Differential Diagnosis for Upper Back Pain and Central Chest Pain

Single Most Likely Diagnosis

• Musculoskeletal strain: This is often the most common cause of upper back pain and can radiate to the central chest area, especially if the strain involves the muscles between the ribs or the thoracic spine. The pain typically worsens with movement or deep breathing.

Other Likely Diagnoses

• Gastroesophageal reflux disease (GERD): GERD can cause chest pain that may be felt in the central chest and can radiate to the upper back. This pain is often worsened by eating or lying down.
• Costochondritis: Inflammation of the cartilage that connects the ribs to the breastbone can cause sharp pains in the chest that may radiate to the upper back, especially with deep breathing or movement.
• Precordial catch syndrome: This condition causes sudden, sharp chest pain, often in the central area, which can radiate to the upper back. It's more common in adolescents and young adults.

Do Not Miss Diagnoses

• Myocardial infarction (heart attack): Although less common in younger individuals without risk factors, myocardial infarction is a critical diagnosis that must not be missed. Central chest pain that radiates to the upper back, especially if accompanied by shortness of breath, sweating, or nausea, requires immediate medical attention.
• Pulmonary embolism: Sudden onset of chest pain that worsens with deep breathing, accompanied by shortness of breath, could indicate a pulmonary embolism, which is life-threatening and requires urgent medical intervention.
• Aortic dissection: Severe, tearing chest pain that radiates to the upper back could be indicative of an aortic dissection, a life-threatening condition where the inner layer of the aorta tears.

Rare Diagnoses

• Pneumothorax: Air in the space between the lungs and chest cavity can cause sudden, sharp chest pain that may radiate to the upper back, especially if the pneumothorax is large.
• Esophageal rupture or perforation: Although rare, a rupture of the esophagus can cause severe chest pain that may radiate to the upper back, often accompanied by difficulty swallowing or severe pain with eating.
• Thoracic spine fracture or osteoporotic compression fracture: In individuals with osteoporosis or after significant trauma, a fracture of the thoracic spine can cause upper back pain that may radiate to the central chest area.