Differential Diagnosis for 71-year-old Female with Atraumatic Right Breast Pain and Dizziness

• Single most likely diagnosis:
  • Costochondritis: This condition, also known as Tietze's syndrome, is characterized by inflammation of the cartilage that connects the ribs to the breastbone, which can cause chest and breast pain. The pain can be sharp and may worsen with movement or deep breathing. Given the atraumatic nature of the pain and the age of the patient, this is a plausible diagnosis. Dizziness could be unrelated or due to pain-related anxiety.
• Other Likely diagnoses:
  • Musculoskeletal strain: Strain or pull in the muscles of the chest wall could cause breast pain and might be accompanied by dizziness if the pain is severe enough to cause vasovagal symptoms.
  • Breast cysts or fibrocystic changes: These are common in women and can cause breast pain. While they might not directly cause dizziness, significant pain could potentially lead to lightheadedness.
  • Referral pain from the spine: Issues like a herniated disk in the thoracic spine could refer pain to the breast area and might also cause dizziness due to nerve compression or irritation affecting balance.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
  • Myocardial infarction (MI): Although the pain is described as atraumatic and localized to the breast, MI can present atypically, especially in women, with pain referred to the chest, arm, or even the breast. Dizziness could be a symptom of decreased cardiac output.
  • Pulmonary embolism (PE): This is another condition that could present with sudden onset of chest pain and dizziness due to decreased oxygenation and potential hypotension.
  • Pneumothorax: Spontaneous pneumothorax could cause sudden chest pain and shortness of breath, potentially leading to dizziness if severe.
• Rare diagnoses:
  • Mondor's disease: A rare condition characterized by thrombophlebitis of the superficial veins of the breast and chest wall, which can cause pain and might be accompanied by systemic symptoms like dizziness in severe cases.
  • Breast cancer with metastasis: Although rare for breast cancer to present with dizziness as a primary symptom, advanced cancer could cause a variety of systemic symptoms, including pain and dizziness, especially if there are metastases affecting other systems.