Differential Diagnosis

The patient presents with a chief complaint of chest pain, which is a symptom that requires careful consideration of various potential causes. The following differential diagnosis is organized into categories to facilitate a thorough evaluation.

• Single most likely diagnosis:
  • Musculoskeletal chest pain: The patient describes the chest pain as sharp and muscular, which is consistent with musculoskeletal pain. The pain switched to the shoulder and resolved completely, which further supports this diagnosis. The patient's occupation as a mechanic may also contribute to musculoskeletal strain.
• Other Likely diagnoses:
  • Gastroesophageal reflux disease (GERD): The patient's chest pain could be related to GERD, especially if the pain is worsened by eating or lying down. However, the patient does not report any symptoms of heartburn or regurgitation.
  • Anxiety or stress-related chest pain: The patient's sharp, muscular chest pain could be related to anxiety or stress, especially if the patient is experiencing emotional distress.
  • Pulmonary embolism (less likely due to lack of other symptoms such as shortness of breath, but still a consideration): Although the patient has no other symptoms suggestive of a pulmonary embolism, such as shortness of breath or tachypnea, this diagnosis cannot be entirely ruled out without further evaluation.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Acute coronary syndrome (ACS): Although the patient is young and has no risk factors for coronary artery disease, ACS is a potentially life-threatening condition that must be considered in any patient with chest pain.
  • Aortic dissection: This is a rare but potentially life-threatening condition that requires immediate attention. The patient's chest pain could be related to an aortic dissection, especially if the pain is severe and tearing in nature.
  • Pulmonary embolism: As mentioned earlier, pulmonary embolism is a potentially life-threatening condition that requires prompt evaluation and treatment.
• Rare diagnoses:
  • Pneumothorax: Although the patient has no symptoms suggestive of a pneumothorax, such as shortness of breath or decreased breath sounds, this diagnosis cannot be entirely ruled out without further evaluation, such as a chest X-ray.
  • Pericarditis: The patient's chest pain could be related to pericarditis, especially if the pain is sharp and worsened by lying down. However, the patient has no other symptoms suggestive of pericarditis, such as a pericardial friction rub.