Differential Diagnosis for Left Sided Chest Wall Pain

Single Most Likely Diagnosis

• Costochondritis: This condition, also known as Tietze's syndrome, is characterized by inflammation of the cartilages and bones in the chest wall. It is a common cause of chest pain that worsens with inspiration and movement, and often resolves spontaneously. The fact that the pain is worse with inspiration and resolves on its own makes costochondritis a likely diagnosis.

Other Likely Diagnoses

• Musculoskeletal strain: Given the patient's age and the nature of the pain, a musculoskeletal strain or injury to the muscles or ribs could be a plausible explanation. Such strains can cause pain that worsens with movement or deep breathing.
• Precordial catch syndrome: This is a condition that causes sharp, stabbing pain in the chest, often worse with deep breathing. It is more common in younger individuals and can resolve spontaneously.

Do Not Miss Diagnoses

• Pulmonary embolism: Although less likely given the spontaneous resolution and the specific characteristics of the pain, pulmonary embolism is a life-threatening condition that must be considered in any differential diagnosis of chest pain. It can cause pain that worsens with inspiration (pleuritic chest pain).
• Myocardial infarction: While less common in a 23-year-old male without risk factors, myocardial infarction (heart attack) can present with atypical symptoms, including chest wall pain. It is crucial to rule out cardiac causes of chest pain due to their potential severity.
• Pneumothorax: Spontaneous pneumothorax can cause sudden onset of chest pain that worsens with inspiration. It is more common in tall, thin males and can be life-threatening if not promptly treated.

Rare Diagnoses

• Sickle cell crisis: In individuals with sickle cell disease, a crisis can cause severe pain, including chest pain, due to vaso-occlusion. This would be less likely without a known history of sickle cell disease.
• Tietze's syndrome with rib fracture: Although costochondritis is considered, a rare complication could involve a fracture of the rib, which would be an uncommon but possible cause of the described pain.
• Slipping rib syndrome: This is a rare condition where the ribs slip out of place, causing severe pain that can mimic other conditions. It is less common and might not be considered initially without specific findings on physical examination.