Differential Diagnosis for 2 Months of Pain Below the Left Breast in a Smoker
- Single Most Likely Diagnosis
- Musculoskeletal pain (costochondritis or intercostal muscle strain): This is a common cause of chest wall pain, especially given the location below the breast. Smoking can contribute to musculoskeletal issues due to decreased blood flow and oxygenation to muscles and bones.
- Other Likely Diagnoses
- Gastroesophageal reflux disease (GERD): Smokers are at increased risk for GERD, which can cause chest pain, especially after eating or at night. The pain can radiate to the area below the breast.
- Pulmonary issues (e.g., pneumonia, pleurisy): Smokers are more prone to respiratory infections and conditions that can cause pain in the chest area, including below the breast.
- Gastritis or peptic ulcer disease: These conditions can cause upper abdominal pain that may radiate to the chest area, including below the breast, and are more common in smokers.
- Do Not Miss Diagnoses
- Myocardial infarction (heart attack): Although less common in younger individuals, smoking significantly increases the risk of cardiovascular disease. Chest pain, even if atypical in location, should always prompt consideration of cardiac causes.
- Pulmonary embolism: Smokers have an increased risk of blood clots and pulmonary embolism, which can cause sudden onset of chest pain.
- Lung cancer: Given the patient's smoking history, lung cancer must be considered, especially if the pain is persistent and accompanied by other symptoms like coughing, weight loss, or shortness of breath.
- Rare Diagnoses
- Pneumothorax: While more common in tall, thin males, a pneumothorax (collapsed lung) can occur in anyone and cause sudden chest pain. Smoking increases the risk of lung diseases that can lead to pneumothorax.
- Esophageal rupture or perforation: A serious condition that can cause severe chest pain and is more likely in individuals with a history of violent vomiting or procedures involving the esophagus.
- Diabetic radiculopathy or thoracic outlet syndrome: These conditions can cause chest pain but are less common and might not be directly related to smoking. However, diabetes is more prevalent in smokers, and thoracic outlet syndrome can be related to musculoskeletal issues exacerbated by smoking.