Differential Diagnosis for Mid Back Pain

The patient presents with mid back pain that worsens with inhalation, which could indicate a variety of causes. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Musculoskeletal strain: Given the patient's recent 9-hour car ride, it's plausible that the prolonged sitting and possible poor posture led to strain on the mid back muscles, causing pain. The fact that the pain is higher than the known compressed L4 and L5 vertebrae suggests a different origin, possibly related to muscle fatigue or strain from the long ride.

• Other Likely Diagnoses

  • Costochondritis: Inflammation of the cartilage that connects the ribs to the breastbone can cause sharp pains in the chest or back that worsen with deep breathing or coughing.
  • Intercostal muscle strain: Similar to musculoskeletal strain, but specifically involving the muscles between the ribs, which could be irritated from the car ride or other activities.
  • Thoracic spine issues: Although the patient mentions the pain is higher than the compressed lumbar vertebrae, other thoracic spine issues such as herniated discs, spinal stenosis, or osteoarthritis could cause mid back pain.

• Do Not Miss Diagnoses

  • Pulmonary embolism: A life-threatening condition where a blood clot lodges in the lungs, which can cause sudden, severe chest or back pain that worsens with deep breathing.
  • Pneumonia or pleurisy: Infections or inflammation of the lung tissue or the lining around the lungs can cause sharp pains that worsen with breathing.
  • Aortic dissection: A serious condition where the inner layer of the aorta tears, which can cause severe, tearing chest or back pain.

• Rare Diagnoses

  • Pancoast tumor: A type of lung cancer located at the top of the lung that can cause shoulder or back pain due to its location and potential to invade nearby structures.
  • Thoracic outlet syndrome: Compression of the nerves or blood vessels between the collarbone and first rib can cause pain in the shoulders and back, though it's less commonly associated with breathing.
  • Osteoporotic vertebral fracture: Although less common in the thoracic spine without significant trauma, osteoporotic fractures can occur and cause sudden back pain.