Differential Diagnosis for Burning over the Upper Back and Shortness of Breath

Single Most Likely Diagnosis

• Gastroesophageal Reflux Disease (GERD): This condition is characterized by the reflux of stomach acid into the esophagus, causing a burning sensation in the chest and upper back. The shortness of breath can be associated with the irritation of the respiratory tract by the acid or due to the triggering of asthma-like symptoms in some individuals.

Other Likely Diagnoses

• Musculoskeletal Strain: Strain or injury to the muscles of the upper back can cause burning pain and, if severe, can lead to breathing difficulties due to pain or muscle spasm.
• Panic Attack or Anxiety: These conditions can cause chest tightness, burning sensations, and shortness of breath due to hyperventilation and increased anxiety.
• Costochondritis: Inflammation of the cartilage that connects the ribs to the breastbone can cause sharp pains and burning sensations in the chest and upper back, potentially leading to discomfort while breathing.

Do Not Miss Diagnoses

• Myocardial Infarction (Heart Attack): Although less common in younger populations, a heart attack can present with atypical symptoms including burning in the upper back and shortness of breath, especially in women or diabetic patients.
• Pulmonary Embolism: A blood clot in the lungs can cause sudden onset of shortness of breath and chest pain, which might be described as burning, especially if it involves the upper back due to referred pain.
• Aortic Dissection: A tear in the aorta can cause severe, tearing chest pain that radiates to the back and is associated with shortness of breath due to potential involvement of the aortic valve or compression of adjacent structures.

Rare Diagnoses

• Esophageal Spasm: Abnormal contractions of the esophagus can cause chest pain and burning sensations, potentially accompanied by difficulty breathing if the spasm is severe.
• Herpes Zoster (Shingles): Reactivation of the varicella-zoster virus can cause a painful rash and burning sensations in a dermatomal distribution, which could involve the upper back and potentially lead to breathing difficulties if the rash affects the lungs or if there's a significant systemic reaction.
• Tietze's Syndrome: A rare condition characterized by inflammation of the cartilages and surrounding tissues of the ribs, leading to chest pain and burning sensations that could be confused with more serious conditions.