Differential Diagnosis for Chest Pain in a 17-Year-Old Female
Single Most Likely Diagnosis
- Costochondritis: This condition is characterized by inflammation of the cartilage that connects the ribs to the sternum. The patient's symptoms of chest pain that worsens with bending forward and is located on the right side of the sternum are consistent with costochondritis. The lack of relief with ASA, Tylenol, and ibuprofen does not rule out this diagnosis, as these medications may not always provide complete relief.
Other Likely Diagnoses
- Musculoskeletal strain: Given the patient's history of fibromyalgia, musculoskeletal strain is a possible cause of her chest pain. The pain's duration and location could be consistent with strain or overuse of the muscles in the chest wall.
- Gastroesophageal reflux disease (GERD): GERD can cause chest pain that is worsened by bending forward. Although the patient does not report radiating discomfort or other typical symptoms of GERD, it is still a possible cause of her chest pain.
- Stress or anxiety-related chest pain: The patient's history of fibromyalgia and the fact that she has been taking multiple medications without relief suggest that stress or anxiety could be contributing to her chest pain.
Do Not Miss Diagnoses
- Myocardial infarction (MI) or acute coronary syndrome: Although rare in a 17-year-old, MI or acute coronary syndrome must be considered, especially if the patient has any risk factors (e.g., family history of early cardiovascular disease). The fact that the patient's pain is not typical for MI (e.g., no radiation to the arm, no diaphoresis) does not rule out this diagnosis.
- Pulmonary embolism (PE): PE is another potentially life-threatening condition that must be considered, even if the patient does not have typical symptoms (e.g., shortness of breath, tachypnea).
- Pneumonia or pneumothorax: These conditions can cause chest pain and must be considered, especially if the patient has any respiratory symptoms (e.g., cough, shortness of breath).
Rare Diagnoses
- Tietze's syndrome: This is a rare condition characterized by inflammation of the cartilage that connects the ribs to the sternum, similar to costochondritis. However, Tietze's syndrome typically involves swelling of the affected area, which is not mentioned in the patient's presentation.
- Sickle cell crisis: If the patient has sickle cell disease, a crisis could cause chest pain. However, this would typically be accompanied by other symptoms (e.g., fever, fatigue).
- Pericarditis: This is inflammation of the pericardium, the sac that surrounds the heart. Pericarditis can cause chest pain that worsens with bending forward, but it is relatively rare in a 17-year-old without any underlying conditions.