Differential Diagnosis for a Patient with PMH of WPW and NSTEMI with Right Sided Chest Pain Radiating into the Scapula

• Single Most Likely Diagnosis
  • Musculoskeletal pain: Given the radiation of pain into the scapula, musculoskeletal pain is a common and likely diagnosis, especially if the patient has been experiencing recent physical activity or strain.
• Other Likely Diagnoses
  • Pulmonary embolism: Although less common, pulmonary embolism can cause chest pain that radiates to the back and is a consideration in any patient with chest pain, especially if there are risk factors such as recent immobilization or cancer.
  • Pneumonia or pleuritis: Infection or inflammation of the lung or pleura can cause sharp, localized chest pain that worsens with deep breathing or coughing, which might radiate to the scapula.
  • Gastroesophageal reflux disease (GERD): GERD can cause chest pain that may radiate to the back, though it typically is more central and associated with eating or lying down.
• Do Not Miss Diagnoses
  • Aortic dissection: Although rare, aortic dissection is a life-threatening condition that can cause severe, tearing chest pain radiating to the back. The presence of WPW and NSTEMI increases the concern for cardiac complications.
  • Myocardial infarction (MI) involving the right coronary artery: The patient's history of NSTEMI and WPW increases the risk for cardiac events. An MI involving the right coronary artery could cause right-sided chest pain.
  • Esophageal rupture: A severe and life-threatening condition that can cause sudden, severe chest pain, often associated with difficulty swallowing or vomiting.
• Rare Diagnoses
  • Pneumothorax: Air in the pleural space can cause sudden, sharp chest pain that worsens with deep breathing, though it's less likely without a clear precipitant like trauma.
  • Cholecystitis or biliary colic: Gallbladder inflammation or stones can cause right upper quadrant abdominal pain that may radiate to the right shoulder or scapula, though this would be less common as a primary presentation of chest pain.