Differential Diagnosis for Burning in the Right Side of Chest with History of Sickle Cell Disease

• Single Most Likely Diagnosis
  • Acute Chest Syndrome (ACS): This is a leading cause of morbidity and mortality in patients with sickle cell disease. The burning sensation in the chest could be due to pulmonary infarction or infection, which are common components of ACS. The history of sickle cell disease significantly increases the likelihood of this diagnosis.
• Other Likely Diagnoses
  • Pulmonary Embolism (PE): Patients with sickle cell disease are at increased risk for thromboembolic events, including PE, due to chronic hemolysis leading to a pro-coagulant state. Chest pain, including a burning sensation, can be a symptom of PE.
  • Rib Infarction: Sickle cell disease can cause vaso-occlusive crises, leading to infarction of various tissues, including the ribs. This could result in localized pain that might be described as burning.
  • Pneumonia: Infections are common triggers for acute chest syndrome in sickle cell patients, and pneumonia could cause chest pain.
• Do Not Miss Diagnoses
  • Myocardial Infarction (MI): Although less common in younger patients with sickle cell disease, MI can occur due to chronic anemia, vasculopathy, or other factors. It is crucial to rule out MI due to its high mortality if untreated.
  • Aortic Dissection: This is a rare but potentially fatal condition that could present with severe, tearing chest pain. While less likely, it's critical to consider in any patient with chest pain, especially if there are risk factors such as hypertension or a history of vascular disease.
• Rare Diagnoses
  • Spontaneous Pneumothorax: This could occur in the context of sickle cell disease due to various pulmonary complications, including cystic changes or infarctions that weaken the lung tissue.
  • Cholecystitis or Biliary Colic: Sickle cell disease increases the risk of gallstones due to chronic hemolysis. While abdominal pain is more typical, referred pain to the chest can occur, especially if the gallbladder is inflamed or if a stone is obstructing the biliary tree.