Differential Diagnosis for 28-year-old Female with Chest Pain
Single Most Likely Diagnosis
- Pulmonary Embolism (PE) is less likely given the low D-dimer (0.29), but the presentation of chest pain and mildly elevated WBC could suggest an infectious or inflammatory process. However, considering the overall clinical picture, Urinary Tract Infection (UTI) seems more likely due to the presence of moderate bacteria and trace blood in the urinalysis, despite the primary complaint being chest pain, which might be referred pain or unrelated.
Other Likely Diagnoses
- Costochondritis: Given the chest pain and the absence of significant findings on troponin and D-dimer, costochondritis is a plausible diagnosis. It's an inflammatory condition of the cartilage that connects the ribs to the breastbone and can cause sharp pains.
- Pneumonia: Although not directly indicated by the information provided (e.g., no mention of lung exam findings or imaging), the elevated WBC count could suggest an infectious process. Pneumonia could cause chest pain and might not be immediately apparent without further diagnostic testing like a chest X-ray.
- Gastroesophageal Reflux Disease (GERD): GERD can cause chest pain and is a common condition. The absence of specific findings on the CBC, CMP, and negative troponins makes this a possible diagnosis, especially if the pain is related to eating or positional.
Do Not Miss Diagnoses
- Pulmonary Embolism (PE): Despite the low D-dimer, PE is a critical diagnosis not to miss due to its high mortality rate if untreated. Clinical judgment and further testing (like CT pulmonary angiogram) might be necessary if there's a high clinical suspicion.
- Myocardial Infarction (MI): Although the troponins are negative, it's crucial to consider MI, especially in younger patients where the presentation might be atypical. Further cardiac evaluation might be warranted.
- Aortic Dissection: This is a life-threatening condition that requires immediate diagnosis and treatment. Chest pain, especially if it's severe, tearing, or radiates to the back, should prompt consideration of this diagnosis, despite the lack of specific risk factors mentioned.
Rare Diagnoses
- Pericarditis: Inflammation of the pericardium can cause chest pain and might be considered if there's a pericardial friction rub on exam or characteristic ECG changes.
- Pneumothorax: Spontaneous pneumothorax can cause sudden chest pain and should be considered, especially if there are risk factors like tall, thin stature or lung disease. A chest X-ray would be diagnostic.
- Esophageal Rupture or Perforation: Although rare, these conditions can cause severe chest pain and are emergencies requiring prompt diagnosis and treatment.