Differential Diagnosis for Chest and Back Pain Radiating to the Neck and Jaw

The patient's symptoms of chest and back pain radiating to the right side of her neck and jaw area could indicate several conditions. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Acute Coronary Syndrome (ACS)/Myocardial Infarction (MI): The patient's symptoms, especially the radiation of pain to the jaw and neck, are classic for myocardial infarction, particularly in women, where the presentation can be more atypical than the traditional chest pain seen in men.

• Other Likely Diagnoses

  • Musculoskeletal Pain: Strain or sprain in the chest or back muscles could cause pain that radiates to the neck and jaw, especially if the patient has recently engaged in unusual physical activity.
  • Gastroesophageal Reflux Disease (GERD): GERD can cause chest pain that may radiate to the neck and jaw, often accompanied by symptoms of heartburn and regurgitation.
  • Pulmonary Embolism: While less common, pulmonary embolism can present with chest pain and, in some cases, radiate to the neck and jaw, especially if the embolism is large and causes significant pulmonary hypertension.

• Do Not Miss Diagnoses

  • Aortic Dissection: A life-threatening condition where the inner layer of the aorta tears, causing severe, tearing chest pain that can radiate to the back and, occasionally, to the jaw and neck. It's crucial to consider this diagnosis due to its high mortality rate if not promptly treated.
  • Pneumothorax: A collapsed lung can cause sudden, severe chest pain that radiates to the shoulder and neck. It's less likely to radiate to the jaw but is a critical diagnosis not to miss due to its potential for respiratory compromise.
  • Esophageal Rupture: A rare but potentially fatal condition that can cause severe chest pain radiating to the neck and back, often accompanied by difficulty swallowing and severe retching.

• Rare Diagnoses

  • Pericarditis: Inflammation of the pericardium, the sac surrounding the heart, can cause chest pain that may improve with leaning forward and worsen with lying down. It's less common for pericarditis pain to radiate to the jaw.
  • Costochondritis: Inflammation of the cartilage that connects the ribs to the sternum can cause chest pain, but it's typically more localized and less likely to radiate to the jaw and neck.
  • Cervical Radiculopathy: Nerve root irritation in the cervical spine can cause pain that radiates from the neck down to the arm and, occasionally, to the chest, but it's less common for this pain to be the primary symptom.

Each of these diagnoses requires careful consideration based on the patient's full clinical presentation, including history, physical examination, and diagnostic tests such as ECG, troponin levels, and imaging studies.