, often accompanied by abdominal symptoms.
  • Thoracic outlet syndrome: Compression of the nerves and blood vessels between the neck and shoulder can cause unilateral chest pain, often accompanied by arm symptoms.