Differential Diagnosis for Retrosternal Chest Pain Post Caesarian Section
Single Most Likely Diagnosis
- Gastroesophageal reflux disease (GERD): This condition is common postpartum, especially after a Caesarian section due to increased intra-abdominal pressure and potential irritation of the esophagus. The negative troponins and CTPA reduce the likelihood of cardiac causes, making GERD a plausible explanation for retrosternal chest pain.
Other Likely Diagnoses
- Musculoskeletal pain: Postoperative pain, especially after a surgical procedure like a Caesarian section, can manifest as chest pain due to strain on the chest wall muscles or costochondritis.
- Pulmonary embolism (with a low probability): Although the CTPA is negative, there's a small chance of a false negative, especially if the study was not of high quality or if the embolism is very small. Clinical correlation and possibly further testing might be needed.
- Anxiety or panic disorder: Postpartum anxiety or panic attacks can cause chest pain that may be perceived as retrosternal.
Do Not Miss Diagnoses
- Pulmonary embolism (despite negative CTPA): As mentioned, a negative CTPA does not completely rule out a pulmonary embolism, especially if clinical suspicion remains high.
- Myocardial infarction (with normal troponins): Although troponins are negative, there are cases of myocardial infarction with normal troponin levels, especially if the test is done very early after the event or in the context of chronic kidney disease.
- Aortic dissection: This is a rare but life-threatening condition that requires immediate diagnosis and treatment. The pain is often severe and can be described as tearing.
Rare Diagnoses
- Spontaneous coronary artery dissection (SCAD): This is a rare cause of myocardial infarction that can occur in postpartum women without traditional risk factors for coronary artery disease.
- Pericarditis: Inflammation of the pericardium can cause sharp chest pain that may improve with sitting up and leaning forward. It's less common but should be considered in the differential diagnosis.
- Esophageal rupture or perforation: Although rare, this is a serious condition that can cause severe chest pain and requires prompt diagnosis and treatment.