Differential Diagnosis for Lateral Side Lower Rib Pain after Cardioversion
- Single most likely diagnosis
- Costochondritis or musculoskeletal strain: This is likely due to the procedure of cardioversion, which may have caused muscle strain or costochondritis, especially if the patient was positioned in a way that put pressure on the lateral side of the lower ribs during the procedure. The pain worsening with laying on the affected side, twisting, and upward extension of the neck is consistent with musculoskeletal or costochondral involvement.
- Other Likely diagnoses
- Precordial catch syndrome: This condition is characterized by sharp, stabbing chest pain that can radiate to the sides and is often exacerbated by movement or position changes, such as twisting or extending the neck.
- Intercostal muscle strain: The intercostal muscles between the ribs can become strained due to the positioning or the procedure itself, leading to pain that worsens with movement or pressure on the affected side.
- Rib fracture: Although less common, a rib fracture could occur if there was significant force applied to the chest during cardioversion, and the pain pattern described could be consistent with this, especially if the fracture is on the lateral side of a lower rib.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pulmonary embolism: While less likely, pulmonary embolism can present with chest pain that worsens with deep breathing or certain positions. It's crucial to consider this diagnosis, especially in a post-procedure patient, due to its high mortality rate if missed.
- Pneumothorax: Air in the pleural space can cause sharp chest pain that worsens with movement or position changes. This is a critical diagnosis to rule out, especially after a procedure that involves access to the thoracic cavity.
- Myocardial infarction or pericarditis: Although cardioversion is a procedure to restore a normal heart rhythm, there is a small risk of complications such as myocardial infarction or pericarditis, which could present with chest pain.
- Rare diagnoses
- Slipping rib syndrome: This is a rare condition where the ribs slip out of place, causing severe pain, usually in the lower chest or upper abdominal area. It could be considered if other diagnoses are ruled out and the pain pattern fits.
- Tietze's syndrome: Similar to costochondritis but involves the inflammation of the cartilages and surrounding tissues, it's less common and could be a consideration if the pain is very localized and other diagnoses are excluded.