Differential Diagnosis for a 13-year-old boy with paroxysmal thoracic pain and "achy joints"
- Single most likely diagnosis:
- Familial Mediterranean Fever (FMF) or more likely Viral Pericarditis given the symptoms of paroxysmal thoracic pain aggravated by deep breathing, coughing, or movement, and a recent similar experience in a family member. However, the most common cause of such symptoms, especially with the additional complaint of "achy joints," could be related to a viral infection.
- Other Likely diagnoses:
- Costochondritis: Inflammation of the cartilage that connects the ribs to the breastbone, which can cause sharp pains in the chest that worsen with deep breathing or coughing.
- Viral Pleurisy: Inflammation of the pleura (the two-layered membrane surrounding the lungs) due to a viral infection, which can cause chest pain that worsens with breathing or coughing.
- Myopericarditis: Inflammation of both the heart muscle (myocardium) and the membrane surrounding the heart (pericardium), often due to a viral infection, which can cause chest pain and "achy joints."
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Pulmonary Embolism: Although rare in children, it's a life-threatening condition that requires immediate attention. The risk factors and presentation might not fully align with the given scenario, but it's crucial to consider in any case of acute chest pain.
- Pneumonia: Especially if caused by a bacterium, it can lead to severe complications if not treated promptly. The symptoms can sometimes mimic those of viral pericarditis or pleurisy.
- Acute Coronary Syndrome: Extremely rare in children but can occur, especially in those with underlying heart conditions.
- Rare diagnoses:
- Sickle Cell Crisis: If the child has sickle cell disease, a crisis can cause severe pain, including chest pain, due to vaso-occlusion.
- Tietze's Syndrome: A rare condition characterized by inflammation of the cartilages and surrounding tissues of the ribs, which can cause chest pain and swelling.
- Relapsing Polychondritis: A rare autoimmune disorder that can cause inflammation of the cartilage in various parts of the body, including the ribs, leading to chest pain.
The justification for these diagnoses is based on the combination of symptoms presented by the patient, including paroxysmal thoracic pain exacerbated by deep breathing, coughing, or movement, and "achy joints," along with a family history of a similar condition. The age of the patient and the acute onset of symptoms also guide the differential diagnosis towards more common and less severe conditions, while still considering life-threatening possibilities.