Differential Diagnosis for Chest Pain
Single most likely diagnosis
- Costochondritis: This condition, also known as Tietze's syndrome, is characterized by inflammation of the cartilage that connects the ribs to the breastbone. The symptoms described, such as chest pain on the left side below the nipple that worsens with palpation and improves with sitting straight, are consistent with costochondritis. The pain's relation to movement and position, rather than exertion, also supports this diagnosis.
Other Likely diagnoses
- Musculoskeletal strain: Given the nature of the pain being worse with hunching over and better when sitting straight, a musculoskeletal strain in the chest wall or intercostal muscles could be a plausible explanation. This type of strain could occur due to overuse, poor posture, or direct injury to the area.
- Gastroesophageal reflux disease (GERD): Although GERD typically presents with symptoms of heartburn and regurgitation, it can sometimes cause chest pain, especially if the pain is worsened by positions that increase abdominal pressure, such as hunching over. However, the lack of association with eating or exertion makes this less likely.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Acute coronary syndrome (ACS): Although the pain profile does not classically suggest ACS (as it's not associated with exertion and has specific positional components), it's crucial to consider ACS in any patient presenting with chest pain, especially in a male over 40. ACS includes conditions such as myocardial infarction (heart attack) and unstable angina.
- Pulmonary embolism (PE): While the symptoms don't strongly suggest PE, any sudden onset of chest pain, especially if accompanied by shortness of breath, warrants consideration of this potentially life-threatening condition.
- Aortic dissection: This is a rare but critical condition where there is a tear in the aorta's inner layer. Although the described pain doesn't fit the classic tearing or ripping sensation often associated with aortic dissection, the severity of the condition necessitates its inclusion in the differential diagnosis.
Rare diagnoses
- Precordial catch syndrome: A benign condition characterized by sharp, stabbing pains in the chest that can be exacerbated by movement or deep breathing. It's more common in younger individuals but can occur at any age.
- Slipping rib syndrome: A condition where the ribs slip out of place, causing chest pain that can be reproduced by pressing on the affected area. It's relatively rare and might be considered if other diagnoses are ruled out.
- Tietze's syndrome of the lower ribs: Similar to costochondritis but less common, involving the cartilage of the lower ribs.