Differential Diagnosis for 63 YOF with Pleuritic Chest Pain
- Single most likely diagnosis
- Costochondritis: This condition is characterized by inflammation of the cartilage that connects the ribs to the breastbone, which can cause sharp pains in the chest that worsen with movement or palpation. The patient's symptoms of pleuritic chest pain reproducible with palpation on the chest wall and a clear chest X-ray support this diagnosis.
- Other Likely diagnoses
- Musculoskeletal strain: Given the reproducibility of pain with palpation, a musculoskeletal strain or injury could be a plausible explanation, especially if the patient has recently engaged in unusual physical activity.
- Pulmonary embolism (PE) with a low d-dimer: Although the d-dimer is slightly elevated at 0.65 mg/L, which is not strongly indicative, pulmonary embolism cannot be entirely ruled out without further imaging, especially in a patient with pleuritic chest pain. However, the clinical probability based on the provided information is lower.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Pulmonary embolism (PE): Despite the low d-dimer and clear chest X-ray, PE is a critical diagnosis to consider due to its high mortality rate if untreated. Further evaluation with CT pulmonary angiography or ventilation-perfusion scan might be necessary, especially if clinical suspicion remains high.
- Aortic dissection: Although less likely given the lack of other symptoms such as severe, tearing pain or differential blood pressures in limbs, aortic dissection is a life-threatening condition that requires immediate diagnosis and treatment.
- Pneumothorax: A spontaneous pneumothorax could present with pleuritic chest pain, and while the chest X-ray is reported as clear, a small pneumothorax might not be visible on an upright chest X-ray. If clinical suspicion is high, a repeat X-ray or CT scan might be warranted.
- Rare diagnoses
- Pneumonia (atypical or early presentation): Some pneumonias, especially those caused by atypical organisms, can present with minimal findings on chest X-ray early in the course of the disease.
- Acute coronary syndrome with atypical presentation: Although less common in women, especially without other risk factors or symptoms, an acute coronary syndrome (ACS) can occasionally present with pleuritic chest pain, especially if there is involvement of the right ventricle or if the patient has a condition like syndrome X.