Differential Diagnosis for Chest Pain Worse with Movement

• Single Most Likely Diagnosis
  • Costochondritis: This condition, also known as Tietze's syndrome, is characterized by inflammation of the cartilage that connects the ribs to the breastbone, leading to sharp pains that worsen with movement or deep breathing. Its prevalence and the specific symptom of pain worsening with movement make it a top consideration.
• Other Likely Diagnoses
  • Musculoskeletal strain: Strains or pulls in the muscles between the ribs or in the chest wall can cause pain that increases with movement. This is a common issue, especially in individuals who have recently engaged in unusual physical activity.
  • Precordial catch syndrome: This condition involves sharp, stabbing pains in the chest that can worsen with movement or deep breathing. It's more common in adolescents and young adults but can occur at any age.
  • Rib fracture: A fracture in one of the ribs can cause severe pain that worsens with movement, coughing, or deep breathing. This would typically follow a traumatic event.
• Do Not Miss Diagnoses
  • Pulmonary embolism: Although the pain from a pulmonary embolism is typically more constant and can be worsened by deep breathing, it's crucial not to miss this potentially life-threatening condition. The pain can sometimes be pleuritic (sharp and worsened by breathing or movement).
  • Pneumothorax: A collapsed lung can cause sharp chest pain that worsens with movement or deep breathing. This is a medical emergency that requires immediate attention.
  • Myocardial infarction (MI): While the classic symptom of an MI is a squeezing or pressure-like pain, some patients, especially women, may experience atypical symptoms, including pain that worsens with movement. It's critical to consider MI in the differential diagnosis, especially in patients with risk factors.
• Rare Diagnoses
  • Sickle cell crisis: In patients with sickle cell disease, a crisis can cause severe chest pain due to vaso-occlusion in the lungs or other areas, which might worsen with movement.
  • Osteonecrosis of the rib: Although rare, this condition can cause chest pain that worsens with movement due to the death of bone tissue in the ribs.
  • Tumors: Both benign and malignant tumors affecting the chest wall, ribs, or lungs can cause chest pain that worsens with movement, though these are less common causes.