Differential Diagnosis for Abdominal and Chest Pain

The patient's presentation of abdominal pain and chest pain requires a thorough evaluation to determine the underlying cause. The following differential diagnosis is organized into categories to facilitate a systematic approach:

• Single Most Likely Diagnosis
  • Gastroesophageal reflux disease (GERD): This condition is a common cause of both abdominal and chest pain, particularly if the pain is burning in nature and worsens with eating or lying down.
• Other Likely Diagnoses
  • Peptic ulcer disease: Ulcers in the stomach or duodenum can cause abdominal pain that radiates to the chest.
  • Cholecystitis: Inflammation of the gallbladder can cause right upper quadrant abdominal pain that may radiate to the chest.
  • Pneumonia: Lower lobe pneumonia can cause chest pain that is referred to the abdomen.
  • Pulmonary embolism: Although less common, a pulmonary embolism can cause sudden onset of chest pain and may be accompanied by abdominal pain if there is associated bowel ischemia.
• Do Not Miss Diagnoses
  • Myocardial infarction: Chest pain is a hallmark of myocardial infarction, and while abdominal pain is not typical, it can occur, especially if there is involvement of the inferior wall of the heart.
  • Aortic dissection: This is a life-threatening condition that can cause severe chest pain and abdominal pain if the dissection involves the abdominal aorta.
  • Esophageal rupture: A rupture of the esophagus can cause severe chest pain and abdominal pain, often with a history of vomiting or severe straining.
• Rare Diagnoses
  • Pancreatic cancer: Although rare, pancreatic cancer can cause abdominal pain that radiates to the chest, especially if the tumor involves the pancreatic body or tail.
  • Herpes zoster: Reactivation of the varicella-zoster virus can cause shingles, which may manifest as abdominal pain and chest pain if the thoracic dermatomes are involved.
  • Intestinal ischemia: Reduced blood flow to the intestines can cause abdominal pain and may be accompanied by chest pain if there is associated cardiac disease or pulmonary embolism.

Each of these diagnoses has a unique set of clinical features, and a thorough history, physical examination, and diagnostic testing are necessary to determine the underlying cause of the patient's symptoms.