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 Acute Pericarditis caused by a viral infection such as Coxsackievirus B. The patient's symptoms of paroxysmal thoracic pain aggravated by deep breathing, coughing, or movement, along with "achy joints," and a family history of similar experience, suggest an inflammatory condition. However, given the acute presentation and the involvement of the thoracic region, acute pericarditis is a strong consideration.
- Other Likely diagnoses:
- Viral Pericarditis due to Adenovirus, Influenza, or Enterovirus: These viruses can cause pericarditis, which presents with chest pain that worsens with movement or deep breathing.
- Costochondritis: An inflammatory condition of the cartilages that connect the ribs to the sternum, which can cause chest pain and is sometimes associated with viral infections.
- Pleurisy: Inflammation of the pleura, the two-layered membrane surrounding the lungs, which can cause sharp chest pain that worsens with breathing or coughing.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Pulmonary Embolism (PE): Although less common in adolescents, PE can present with sudden onset of chest pain and must be considered, especially if there's a history of recent immobilization, trauma, or family history of clotting disorders.
- Myocardial Infarction: Rare in adolescents but can occur, especially with underlying heart conditions.
- Pneumonia: Can cause pleuritic chest pain and must be considered, especially if there are symptoms of infection such as fever or cough.
- Rare diagnoses:
- Sickle Cell Crisis: If the patient has sickle cell disease, a crisis can cause severe chest pain due to vaso-occlusion.
- Tietze's Syndrome: A rare inflammatory condition of the cartilages of the chest wall, which can mimic the symptoms of pericarditis or costochondritis.
- Autoimmune conditions such as Systemic Lupus Erythematosus (SLE) or Rheumatoid Arthritis (RA), which can cause joint pain and, less commonly, chest pain due to pericarditis or pleuritis.