Differential Diagnosis for Sharp Mid Chest Pain
Single most likely diagnosis
- Acute Pericarditis: The presence of a precordial rub and sharp mid chest pain that worsens when supine are classic symptoms of acute pericarditis. The pain often improves with sitting up and leaning forward.
Other Likely diagnoses
- Costochondritis: This condition, also known as Tietze's syndrome, involves inflammation of the cartilage that connects the ribs to the breastbone, which can cause sharp chest pain and tenderness. However, it typically doesn't worsen with supine position.
- Precordial catch syndrome: A benign condition that causes sharp, stabbing chest pain, often related to the position of the body. It can be exacerbated by certain positions but doesn't typically have a rub.
- Pulmonary embolism with pulmonary infarction: While less common, a pulmonary embolism can cause sharp chest pain, especially if it leads to pulmonary infarction. However, the pain is usually more pleuritic and associated with other symptoms like dyspnea.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Myocardial infarction (MI): Although the presentation is atypical for an MI, it's crucial to rule out this life-threatening condition, especially in patients with risk factors. The pain of MI can sometimes be sharp, especially if it involves the right ventricle or is a variant like Prinzmetal’s angina.
- Aortic dissection: This is a medical emergency that can present with sudden, severe chest pain that can be sharp. The pain often radiates to the back and can change with movement, although worsening with supine position is not a hallmark.
- Pneumothorax: A spontaneous pneumothorax can cause sharp, pleuritic chest pain and can be life-threatening if not recognized and treated promptly.
Rare diagnoses
- Esophageal rupture or perforation: This condition can cause severe, sharp chest pain, especially if it involves the lower esophagus. However, it's usually associated with a history of vomiting, retching, or an esophageal procedure.
- Mediastinitis: Inflammation of the tissues in the mediastinum can cause sharp chest pain, fever, and other systemic symptoms. It's a rare condition often associated with esophageal perforation or other infections.