Differential Diagnosis for Right Chest Tightness with Pain

The patient presents with acute onset of sharp pain to the right back, difficulty breathing, and right chest tightness. Given her medical history of hypertension and diabetes, the following differential diagnoses are considered:

• Single Most Likely Diagnosis
  • Pulmonary Embolism (PE): Although the EKG is normal, PE can present with sudden onset of sharp chest pain and difficulty breathing. The patient's history of hypertension and diabetes may increase her risk for thromboembolic events.
• Other Likely Diagnoses
  • Musculoskeletal Pain: The sharp pain to the right back could be due to musculoskeletal strain or costochondritis, which is inflammation of the cartilage that connects the ribs to the breastbone.
  • Pneumonia: Although the abdominal exam is unremarkable, pneumonia can cause chest pain and difficulty breathing. The patient's symptoms could be due to a lower lobe pneumonia.
  • Gastroesophageal Reflux Disease (GERD): GERD can cause chest pain and difficulty breathing, especially if the patient has a history of gastrointestinal issues.
• Do Not Miss Diagnoses
  • Aortic Dissection: This is a life-threatening condition that requires immediate attention. Although the patient's EKG is normal, aortic dissection can present with sudden onset of severe chest or back pain.
  • Myocardial Infarction (MI): Although the EKG is normal, it's essential to consider MI, especially in a patient with a history of hypertension and diabetes. MI can present with atypical symptoms, including sharp chest pain and difficulty breathing.
  • Pulmonary Hypertension: This condition can cause chest pain and difficulty breathing, especially in patients with a history of hypertension and diabetes.
• Rare Diagnoses
  • Pneumothorax: A spontaneous pneumothorax can cause sudden onset of sharp chest pain and difficulty breathing. Although rare, it's essential to consider this diagnosis, especially if the patient has a history of lung disease.
  • Esophageal Rupture: This is a rare but life-threatening condition that requires immediate attention. Esophageal rupture can cause severe chest pain and difficulty breathing.