Differential Diagnosis for 52 YOM with Rib Pain

Single Most Likely Diagnosis

• Musculoskeletal strain: The patient's symptoms of developing pain to the right ribs after physical activity (passing boxes of pumpkins) and the absence of any fracture or abnormality on the chest X-ray make musculoskeletal strain the most likely diagnosis. The pain level of 8/10 and the presence of shortness of breath (SOB) without increased work of breathing (WOB) could be related to the strain causing discomfort and mild respiratory distress.

Other Likely Diagnoses

• Costochondritis: This condition, which is an inflammation of the cartilage that connects the ribs to the breastbone, could explain the patient's rib pain, especially if the pain is reproducible with palpation of the costochondral junctions.
• Intercostal muscle strain: Similar to musculoskeletal strain, but more specifically involving the muscles between the ribs, which could cause pain and SOB due to the discomfort of breathing and moving.

Do Not Miss Diagnoses

• Pulmonary embolism (PE): Although less likely given the context of physical exertion and the absence of other typical symptoms like tachypnea or significant hypoxia, PE is a potentially life-threatening condition that must be considered, especially in patients with risk factors.
• Myocardial infarction (MI): Chest pain and SOB can also be symptoms of an MI. The absence of typical ECG changes or elevated troponins would be necessary to rule out this diagnosis, but it's crucial to consider, especially in a 52-year-old male.
• Pneumothorax: Despite the chest X-ray not showing any abnormalities, a small pneumothorax could potentially not be visible, especially if it's very small. Clinical suspicion should remain high if the patient's condition worsens.

Rare Diagnoses

• Slipping rib syndrome: A condition where the ribs slip out of place, causing severe pain. It's less common but could be considered if other diagnoses are ruled out and the patient's symptoms persist.
• Tietze's syndrome: Similar to costochondritis but involves the inflammation of the cartilages and surrounding tissues of the ribs. It's rare and usually presents with swelling, which might not be mentioned in the initial presentation.