Differential Diagnosis for Chest Wall Pain
The following is a comprehensive differential diagnosis for chest wall pain, categorized for clarity and emphasis on critical conditions.
- Single Most Likely Diagnosis
- Costochondritis: This is the most common cause of chest wall pain, characterized by inflammation of the cartilage that connects the ribs to the sternum. It is often related to trauma, overuse, or viral infections.
- Other Likely Diagnoses
- Musculoskeletal strain: Strains or pulls in the muscles of the chest wall can cause significant pain, often related to physical activity or heavy lifting.
- Rib fracture: Fractures of the ribs can cause sharp, localized pain and are usually the result of trauma.
- Tietze's syndrome: Similar to costochondritis but involves the inflammation of the cartilages and the adjacent bones, leading to pain and swelling.
- Do Not Miss Diagnoses
- Myocardial infarction (MI): Although chest wall pain is typically not the primary symptom of an MI, atypical presentations can occur, especially in women, diabetics, and the elderly. Missing an MI can be fatal.
- Pulmonary embolism (PE): A life-threatening condition where a blood clot lodges in the lungs, which can sometimes present with chest wall pain, especially if the clot is peripherally located.
- Pneumothorax: Air in the pleural space can cause chest pain that may be perceived as coming from the chest wall, and it requires immediate medical attention.
- Rare Diagnoses
- Sickle cell crisis: Patients with sickle cell disease can experience episodes of severe pain, including chest pain, due to vaso-occlusive crises.
- Osteomyelitis or osteitis of the ribs or sternum: Infections of the bone can cause localized pain and are more common in immunocompromised patients or those with a history of trauma.
- Tumors of the chest wall: Both benign and malignant tumors can cause chest wall pain, though they are less common causes.
Each of these diagnoses has distinct characteristics and risk factors, and a thorough history, physical examination, and diagnostic testing are essential for accurate diagnosis and appropriate management.