Differential Diagnosis for Chest Pain after Trauma

The patient presents with sharp, right-sided, positional chest pain that began after a traumatic fall onto the chest area during a game of pickleball. The pain is on and off, suggesting a possible musculoskeletal or rib injury. Here's a categorized differential diagnosis:

• Single most likely diagnosis

  • Costochondritis or Rib Fracture: The patient's history of falling forward and landing on the chest, followed by the development of sharp, positional chest pain, strongly suggests a musculoskeletal injury such as costochondritis (inflammation of the cartilage that connects the ribs to the breastbone) or a rib fracture. These conditions are common after blunt chest trauma and can cause sharp, localized pain that worsens with movement or deep breathing.

• Other Likely diagnoses

  • Musculoskeletal Strain: The trauma could have caused strain to the muscles or ligaments in the chest wall, leading to pain.
  • Precordial Catch Syndrome: This condition involves sharp, stabbing chest pain that can be exacerbated by position and is often seen in younger individuals after trauma or strain.
  • Pulmonary Contusion: Although less likely without respiratory symptoms, a pulmonary contusion (bruise of the lung) could cause chest pain after a traumatic injury.

• Do Not Miss diagnoses

  • Pneumothorax: A collapsed lung can occur after chest trauma and may present with sudden, sharp chest pain and shortness of breath. It's crucial to diagnose promptly as it can be life-threatening.
  • Myocardial Contusion: A bruise of the heart muscle can occur after blunt chest trauma and may mimic myocardial infarction symptoms, including chest pain.
  • Aortic Injury: Although rare, injuries to the aorta, such as a dissection, can be catastrophic and present with severe, tearing chest pain.

• Rare diagnoses

  • Sternal Fracture: While possible, sternal fractures are less common than rib fractures and may present with midline chest pain.
  • Diaphragmatic Injury: Trauma can cause diaphragmatic rupture, which might present with abdominal contents in the chest cavity and could cause chest pain, among other symptoms.
  • Osteochondral Fracture of the Sternum or Ribs: A piece of cartilage or bone could become detached due to the trauma, causing pain.

Each of these diagnoses should be considered in the context of the patient's symptoms, physical examination findings, and appropriate diagnostic tests such as imaging studies (e.g., X-rays, CT scans) and possibly an electrocardiogram (ECG) to rule out cardiac involvement.