Differential Diagnosis for Neuropathic-like Reproducible Palpable Pain on the Left Side of the Thorax
- Single Most Likely Diagnosis
- Postherpetic neuralgia or herpes zoster: This condition often presents with severe, neuropathic pain in a dermatomal distribution, which could be localized to one side of the thorax. The pain can be exacerbated by light touch or palpation, making it a plausible explanation for the patient's symptoms.
- Other Likely Diagnoses
- Costochondritis or Tietze's syndrome: These conditions involve inflammation of the cartilages and joints that connect the ribs to the sternum, leading to sharp pains that can be reproduced by palpation. They are common causes of chest pain and could easily present with neuropathic-like qualities.
- Intercostal neuralgia: This condition involves irritation or damage to the nerves that run between the ribs, which can cause sharp, stabbing pains that are worsened by movement or palpation.
- Rib fracture or trauma: Trauma to the chest can cause fractures or soft tissue injuries that result in localized, reproducible pain.
- Do Not Miss Diagnoses
- Myocardial infarction (MI) or acute coronary syndrome: Although the pain of MI is typically described as squeezing or pressure, it can sometimes present atypically, especially in women or diabetic patients, with neuropathic-like qualities. Missing this diagnosis could be fatal.
- Pulmonary embolism: This condition can cause sudden, severe chest pain that may be worsened by deep breathing or movement. While not typically described as neuropathic, the severity and potential for fatal outcome make it a "do not miss" diagnosis.
- Pneumothorax: A collapsed lung can cause sharp, stabbing chest pain that worsens with movement or deep breathing. The pain can be localized and reproducible, making it a critical diagnosis not to overlook.
- Rare Diagnoses
- Thoracic outlet syndrome: This condition involves compression of the nerves and/or blood vessels that pass through the thoracic outlet (the space between the collarbone and first rib), leading to pain and other symptoms in the chest and arm.
- Sickle cell crisis: In patients with sickle cell disease, a crisis can cause severe, neuropathic-like pain due to vaso-occlusion and tissue ischemia, which can be localized to the chest.
- Osteonecrosis or bone tumors of the ribs: Although rare, these conditions can cause localized, severe pain that may have neuropathic qualities due to nerve involvement or compression.