Differential Diagnosis of Chest Pain Post MVC

The following differential diagnosis is organized into categories to help guide the thought process:

• Single Most Likely Diagnosis
  • Musculoskeletal injury (e.g., chest wall contusion, rib fracture): This is the most likely diagnosis due to the direct trauma to the chest from the motor vehicle collision (MVC), which can cause blunt force injuries to the chest wall and ribs.
• Other Likely Diagnoses
  • Pneumothorax: The force of the collision can cause lung injury leading to air leakage into the pleural space.
  • Pulmonary contusion: Similar to musculoskeletal injuries, the lungs can also be directly injured from the collision, leading to bruising and bleeding.
  • Myocardial contusion: Although less common, the heart can be injured from the collision, especially if there was significant force applied to the chest.
• Do Not Miss Diagnoses
  • Aortic dissection: Although less likely, this is a potentially life-threatening condition that requires immediate attention. The force of the collision can cause a tear in the aorta, leading to dissection.
  • Cardiac tamponade: This is another life-threatening condition where fluid accumulates in the pericardial sac, compressing the heart and impeding its function.
  • Esophageal rupture: A rupture of the esophagus can occur from the collision and is a medical emergency requiring prompt treatment.
• Rare Diagnoses
  • Diaphragmatic rupture: This is a rare but possible injury from the MVC, where the diaphragm is torn, potentially allowing abdominal organs to herniate into the thoracic cavity.
  • Tracheobronchial injury: Direct injury to the airways can occur, although this is less common compared to other injuries.
  • Spinal injury with referred chest pain: In some cases, chest pain post-MVC can be referred from a spinal injury, highlighting the importance of a thorough neurological examination.