Pleuritic Pain Differential Diagnosis

Pleuritic pain refers to chest pain that worsens with breathing, which can be caused by various conditions affecting the pleura, the two-layered membrane surrounding the lungs. The differential diagnosis for pleuritic pain can be categorized as follows:

• Single Most Likely Diagnosis

  • Pulmonary Embolism (PE): This is often considered the single most likely diagnosis for pleuritic pain due to its potential severity and the need for immediate treatment. PE occurs when a blood clot lodges in an artery of the lung, causing sudden and severe pain that worsens with deep breathing.

• Other Likely Diagnoses

  • Pneumonia: Inflammation of the lung tissue, which can cause pleuritic pain, especially if the infection involves the pleura.
  • Pleurisy: Inflammation of the pleura itself, which can be caused by viral infections, pneumonia, or other conditions.
  • Acute Coronary Syndrome (ACS): Although typically associated with non-pleuritic chest pain, ACS can occasionally present with pleuritic pain, especially if there is associated pericarditis.
  • Costochondritis: Inflammation of the cartilage that connects the ribs to the breastbone, which can cause sharp pains that may worsen with deep breathing.

• Do Not Miss Diagnoses

  • Pulmonary Embolism (already mentioned but emphasized here due to its critical nature): The risk of missing a PE is high due to its variable presentation, and the consequences of a missed diagnosis can be fatal.
  • Aortic Dissection: A tear in the inner layer of the aorta, which can cause severe, tearing chest pain that may be pleuritic in nature.
  • Pneumothorax: Air in the pleural space, which can cause sudden, severe pleuritic pain and can be life-threatening if not promptly treated.
  • Pericarditis: Inflammation of the pericardium, the sac surrounding the heart, which can cause sharp, pleuritic chest pain.

• Rare Diagnoses

  • Lymphangitic Carcinomatosis: Spread of cancer to the lymphatic vessels of the lungs, which can cause pleuritic pain among other symptoms.
  • Eosinophilic Pneumonia: A rare type of pneumonia characterized by an accumulation of eosinophils in the lungs, which can present with pleuritic pain.
  • Sarcoidosis: An autoimmune disease that can affect multiple parts of the body, including the lungs, and cause pleuritic pain.
  • Tuberculous Pleurisy: Pleural infection with Mycobacterium tuberculosis, which is more common in certain geographic areas and populations.

Each of these diagnoses has a unique set of clinical features, and a thorough history, physical examination, and diagnostic testing are essential for making an accurate diagnosis.