Differential Diagnosis of Retrosternal Chest Pain
The differential diagnosis for retrosternal chest pain is broad and includes various cardiac, gastrointestinal, and other conditions. Here's a categorized list of potential diagnoses:
Single Most Likely Diagnosis
- Gastroesophageal reflux disease (GERD): This is often the most common cause of retrosternal chest pain due to the retrosternal location of the esophagus and the high prevalence of GERD in the population. Symptoms can mimic cardiac conditions, making diagnosis sometimes challenging.
Other Likely Diagnoses
- Coronary artery disease (CAD) or myocardial infarction (MI): Although not the most common cause, CAD/MI is a critical consideration due to its potential severity and the need for urgent intervention.
- Esophageal spasm or esophagitis: These conditions can cause severe retrosternal chest pain and are often related to GERD or other esophageal disorders.
- Pericarditis: Inflammation of the pericardium can cause sharp, stabbing chest pain that may be retrosternal and can be accompanied by a pericardial friction rub.
Do Not Miss Diagnoses
- Pulmonary embolism (PE): Although less common, PE is a life-threatening condition that requires immediate diagnosis and treatment. It can present with sudden onset of chest pain, among other symptoms.
- Aortic dissection: A tear in the aorta's inner layer can cause severe, tearing chest pain that can be retrosternal. It's a medical emergency that requires prompt recognition and intervention.
- Esophageal rupture or perforation: A severe and potentially life-threatening condition that can cause sudden onset of severe retrosternal chest pain, often accompanied by difficulty swallowing or breathing.
Rare Diagnoses
- Mediastinitis: Inflammation of the tissues in the mediastinum can cause retrosternal chest pain and is often associated with infection or other rare conditions.
- Pneumomediastinum: Air in the mediastinum can cause chest pain and is usually related to lung disease or traumatic injury.
- Thyroid or parathyroid disorders: Certain conditions affecting these glands can cause retrosternal chest pain, although this is less common.
- Tietze's syndrome: A rare condition characterized by inflammation of the cartilages and surrounding tissues of the ribs, which can cause chest pain that may be retrosternal.