Differential Diagnosis for 31-year-old with Severe Health Anxiety and Physical Symptoms
Single Most Likely Diagnosis
- Somatic Symptom Disorder: Given the patient's severe health anxiety and the presence of physical symptoms such as fullness under the left ribs and palpable lymph nodes, which have been ongoing for 10 months without a clear medical explanation, somatic symptom disorder is a likely diagnosis. The patient's anxiety about their health is likely contributing to the amplification of these physical symptoms.
Other Likely Diagnoses
- Musculoskeletal Strain or Tension: The significant shoulder muscle tension in the left arm could be contributing to the fullness under the left ribs, suggesting a musculoskeletal origin for some of the patient's symptoms.
- Benign Lymph Node Enlargement: The presence of small, movable lymph nodes in the left elbow could be due to a benign condition, especially given the absence of other systemic symptoms such as fever or weight loss.
- Gastrointestinal Issues (e.g., Irritable Bowel Syndrome): The intermittent fullness under the left ribs could also be related to gastrointestinal issues, which are common and can be exacerbated by stress and anxiety.
Do Not Miss Diagnoses
- Lymphoma: Although less likely, lymphoma is a critical diagnosis not to miss. The presence of palpable lymph nodes, even if they are small and movable, warrants consideration of lymphoma, especially if other risk factors are present.
- Breast Cancer with Axillary Lymph Node Involvement: Given the location of the lymph nodes in the left elbow (which could be mistaken for axillary nodes) and the presence of a picked ingrown hair (which could potentially lead to infection or be a red herring), breast cancer with lymph node involvement is a diagnosis that must be considered and ruled out, particularly in a female patient.
- Gastrointestinal Cancer (e.g., Stomach or Pancreatic Cancer): These cancers can present with vague abdominal symptoms such as fullness and are important to consider, especially if the patient has risk factors or if the symptoms persist or worsen over time.
Rare Diagnoses
- Sarcoidosis: This is a rare condition that can cause lymph node enlargement and could potentially explain some of the patient's symptoms, although it would be less likely without other systemic symptoms such as lung involvement.
- Neurological Conditions (e.g., Thoracic Outlet Syndrome): Conditions affecting the nerves could potentially cause some of the patient's symptoms, including muscle tension and the sensation of fullness, although these would be less common explanations for the combination of symptoms presented.