Differential Diagnosis for Right Sided Pleuritic Chest Pain
Single Most Likely Diagnosis
- Pulmonary Embolism (PE): Although the PERC score is 0, which suggests a low probability of PE, the presence of pleuritic chest pain and dyspnea in a young adult without other obvious causes warrants consideration. The fact that the patient is not tachycardic does not rule out PE, as some patients may not exhibit typical vital sign abnormalities.
Other Likely Diagnoses
- Pneumonia: Despite the absence of cough, pneumonia can present with pleuritic chest pain and dyspnea. The lack of cough does not rule out this diagnosis, especially if the pneumonia is viral or if the patient has a non-productive cough.
- Pleuritis: Inflammation of the pleura can cause sharp, pleuritic chest pain. This could be due to various causes, including viral infections or autoimmune diseases.
- Costochondritis: Inflammation of the costochondral junctions can cause sharp chest pain that may be pleuritic in nature, especially if the inflammation involves the lower ribs.
Do Not Miss Diagnoses
- Aortic Dissection: Although rare in young adults without a history of hypertension or connective tissue disease, aortic dissection can present with sudden, severe chest pain that may be pleuritic. It is a life-threatening condition that requires immediate diagnosis and treatment.
- Pneumothorax: A spontaneous pneumothorax can occur in young, healthy adults, especially those who are tall and thin. It can present with sudden onset of pleuritic chest pain and dyspnea.
- Cardiac Causes (e.g., Pericarditis, Myocardial Infarction): While less common in young adults, cardiac causes of chest pain should not be missed, as they can be life-threatening.
Rare Diagnoses
- Pulmonary Artery Sarcoma: A rare tumor that can cause chest pain and dyspnea due to obstruction of the pulmonary artery.
- Diaphragmatic Hernia: A rare condition where abdominal contents herniate through the diaphragm, which can cause pleuritic chest pain and dyspnea.
- Eosinophilic Pneumonia: A rare condition characterized by infiltration of the lungs with eosinophils, which can cause pleuritic chest pain and dyspnea.