Differential Diagnosis for Chest and Back Pain in a Younger Patient

Single Most Likely Diagnosis

• Musculoskeletal strain: This is often the most common cause of chest and back pain in younger patients, resulting from overuse, poor posture, or direct injury to the muscles and bones of the chest and back.

Other Likely Diagnoses

• Costochondritis: Inflammation of the cartilage that connects the ribs to the breastbone, which can cause sharp pains in the chest and back.
• Precordial catch syndrome: A condition characterized by sudden, sharp pains in the chest and back, often related to changes in position or breathing.
• Gastroesophageal reflux disease (GERD): Stomach acid flowing back into the esophagus can cause chest pain that may radiate to the back.
• Pulmonary embolism (less common in younger patients without risk factors): A blood clot in the lungs, which can cause sudden, severe chest pain that may also be felt in the back.

Do Not Miss Diagnoses

• Aortic dissection: A tear in the inner layer of the aorta, which can cause severe, tearing chest and back pain. Although rare, it is life-threatening and requires immediate medical attention.
• Pneumothorax: Air in the space between the lungs and chest cavity, which can cause sudden, severe chest pain that may radiate to the back.
• Myocardial infarction (MI): Although less common in younger patients, MI can occur and presents with chest pain that may radiate to the back, arm, or jaw.
• Spinal infection or fracture: Infections like osteomyelitis or discitis, or fractures, can cause severe back pain that may radiate to the chest.

Rare Diagnoses

• Tietze's syndrome: A rare condition characterized by inflammation of the cartilage and surrounding tissues in the chest, causing chest and back pain.
• Sickle cell crisis: In patients with sickle cell disease, a crisis can cause severe pain episodes, including chest and back pain, due to sickling of red blood cells.
• Herpes zoster (shingles): Reactivation of the varicella-zoster virus can cause a painful rash that may precede the onset of chest and back pain.
• Ehlers-Danlos syndrome: A group of disorders that affect connective tissues, which can lead to musculoskeletal pain, including chest and back pain, due to joint hypermobility and tissue fragility.