Differential Diagnosis for Chest Pain
The patient's symptoms of chest pain, tightness, shortness of breath, lightheadedness, radiation to the back of the neck, and pleuritic nature of the pain suggest a range of possible diagnoses. Here is a categorized differential diagnosis:
Single Most Likely Diagnosis
- Acute Coronary Syndrome (ACS): The combination of chest pain with tightness, shortness of breath, and radiation to the back of the neck is highly suggestive of ACS, which includes conditions such as myocardial infarction (MI). The pleuritic component could be due to pulmonary congestion or associated pericarditis.
Other Likely Diagnoses
- Pulmonary Embolism (PE): The presence of pleuritic chest pain, shortness of breath, and lightheadedness could indicate a pulmonary embolism, especially if there are risk factors such as recent immobilization, cancer, or thrombophilia.
- Aortic Dissection: Chest pain that radiates to the back and is associated with shortness of breath and lightheadedness could be indicative of an aortic dissection, particularly if the pain is described as tearing or ripping.
- Pericarditis: Pleuritic chest pain and shortness of breath could be due to pericarditis, which might also cause lightheadedness if there is associated cardiac tamponade.
Do Not Miss Diagnoses
- Pneumothorax: A pleuritic chest pain with shortness of breath could indicate a pneumothorax, which is a medical emergency requiring immediate intervention.
- Esophageal Rupture: Severe chest pain that is pleuritic and associated with difficulty breathing could be due to an esophageal rupture, a condition that requires prompt diagnosis and treatment.
- Cardiac Tamponade: This condition, which can result from pericarditis or other causes, presents with chest pain, shortness of breath, and lightheadedness due to impaired cardiac filling.
Rare Diagnoses
- Pulmonary Artery Dissection: Although rare, this condition could present with similar symptoms to a pulmonary embolism or aortic dissection, including chest pain and shortness of breath.
- ** Mediastinal Emphysema**: This condition, which can result from esophageal rupture or other causes, might present with pleuritic chest pain and shortness of breath.
- Spontaneous Coronary Artery Dissection (SCAD): A rare cause of acute coronary syndrome, particularly in younger women without traditional cardiovascular risk factors, presenting with sudden onset chest pain.