Differential Diagnosis for 35-year-old Male with Chest Pain and Numbness
Single Most Likely Diagnosis
- Costochondritis: This condition is characterized by sharp, reproducible chest pain to palpation, which matches the patient's symptoms. The chronic nature of the numbness down the left arm could be related to a musculoskeletal issue or a referred pain from the chest wall.
Other Likely Diagnoses
- Musculoskeletal strain or injury: Given the sharp and reproducible nature of the chest pain, a musculoskeletal issue such as a strain or injury to the chest wall or shoulder region is possible. This could also explain the numbness in the arm if it's related to a nerve impingement or referred pain.
- Post-thrombotic syndrome: Although the patient is on anticoagulation for a history of pulmonary embolism (PE), post-thrombotic syndrome could potentially cause chronic pain and numbness in the arm, especially if there's residual damage from the PE.
Do Not Miss Diagnoses
- Aortic dissection: Although less likely given the patient's age and the nature of the pain, aortic dissection is a life-threatening condition that must be considered, especially in anyone presenting with chest pain. The sharp, reproducible nature of the pain could potentially be misleading.
- Pulmonary embolism recurrence: Despite being on anticoagulation, there's always a risk of PE recurrence, which could present with chest pain and potentially numbness or pain in the arm if related to a large clot causing pressure effects.
- Myocardial infarction: While the patient's age and the description of the pain make this less likely, myocardial infarction (MI) can present atypically, and the risk factors for MI (such as those that led to PE) could also predispose to coronary artery disease.
Rare Diagnoses
- Tietze's syndrome: A rare condition similar to costochondritis but involves the cartilages of the upper ribs. It could explain the sharp chest pain but is less likely to cause chronic numbness down the arm.
- Thoracic outlet syndrome: This condition involves compression of the nerves and/or blood vessels that pass into the thoracic outlet (the space between your collarbone and first rib). It could explain both the chest pain and the numbness in the arm but is less common and typically presents with specific maneuvers that reproduce the symptoms.
- Pancoast tumor: A rare type of lung cancer that grows in the upper part of the lung and can invade nearby structures, causing chest pain and numbness in the arm due to nerve involvement. Given the patient's history of PE and the chronic nature of symptoms, this would be an unlikely but important diagnosis to consider if other causes are ruled out.