Differential Diagnosis for 31-year-old with Severe Health Anxiety and Physical Symptoms
Single Most Likely Diagnosis
- Anxiety-related somatic symptoms: The patient's severe health anxiety and the nature of the symptoms (e.g., fullness under the left ribs that varies with position, shoulder tension, and knots in the left arm) are consistent with somatic symptom disorder, where anxiety manifests as physical complaints without a clear medical cause.
Other Likely Diagnoses
- Gastroesophageal reflux disease (GERD): The symptom of fullness under the left ribs, particularly when sitting, could be related to GERD, which is exacerbated by position and can cause discomfort in the upper abdomen.
- Musculoskeletal strain: The presence of shoulder tension and knots in the left arm suggests musculoskeletal issues, possibly due to poor posture, overuse, or anxiety-related muscle tension.
- Benign lymphadenopathy: The palpable, bean-sized, moveable lymph nodes in the left elbow and side of the neck could be reactive (benign) lymphadenopathy, which can occur in response to minor infections or inflammation, including the ingrown hair that was picked two weeks prior.
Do Not Miss Diagnoses
- Lymphoma: Although less likely, lymphoma must be considered due to the presence of lymphadenopathy. It is crucial to investigate further to rule out this potentially life-threatening condition.
- Splenomegaly or splenic infarction: The fullness under the left ribs could, in rare cases, be related to splenomegaly (enlarged spleen) or a splenic infarction, which would require immediate medical attention.
- Gastric or pancreatic cancer: Although very unlikely in a 31-year-old, any persistent or unexplained abdominal symptoms warrant consideration of malignancy to ensure early detection and treatment.
Rare Diagnoses
- Sarcoidosis: This condition can cause lymphadenopathy and might lead to symptoms like those described, although it would be an uncommon presentation.
- Thoracic outlet syndrome: This condition involves compression of the nerves and/or blood vessels that pass into the thoracic outlet (the space between your collarbone and first rib), which could potentially explain some of the arm and shoulder symptoms, but it's less likely given the other symptoms.
- Hodgkin lymphoma: Similar to non-Hodgkin lymphoma, Hodgkin lymphoma is a type of cancer that affects the immune system and could present with lymphadenopathy, but it's rare and would be less likely without other systemic symptoms.