Differential Diagnosis for 77 year old with right sided left breast pain

• Single most likely diagnosis
  • Costochondritis: This condition, characterized by inflammation of the cartilage that connects the ribs to the breastbone, is a common cause of breast pain, especially in older adults. The pain is typically sharp and can be exacerbated by movement or deep breathing.
• Other Likely diagnoses
  • Musculoskeletal strain: Given the age of the patient, musculoskeletal issues such as strain or injury to the muscles or tendons in the chest wall could be a plausible cause for the pain.
  • Breast cysts or fibroadenomas: Although less common in older adults, these benign breast conditions can cause localized pain.
  • Gastroesophageal reflux disease (GERD): GERD can cause chest pain that may be referred to the breast area, especially if the pain is exacerbated by eating or lying down.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Myocardial infarction (MI): Although the pain is described as "right sided left breast pain," which is an unusual description and may indicate confusion, it's crucial to consider cardiac causes, especially in older adults. MI can present with atypical pain.
  • Pulmonary embolism (PE): Similar to MI, PE is a life-threatening condition that can present with chest pain, and while the description is unusual, it should be considered, especially if there are associated symptoms like shortness of breath.
  • Breast cancer: Although less likely to present with pain as the primary symptom, breast cancer must be considered, especially in older adults, as it can be deadly if not diagnosed and treated promptly.
• Rare diagnoses
  • Tietze's syndrome: A rare condition characterized by inflammation of the cartilages and surrounding tissues of the chest wall, similar to costochondritis but less common and can involve swelling.
  • Sickle cell disease crisis: In patients with sickle cell disease, a crisis can cause severe pain, including chest pain, though this would be more typical in younger patients or those with a known history of the disease.
  • Pneumothorax: A collapsed lung can cause sudden, severe chest pain, which might be referred to the breast area, though this is less common and usually associated with other symptoms like shortness of breath.