Differential Diagnosis for Pleuritic Chest Pain

Pleuritic chest pain refers to pain that worsens with breathing, often indicating involvement of the pleura, the two-layered membrane surrounding the lungs and lining the chest cavity. The differential diagnosis for pleuritic chest pain can be categorized as follows:

• Single Most Likely Diagnosis
  • Pulmonary Embolism (PE): Although not the most common cause, it's a critical diagnosis to consider due to its high mortality rate if untreated. The pain is typically sharp and stabbing, worsened by deep breathing or coughing.
• Other Likely Diagnoses
  • Viral Pleurisy: Often follows a viral upper respiratory infection, presenting with sharp chest pain that worsens with deep breathing or coughing.
  • Pneumonia: Especially when it involves the pleura, can cause pleuritic chest pain. The pain is usually accompanied by fever, cough, and shortness of breath.
  • Pleuritis: Inflammation of the pleura, which can be due to various causes including viral infections, can cause sharp chest pain that worsens with breathing.
• Do Not Miss Diagnoses
  • Pulmonary Embolism (PE): Already mentioned, but crucial to reiterate due to its potential for high mortality if missed.
  • Aortic Dissection: Presents with severe, tearing chest pain that can be pleuritic if the dissection involves the descending aorta. It's a medical emergency.
  • Pneumothorax: Air in the pleural space can cause sudden, sharp chest pain that worsens with breathing. A tension pneumothorax is life-threatening.
  • Cardiac Ischemia/Myocardial Infarction: While typically presenting with non-pleuritic chest pain, some myocardial infarctions (especially those involving the right ventricle) can cause pleuritic pain.
• Rare Diagnoses
  • Lymphoma: Can cause pleuritic chest pain if there is involvement of the pleura or mediastinum.
  • Sarcoidosis: A systemic disease that can cause pleurisy among other manifestations.
  • Tuberculosis: Can cause pleuritic chest pain, especially in endemic areas or in individuals with risk factors.
  • Asbestos-related Pleural Disease: Can cause pleuritic pain years after exposure to asbestos.

Each of these diagnoses has distinct features and risk factors that can guide the clinician towards the correct diagnosis. A thorough history, physical examination, and appropriate diagnostic tests are essential for accurately diagnosing the cause of pleuritic chest pain.