What is the diagnosis for a 63-year-old female (YOF: years old female) presenting with central chest pressure, negative troponin, normal electrocardiogram (ECG), and elevated white blood cell (WBC) count with neutrophilia?

Differential Diagnosis for Central Chest Pressure in a 63-Year-Old Female

Single Most Likely Diagnosis

• Pneumonia: Given the elevated WBC count (14.9) and neutrophils (11.8), pneumonia is a strong consideration, especially since the symptoms include central chest pressure, which could be indicative of an infectious process affecting the lungs.

Other Likely Diagnoses

• Pulmonary Embolism (PE): Although the ECG is normal and troponin is negative, a pulmonary embolism could still be a possibility, especially if there are other risk factors present (e.g., recent immobilization, family history of clotting disorders). The chest pressure could be a symptom of a PE.
• Acute Bronchitis: This condition could also present with chest pressure and an elevated WBC count, especially if it's caused by a bacterial infection.
• Gastroesophageal Reflux Disease (GERD): GERD can cause chest pressure that might be confused with cardiac issues, and it's a common condition in the general population.

Do Not Miss Diagnoses

• Myocardial Infarction (MI) with Normal Troponin: Although the troponin is negative, it's crucial not to miss an MI, especially in a 63-year-old female. Early troponin levels can be negative in the very early stages of an MI, or there could be a condition affecting troponin levels (e.g., chronic kidney disease).
• Aortic Dissection: This is a life-threatening condition that requires immediate diagnosis and treatment. Chest pressure is a common symptom, and it's critical not to miss this diagnosis, even though it's less likely.
• Pneumothorax: A spontaneous pneumothorax could cause sudden chest pressure and would be a medical emergency, especially if it's a tension pneumothorax.

Rare Diagnoses

• Esophageal Rupture: Although rare, an esophageal rupture (Boerhaave's syndrome) could present with severe chest pain and would be a medical emergency.
• Mediastinitis: Inflammation of the tissues in the mediastinum could cause chest pressure and is often associated with infection or trauma.
• Pericarditis: Inflammation of the pericardium could cause chest pain that might be confused with other conditions. It's less likely given the normal ECG but could still be a consideration, especially if there's a pericardial friction rub on physical examination.