Differential Diagnosis for Sharp Right Breast Pain

The veteran's symptoms of sharp right breast pain, which occurs with palpation and certain movements, along with a history of recent falls, guide the differential diagnosis. The absence of systemic symptoms such as fever, redness, swelling, or nipple discharge helps to narrow down the possibilities.

• Single Most Likely Diagnosis
  • Costochondritis: This condition, also known as Tietze's syndrome, involves inflammation of the cartilage that connects the ribs to the breastbone. It can cause sharp pains in the chest that worsen with movement or palpation. Given the veteran's history of falls, which could have caused trauma to the chest wall, and the nature of the pain, costochondritis is a plausible diagnosis.
• Other Likely Diagnoses
  • Musculoskeletal Strain: The falls could have resulted in a strain to the muscles of the chest wall, leading to pain that is exacerbated by movement or palpation.
  • Breast Contusion: A direct blow to the breast from a fall could cause a contusion, leading to localized pain, especially with pressure or movement.
• Do Not Miss Diagnoses
  • Cardiac Conditions (e.g., Myocardial Infarction, Pericarditis): Although the veteran denies symptoms like fevers and has no apparent systemic illness, cardiac conditions can sometimes present atypically, especially in women. The sharp pain and history of falls (potentially causing trauma) necessitate considering cardiac causes, even if less likely.
  • Pulmonary Embolism: Given the falls, there's a risk of deep vein thrombosis (DVT) leading to pulmonary embolism (PE), which can cause sharp chest pain. The absence of respiratory symptoms does not rule out PE, as it can present subtly.
• Rare Diagnoses
  • Tietze's Syndrome with Involvement of the Pectoral Muscles: While similar to costochondritis, Tietze's syndrome specifically involves the second or third costosternal junctions and can be accompanied by swelling.
  • Sickle Cell Crisis: If the veteran has sickle cell disease, a crisis could potentially cause chest pain due to vaso-occlusive episodes affecting the chest wall or lungs.

Each diagnosis is considered based on the veteran's symptoms and history, with an emphasis on not missing potentially life-threatening conditions, even if they seem less likely based on the initial presentation.