Differential Diagnosis for Chest Pain

The patient presents with pain located below bilateral breasts, described as a squeezing sensation radiating into her back, similar to a hug, and has a past medical history of Multiple Sclerosis (MS). Here's a categorized differential diagnosis:

• 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 (sternum). The symptoms can include sharp pains or aching sensations in the chest, which can radiate to the back and are often described as feeling like a squeezing or pressing sensation. Given the location and nature of the pain, costochondritis is a plausible explanation.

• Other Likely Diagnoses

  • Musculoskeletal Pain: Given the description of the pain feeling like a hug, musculoskeletal issues such as strained muscles in the chest or back could be a cause. The patient's MS could potentially contribute to muscle spasms or increased sensitivity to musculoskeletal pain.
  • Gastroesophageal Reflux Disease (GERD): GERD can cause chest pain that may radiate to the back. The pain is often described as burning but can also feel like pressure or squeezing.
  • Breast Conditions: Conditions such as mastitis or breast cysts could potentially cause pain that radiates to the back, although these are less likely given the bilateral and specific location of the pain below the breasts.

• Do Not Miss Diagnoses

  • Myocardial Infarction (MI) or Acute Coronary Syndrome: Although less common in younger individuals, MI can present with atypical symptoms, especially in women. The squeezing sensation could be mistaken for other conditions, but MI is a medical emergency that requires immediate attention.
  • Pulmonary Embolism (PE): PE can cause sudden, severe chest pain that may radiate to the back. While the patient's symptoms do not classically suggest PE, it's a condition that could be deadly if missed.
  • Aortic Dissection: This is a serious condition where there is a tear in the aorta's inner layer. It can cause severe, tearing chest pain that radiates to the back. Given the potential severity, it's crucial not to miss this diagnosis.

• Rare Diagnoses

  • Spondyloarthritis: Conditions like ankylosing spondylitis could potentially cause chest pain due to involvement of the spine and rib cage, though this would be less common and typically associated with other symptoms like back stiffness and limited mobility.
  • Neuropathic Pain Related to MS: While MS can cause a wide range of neurological symptoms, neuropathic pain syndromes could potentially cause chest pain. However, the description provided does not strongly suggest a neuropathic origin typical of MS-related pain.