Differential Diagnosis for Chest Pain and Associated Symptoms
Single Most Likely Diagnosis
- Diabetic Cardiomyopathy or Coronary Artery Disease: Given the patient's history of poorly controlled diabetes mellitus (DM), the sharp chest pain, especially with radiation across the chest, suggests cardiac involvement. Diabetic cardiomyopathy or coronary artery disease could explain the chest pain, and the patient's DM history increases the risk for these conditions.
Other Likely Diagnoses
- Peripheral Artery Disease (PAD): The patient's complaint of the right knee giving out, combined with a history of a thicker right leg since birth and current right leg swelling, could indicate PAD, especially in the context of poorly controlled diabetes.
- Deep Vein Thrombosis (DVT): The swelling in the right leg, described as never having been this swollen before, could suggest DVT, a condition that requires urgent evaluation.
- Musculoskeletal Pain: Sharp chest pain could also be musculoskeletal in origin, especially if the patient has been experiencing recent increases in physical activity or has a history of musculoskeletal issues.
Do Not Miss Diagnoses
- Pulmonary Embolism (PE): Although the patient's symptoms do not classically present as a PE, the sudden onset of chest pain and leg swelling could be indicative of a PE, which is life-threatening and requires immediate diagnosis and treatment.
- Aortic Dissection: This is a life-threatening condition that could present with sharp, radiating chest pain. Although less likely given the patient's presentation, it cannot be missed due to its high mortality rate.
- Myocardial Infarction (MI): The patient's symptoms of chest pain, especially with radiation, could indicate an MI, which is a medical emergency.
Rare Diagnoses
- Thoracic Outlet Syndrome: This condition could cause sharp chest pain and arm symptoms but is less likely given the patient's primary complaint of chest pain radiating across the chest.
- Spinal or Rib Pathology: Conditions affecting the spine or ribs, such as a thoracic spine fracture or osteomyelitis, could cause sharp chest pain but are less likely without specific trauma or infection history.
- Pneumothorax: Although possible, the presentation does not strongly suggest pneumothorax without additional symptoms like shortness of breath or recent trauma.