Differential Diagnosis for Intercostal Pain and Pleurisy

When differentiating between intercostal pain and pleurisy, it's crucial to consider various diagnoses based on their likelihood and potential impact on patient outcomes. The following categories help organize the thought process:

• Single Most Likely Diagnosis
  • Musculoskeletal strain: This is often the most common cause of intercostal pain, resulting from overuse, trauma, or strain of the intercostal muscles. The pain is typically sharp, localized to the area of strain, and worsens with movement or deep breathing.
• Other Likely Diagnoses
  • Pleurisy: Inflammation of the pleura, which are the two layers of tissue surrounding the lungs and lining the chest cavity. Pleurisy can cause sharp, stabbing pain that worsens with breathing, coughing, or sneezing. It can be due to various causes, including viral infections, pneumonia, or pulmonary embolism.
  • Costochondritis: Inflammation of the cartilage that connects the ribs to the breastbone (sternum), leading to pain in the chest wall. The pain can mimic pleurisy but is usually more localized and tender to the touch.
  • Rib fracture: A break in one or more ribs, which can cause severe pain that worsens with deep breathing, coughing, or movement. The pain is typically sharp and localized to the area of the fracture.
• Do Not Miss Diagnoses
  • Pulmonary embolism: A blood clot in the lungs that can cause sudden, severe chest pain, especially with deep breathing. It's a life-threatening condition that requires immediate medical attention.
  • Pneumonia: An infection of the lungs that can cause pleuritic chest pain, fever, cough, and difficulty breathing. It's essential to diagnose and treat promptly to prevent complications.
  • Myocardial infarction (heart attack): Although less common, chest pain can be a symptom of a heart attack, especially if it radiates to the arm, neck, or jaw, and is accompanied by shortness of breath, nausea, or lightheadedness.
• Rare Diagnoses
  • Tietze's syndrome: A rare inflammatory condition that affects the cartilage of the ribs, causing chest pain and swelling. It's similar to costochondritis but can involve the surrounding muscles and joints.
  • Sickle cell crisis: A condition that occurs in people with sickle cell disease, where abnormal red blood cells can cause episodes of severe pain, including chest pain, due to vaso-occlusion.

Each diagnosis has distinct characteristics and potential causes, emphasizing the importance of a thorough medical history, physical examination, and diagnostic tests to accurately differentiate between intercostal pain and pleurisy, as well as to identify other possible causes.