Differential Diagnosis for Back and Chest Pain
- Single most likely diagnosis
- Musculoskeletal strain: This is the most likely diagnosis given the initial presentation of back pain under the shoulder area, which could be due to muscle strain or overuse, and the subsequent radiation of pain to the breasts and chest area, possibly due to referred pain or further strain.
- Other Likely diagnoses
- Costochondritis: Inflammation of the cartilage that connects the ribs to the breastbone can cause pain in the chest and breast area, which might radiate to the back.
- Intercostal muscle strain: Strain in the muscles between the ribs can cause pain in the chest, back, and breast area.
- Gastroesophageal reflux disease (GERD): Although primarily causing heartburn, severe cases can lead to chest and back pain.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Myocardial infarction (heart attack): Although less common in younger individuals, chest pain can be a symptom of a heart attack, especially if accompanied by other symptoms like shortness of breath, nausea, or arm pain.
- Pulmonary embolism: Sudden onset of chest pain, especially if accompanied by shortness of breath, could indicate a blood clot in the lungs.
- Pneumonia or pleuritis: Infection or inflammation of the lung or its lining can cause chest and back pain.
- Rare diagnoses
- Tietze's syndrome: A rare inflammatory condition affecting the cartilages of the ribs, causing chest pain.
- Sickle cell crisis: In individuals with sickle cell disease, a crisis can cause severe pain episodes, including back and chest pain.
- Pancoast tumor: A rare type of lung cancer that can cause shoulder and chest pain due to its location at the top of the lung.