Differential Diagnosis for Chest Pain

The patient's complaint of sudden-onset chest pain on the right side that increases with respiration suggests several potential diagnoses. These can be categorized as follows:

• Single Most Likely Diagnosis

  • Pneumothorax: This condition, where air leaks into the space between the lung and chest wall, can cause sudden chest pain that worsens with breathing. The pain is typically sharp and can be localized to one side of the chest.

• Other Likely Diagnoses

  • Pulmonary Embolism (PE): Although PE often presents with more diffuse or central chest pain, it can cause unilateral pain, especially if the embolism is peripheral. The pain can worsen with deep breathing.
  • Pleuritis/Pleurisy: Inflammation of the pleura can cause sharp chest pain that worsens with breathing, coughing, or movement. It can be unilateral and is often associated with viral infections or other inflammatory conditions.
  • Costochondritis: Inflammation of the cartilage that connects the ribs to the sternum can cause chest pain, but it typically does not worsen significantly with respiration.

• Do Not Miss Diagnoses

  • Myocardial Infarction (MI): Although less likely given the description of pain worsening with respiration, MI can present atypically, especially in women, diabetics, or the elderly. It's crucial to consider MI in any patient with chest pain.
  • Aortic Dissection: This is a life-threatening condition where the inner layer of the aorta tears. It can cause severe, tearing chest pain that may radiate to the back. Although the pain is often more central and constant, it's a diagnosis that cannot be missed.
  • Esophageal Rupture: A severe condition that can cause chest pain, often after vomiting or retching. The pain can be severe and constant, and while less likely to be confused with pain worsening only with respiration, it's a critical diagnosis to consider.

• Rare Diagnoses

  • Pneumomediastinum: Air in the mediastinum can cause chest pain, often after a traumatic event or as a complication of a medical procedure. The pain can be severe and may worsen with breathing.
  • Diaphragmatic Rupture: A rare condition where the diaphragm tears, allowing abdominal contents to herniate into the chest cavity. It can cause severe chest and abdominal pain, especially with breathing or movement.