Differential Diagnosis for 60F with Intermittent Left Subscapular Pain
- Single most likely diagnosis
- Musculoskeletal strain or referred pain: This is the most likely diagnosis given the intermittent nature of the pain and the lack of aggravating or precipitating factors. The recent viral illness could have led to muscle strain or referred pain.
- Other Likely diagnoses
- Gastroesophageal reflux disease (GERD): GERD can cause referred pain to the subscapular region, especially if the patient has had a recent viral illness that could have triggered or worsened symptoms.
- Pulmonary embolism (less likely due to lack of respiratory symptoms, but still a consideration): Although less likely, pulmonary embolism can cause sudden onset of subscapular pain, and the recent viral illness could be a risk factor for thromboembolism.
- Costochondritis or Tietze's syndrome: These conditions can cause chest pain that may radiate to the subscapular region, and the recent viral illness could have triggered the onset of symptoms.
- Do Not Miss diagnoses
- Myocardial infarction: Although the patient does not have typical symptoms of myocardial infarction, such as chest pressure or shortness of breath, it is essential to consider this diagnosis, especially in a 60-year-old female.
- Aortic dissection: This is a life-threatening condition that can cause sudden onset of severe subscapular pain, and it is crucial to rule out this diagnosis.
- Pulmonary embolism (again, due to its high mortality rate if missed): As mentioned earlier, pulmonary embolism is a critical diagnosis to consider, even if it seems less likely.
- Rare diagnoses
- Pancreatitis: This condition can cause referred pain to the subscapular region, although it is less common.
- Splenic infarction or rupture: These conditions can cause sudden onset of severe subscapular pain, although they are rare and usually associated with underlying conditions such as sickle cell disease or trauma.
- Diabetic radiculopathy or thoracic radiculopathy: These conditions can cause subscapular pain, although they are less common and usually associated with underlying conditions such as diabetes or spinal disease.