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
- Urinary Tract Infection (UTI): The presence of moderate bacteria and trace blood in the urinalysis, along with a mildly elevated WBC count, suggests a UTI. The chest pain could be referred pain or unrelated to the UTI.
Other Likely Diagnoses
- Costochondritis: Inflammation of the cartilage that connects the ribs to the breastbone, which can cause chest pain. The elevated WBC count could be a response to inflammation.
- Musculoskeletal Chest Pain: Given the absence of cardiopulmonary abnormalities on the chest X-ray and normal troponin levels, musculoskeletal pain is a possibility.
- Gastroesophageal Reflux Disease (GERD): Can cause chest pain and is a common condition in the general population.
Do Not Miss Diagnoses
- Pulmonary Embolism (PE): Although the D-dimer is low, it's essential to consider PE due to its high mortality rate if missed. Further evaluation with imaging (e.g., CT pulmonary angiogram) might be necessary if clinical suspicion remains high.
- Aortic Dissection: A life-threatening condition that requires immediate attention. Although less likely in a young female without risk factors, it cannot be entirely ruled out without further imaging (e.g., CT angiogram of the chest).
- Myocardial Infarction: Despite normal troponin levels, it's crucial to consider myocardial infarction, especially if the patient has risk factors or if the chest pain is suggestive of cardiac origin.
Rare Diagnoses
- Pneumonia: Could present with chest pain and an elevated WBC count, but the chest X-ray did not show acute cardiopulmonary abnormalities.
- Pericarditis: Inflammation of the pericardium, which can cause chest pain. The ECG and further evaluation would be necessary to diagnose this condition.
- Esophageal Rupture or Perforation: A rare but serious condition that can cause severe chest pain. The history and further diagnostic tests (e.g., esophagram) would be crucial in diagnosing this condition.