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): This is the most likely diagnosis given the combination of chest pain, tightness, shortness of breath, and radiation to the back of the neck. The pleuritic nature of the pain could be due to pulmonary embolism, but in a middle-aged gentleman, ACS is more likely.
Other Likely Diagnoses
- Pulmonary Embolism (PE): The pleuritic nature of the pain and shortness of breath make PE a likely diagnosis. The radiation to the back of the neck could be due to a large PE.
- Pneumonia or Pleurisy: The pleuritic pain and shortness of breath could be due to an infectious or inflammatory process in the lungs.
- Gastroesophageal Reflux Disease (GERD): GERD can cause chest pain that radiates to the back and is worsened by lying down or eating certain foods.
Do Not Miss Diagnoses
- Aortic Dissection: A tear in the aorta can cause severe, tearing chest pain that radiates to the back and can be fatal if not promptly treated.
- Pulmonary Embolism with Hemodynamic Instability: A large PE can cause hemodynamic instability, which is life-threatening and requires immediate treatment.
- Cardiac Tamponade: Fluid accumulation in the pericardial sac can cause chest pain, shortness of breath, and lightheadedness, and can be fatal if not promptly treated.
Rare Diagnoses
- Esophageal Rupture: A rare but life-threatening condition that can cause severe chest pain and shortness of breath.
- Spontaneous Pneumothorax: A rare condition that can cause sudden onset of chest pain and shortness of breath.
- Pericarditis: Inflammation of the pericardium can cause chest pain that is worsened by lying down or deep breathing.