Differential Diagnosis for Left Chest Pain

The patient presents with left chest pain that lasts a few seconds and occurs about 5 times per hour for about 2 days. Here is 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. It can cause sharp, stabbing pains in the chest that can be brief and recurrent, fitting the patient's symptoms. The pain can be exacerbated by movement or deep breathing.

• Other Likely Diagnoses

  • Musculoskeletal strain: Strain or injury to the muscles or ligaments in the chest wall can cause pain that is sharp and intermittent, especially if the strain is minor and only causes discomfort with certain movements.
  • Gastroesophageal reflux disease (GERD): Although GERD typically causes a burning pain, it can sometimes present as sharp, fleeting pains, especially if the reflux is intermittent and not severe.
  • Precordial catch syndrome: This is a condition that causes sharp, stabbing pains in the chest, often related to the position of the body or deep breathing. It is more common in adolescents but can occur at any age.

• Do Not Miss Diagnoses

  • Myocardial infarction (MI) or acute coronary syndrome: Although the patient's pain is brief and recurrent, which is atypical for MI, cardiac causes must always be considered, especially in patients with risk factors for coronary artery disease. The presentation can sometimes be atypical, especially in women or diabetic patients.
  • Pulmonary embolism (PE): Sudden, sharp chest pain can be a symptom of PE, especially if it worsens with deep breathing. Although the pain pattern described is not typical, any chest pain that could potentially be related to a PE must be thoroughly investigated.
  • Aortic dissection: This is a life-threatening condition where there is a tear in the aorta's inner layer. It can cause severe, sharp pain that can be fleeting if the dissection is minor and intermittent. However, it is more commonly associated with constant, severe pain.

• Rare Diagnoses

  • Pneumothorax: A small pneumothorax could potentially cause brief, sharp pains, especially if it is not under tension and does not cause significant lung collapse.
  • Pericarditis: Inflammation of the pericardium, the sac surrounding the heart, can cause sharp, stabbing chest pains that can be positional. The pain is often more constant but can have periods of exacerbation.
  • Esophageal spasm: This condition involves abnormal muscle contractions of the esophagus, which can cause sharp, fleeting chest pains, often related to swallowing or eating.