Differential Diagnosis for Rib Pain in an 85-year-old Patient
Single Most Likely Diagnosis
- Osteoporotic fracture: Given the patient's age (85 years), a nondisplaced fracture of the seventh rib could be due to osteoporosis, which is common in the elderly and can lead to fractures with minimal trauma.
Other Likely Diagnoses
- Traumatic rib fracture: A possible cause of the rib pain and the questionable nondisplaced fracture, especially if the patient has a history of recent trauma or fall.
- Costochondritis: Inflammation of the cartilage that connects the ribs to the breastbone, which can cause rib pain and could be considered if the fracture is ruled out or not clearly identified.
- Musculoskeletal strain: Strain or pull of the muscles between the ribs could cause pain and might be considered, especially if the patient has been engaging in unusual physical activity.
Do Not Miss Diagnoses
- Pulmonary embolism: Although the left lung is clear on the X-ray, pulmonary embolism can sometimes present with chest or rib pain and is a life-threatening condition that should not be missed.
- Aortic dissection: A serious condition where there is a tear in the aorta, which can cause severe chest or back pain and is more common in the elderly.
- Pneumonia or lung infection: Even though the X-ray shows no infiltrate, clinical correlation is necessary as pneumonia can present atypically in the elderly.
Rare Diagnoses
- Rib metastasis: Although the X-ray does not show a lytic or blastic lesion, metastatic disease to the ribs is a possibility, especially in older adults with a history of cancer.
- Multiple myeloma: A type of blood cancer that can cause bone lesions, including in the ribs, though this would typically be associated with other systemic symptoms and findings.
- Stress fracture: More common in younger individuals or those with a history of repetitive stress or activity, but could be considered in the differential, especially if the patient has an unusual activity level for their age.