Differential Diagnosis for Sharp Midsternal Chest Pain in a 17-Year-Old

Single Most Likely Diagnosis

• Costochondritis: This condition, also known as Tietze's syndrome, is characterized by sharp pains in the chest due to inflammation of the cartilage that connects the ribs to the breastbone. It can be exacerbated by exercise or even deep breathing and can occur at rest. The sharp, stabbing nature of the pain and its relation to movement or exercise makes costochondritis a plausible diagnosis.

Other Likely Diagnoses

• Musculoskeletal Strain: Strains or pulls in the muscles between the ribs or in the chest wall can cause sharp, stabbing pains, especially with movement or exercise.
• Stress or Anxiety-Related Chest Pain: Anxiety can cause sharp, fleeting chest pains, which might be exacerbated by physical activity due to increased heart rate and breathing.
• Gastroesophageal Reflux Disease (GERD): Although more commonly associated with a burning sensation, GERD can sometimes cause sharp chest pains, especially if acid reflux triggers a spasm in the esophagus.

Do Not Miss Diagnoses

• Myocardial Infarction (MI) or Cardiac Ischemia: Although rare in a 17-year-old, cardiac issues such as MI or ischemia can present with sharp chest pain and must be ruled out due to their potentially fatal outcomes.
• Pulmonary Embolism (PE): A blood clot in the lungs can cause sudden, sharp chest pain that worsens with deep breathing or exercise. It's crucial to consider PE due to its high mortality rate if untreated.
• Pneumothorax: A collapsed lung can cause sharp, stabbing chest pain that can be exacerbated by deep breathing or movement.

Rare Diagnoses

• Pericarditis: Inflammation of the sac surrounding the heart can cause sharp chest pain, which may improve with sitting up and leaning forward.
• Precordial Catch Syndrome: A benign condition that causes sharp, stabbing pains in the chest, often related to specific positions or movements.
• Mitral Valve Prolapse: A condition where the two valve flaps of the mitral valve do not close smoothly or evenly, which can cause chest pain, although this is less common.

Each of these diagnoses should be considered and evaluated based on the patient's full medical history, physical examination, and appropriate diagnostic tests to determine the underlying cause of the chest pain.