Differential Diagnosis for Chest Pain

The patient presents with pain on the right side of the chest that worsens with deep breathing, accompanied by pain near the clavicle and shoulder. This symptomatology can be associated with various conditions, ranging from musculoskeletal issues to life-threatening emergencies. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Musculoskeletal Pain/Costochondritis: This condition involves inflammation of the cartilage that connects the ribs to the breastbone (sternum). The pain can be sharp and worsen with deep breathing or movement, fitting the patient's symptoms. The involvement of the clavicle and shoulder area could be referred pain or associated with the musculoskeletal strain.

• Other Likely Diagnoses

  • Pleurisy: Inflammation of the pleura, the two-layered membrane surrounding the lungs, can cause sharp chest pain that worsens with breathing. The pain can be localized to one side and may radiate to the shoulder or clavicle area.
  • Pneumonia: An infection in the lungs can cause chest pain, especially when taking deep breaths, along with other symptoms like fever, cough, and shortness of breath.
  • Pulmonary Embolism (less likely given the description but still a consideration): A blood clot in the lungs can cause sudden, sharp chest pain that worsens with deep breathing, though it typically presents with more systemic symptoms like tachypnea and tachycardia.

• Do Not Miss Diagnoses

  • Myocardial Infarction (MI): Although the pain description doesn't perfectly match the classic presentation of an MI (which is more central and radiates to the arm, jaw, or neck), any chest pain, especially if new onset, warrants consideration of cardiac causes due to the high stakes of missing an MI.
  • Pneumothorax: A collapsed lung can cause sudden, severe chest pain that worsens with breathing, and it's a medical emergency.
  • Aortic Dissection: A tear in the aorta's inner layer can cause severe, tearing chest pain that can radiate to the back or shoulder area. It's a rare but life-threatening condition.

• Rare Diagnoses

  • Tietze's Syndrome: Similar to costochondritis but involves the inflammation of the cartilages and surrounding tissues of the ribs. It's less common and can be difficult to distinguish from costochondritis.
  • Thoracic Outlet Syndrome: Compression of the nerves or blood vessels between the collarbone and first rib can cause pain in the shoulder and chest area, though it's less commonly associated with breathing difficulties.

Given the symptoms, an urgent care visit might be appropriate for initial evaluation if the patient is stable and the symptoms are not severe. However, if the patient experiences severe difficulty breathing, chest pain that feels like pressure or squeezing, or if the pain radiates to the arm, jaw, or neck, an ER visit is warranted due to the potential for life-threatening conditions. The decision should be based on the severity of symptoms and the patient's overall clinical presentation.