Differential Diagnosis for Left Lower Rib Pain

The patient presents with left lower rib pain that started after lawn mowing, with a history of recent illness and ongoing cough. The following differential diagnoses are considered:

• Single Most Likely Diagnosis
  • Musculoskeletal Strain: The pain started after physical activity (lawn mowing) and is localized to the left lower ribs, suggesting a musculoskeletal origin. The tenderness underneath the left lower ribs further supports this diagnosis.
• Other Likely Diagnoses
  • Costochondritis: Inflammation of the cartilage that connects the ribs to the breastbone, which can cause chest pain. The patient's recent illness and cough could be contributing factors.
  • Gastroesophageal Reflux Disease (GERD): The patient's bloated abdomen and recent weight gain could be related to GERD, which can cause referred pain to the left lower chest.
  • Pulmonary Embolism (less likely due to lack of risk factors and normal oxygen saturation): Although less likely, pulmonary embolism should be considered in the differential diagnosis due to the patient's recent illness and smoking history.
• Do Not Miss Diagnoses
  • Myocardial Infarction: Although the patient's ECG is planned, and the cardiovascular examination is normal, myocardial infarction should be ruled out, especially given the patient's family history of heart disease and smoking history.
  • Pneumonia: The patient's recent illness and ongoing cough could be indicative of pneumonia, which can cause pleuritic chest pain.
  • Pulmonary Embolism: As mentioned earlier, pulmonary embolism is a potentially life-threatening condition that should not be missed.
• Rare Diagnoses
  • Rib Fracture: Although less likely, a rib fracture could be considered, especially if the patient had a traumatic injury while lawn mowing.
  • Tietze's Syndrome: A rare condition characterized by inflammation of the cartilage that connects the ribs to the breastbone, which can cause chest pain.
  • Sickle Cell Crisis: Although the patient's hemoglobin A1c is normal, sickle cell crisis should be considered in the differential diagnosis, especially if the patient has a history of sickle cell disease.