Differential Diagnosis for Pleuritic Chest Pain
Single Most Likely Diagnosis
- Pulmonary Embolism (PE): This is often considered the most likely diagnosis for pleuritic chest pain due to its relatively high prevalence and the severity of the condition. Pleuritic chest pain is a classic symptom of PE, especially when accompanied by other signs such as tachypnea, tachycardia, and risk factors for thromboembolism.
Other Likely Diagnoses
- Pneumonia: Pleuritic chest pain can be a symptom of pneumonia, particularly when the infection involves the pleura. The pain is typically sharp and worsens with deep breathing or coughing.
- Pleuritis: Inflammation of the pleura (pleuritis) can cause sharp, stabbing chest pain that worsens with breathing. This can be due to various causes, including viral infections, autoimmune diseases, or as a complication of pneumonia.
- Acute Coronary Syndrome (ACS): While ACS typically presents with a dull, squeezing chest pain, some patients may experience pleuritic-type pain, especially if there is associated pericarditis.
Do Not Miss Diagnoses
- Pulmonary Embolism (already mentioned but emphasized here due to its critical nature): The risk of missing PE is high due to its variable presentation, and the consequences of a missed diagnosis can be fatal.
- Aortic Dissection: This is a medical emergency that can present with sudden, severe, tearing chest pain that may be pleuritic in nature. It requires immediate diagnosis and treatment.
- Pneumothorax: Spontaneous pneumothorax can cause sudden onset of pleuritic chest pain and shortness of breath. It is critical to diagnose and treat promptly to prevent further complications.
Rare Diagnoses
- Pulmonary Infarction: While not as common as other diagnoses, pulmonary infarction can occur due to various reasons, including PE, and may present with pleuritic chest pain.
- Diaphragmatic Pleuritis: Inflammation of the diaphragmatic pleura can cause pleuritic chest pain, often accompanied by shoulder pain due to referred pain via the phrenic nerve.
- Sarcoidosis: This autoimmune disease can affect the lungs and cause pleuritic chest pain among other symptoms, though it is less common than other diagnoses listed here.