Differential Diagnosis for a 52-year-old Woman with Left-Sided Chest Pain

Single Most Likely Diagnosis

• Musculoskeletal Chest Pain: Given the resolution of pain with ibuprofen (an NSAID), this diagnosis is highly plausible. Musculoskeletal pain can mimic cardiac or pulmonary issues but typically responds well to anti-inflammatory medications.

Other Likely Diagnoses

• Gastroesophageal Reflux Disease (GERD): Chest pain that radiates to the back and is not relieved by rest or worsened by exertion could be indicative of GERD, especially if the pain is related to eating or positional.
• Pulmonary Embolism (less likely given the lack of other symptoms but still a consideration): Although less likely due to the absence of typical symptoms like shortness of breath or tachypnea, and the fact that the pain is somewhat relieved by NSAIDs, it cannot be entirely ruled out without further investigation.
• Costochondritis: Inflammation of the cartilage that connects the ribs to the breastbone can cause sharp pains in the chest that may radiate to the back and can be tender to the touch.

Do Not Miss Diagnoses

• Acute Coronary Syndrome (ACS): Despite a normal ECG and troponin, ACS cannot be completely ruled out, especially in a woman of this age group. Atypical presentations are more common in women, and serial troponins along with clinical judgment are crucial.
• Aortic Dissection: Although rare, aortic dissection is a life-threatening condition that presents with severe, tearing chest pain radiating to the back. The absence of typical risk factors (like hypertension) does not rule out this diagnosis.
• Pulmonary Embolism: As mentioned earlier, while less likely, it's crucial not to miss this potentially fatal condition.

Rare Diagnoses

• Pericarditis: Inflammation of the pericardium can cause chest pain that may improve with sitting up and leaning forward. It's less common but should be considered, especially if there's a pericardial friction rub on examination.
• Esophageal Spasm or Esophageal Rupture: These conditions can cause severe chest pain but are less common. Esophageal rupture is a medical emergency.
• Pneumothorax: Spontaneous pneumothorax can cause sudden onset of chest pain and shortness of breath, more common in tall, thin individuals or those with lung disease.

Each of these diagnoses requires careful consideration of the patient's history, physical examination, and possibly further diagnostic testing to determine the cause of the chest pain accurately.