Differential Diagnosis for Sharp Left Upper/Mid Abdominal Pain Worsened by Deep Breaths

• Single Most Likely Diagnosis
  • Pleuritic Chest Pain or Pneumonia: The pain worsening with deep breaths suggests involvement of the pleura. Given the location in the left upper/mid abdomen, which can be referred pain from the lower chest, pleuritic chest pain or pneumonia affecting the left lower lobe of the lung is a strong consideration.
• Other Likely Diagnoses
  • Gastroesophageal Reflux Disease (GERD): Although GERD typically presents with heartburn and regurgitation, severe cases can cause sharp chest or upper abdominal pain that worsens with deep breathing or lying down.
  • Peptic Ulcer Disease: A peptic ulcer in the stomach or duodenum can cause sharp, burning pain in the upper abdomen. While not typically worsened by deep breaths, the pain can radiate and be confused with pleuritic pain.
  • Splenic Infarct or Rupture: Given the left upper quadrant location, conditions affecting the spleen, such as an infarct or rupture, should be considered, especially if there's a history of trauma or underlying conditions like sickle cell disease.
• Do Not Miss Diagnoses
  • Pulmonary Embolism: Although more commonly associated with sudden onset dyspnea, tachypnea, and chest pain, pulmonary embolism can present atypically, especially in the elderly or those with underlying lung disease. The worsening of pain with deep breaths could be mistaken for pleuritic chest pain.
  • Aortic Dissection: This is a medical emergency that can present with severe, tearing chest or abdominal pain. While the pain is classically described as migrating, any severe pain that worsens with deep breaths or movement should prompt consideration of aortic dissection.
  • Perforated Visrus: A perforation in the stomach or intestines can lead to peritonitis, presenting with severe abdominal pain. While not typically pleuritic, the pain can be so severe that any movement, including deep breathing, exacerbates it.
• Rare Diagnoses
  • Diaphragmatic Hernia: A rare condition where there's a protrusion of abdominal organs into the thoracic cavity through a defect in the diaphragm. This can cause abdominal pain that worsens with breathing or movement.
  • Pancreaticopleural Fistula: A rare complication of pancreatitis where there's a fistulous connection between the pancreas and the pleural space, leading to pleuritic chest pain and abdominal pain.