Differential Diagnosis for Chest Tightness on the Right Side
When considering a patient who experiences tightness on the right side of the chest upon taking a deep breath, several potential diagnoses come to mind, categorized as follows:
Single Most Likely Diagnosis
- Pleurisy: This condition, characterized by inflammation of the pleura (the two-layered membrane surrounding the lungs and lining the chest cavity), is a common cause of sharp chest pain that worsens with deep breathing. The pain is typically localized to one side of the chest and can be accompanied by other symptoms such as cough or fever, depending on the underlying cause.
Other Likely Diagnoses
- Pneumonia: An infection of the lung primarily affecting the small air sacs known as alveoli, which can cause symptoms including chest pain that worsens with deep breathing, cough, fever, and difficulty breathing.
- Pulmonary Embolism (small or peripheral): A blockage of an artery in the lungs that can cause sudden and severe chest pain, which may worsen with deep breathing, though this symptom can be variable.
- Costochondritis: Inflammation of the cartilage that connects a rib to the breastbone (sternum), leading to sharp pains in the chest that can worsen with deep breathing or movement.
- Musculoskeletal Pain: Strain or injury to the muscles or ribs can cause chest pain that worsens with movement or deep breathing.
Do Not Miss Diagnoses
- Pulmonary Embolism (large or central): A larger blockage in the lungs can be life-threatening and requires immediate medical attention. Symptoms can include sudden onset of chest pain, shortness of breath, and potentially syncope.
- Myocardial Infarction (Heart Attack): While typically associated with left-sided chest pain, myocardial infarctions can occasionally present with right-sided chest pain, especially if the right ventricle is involved.
- Pneumothorax: Air in the space between the lungs and chest wall, which can cause the lung to collapse partially or completely. Symptoms include sudden chest pain and shortness of breath, which can worsen with deep breathing.
Rare Diagnoses
- Lung Cancer: Though less common as an initial presentation, lung cancer can cause chest pain due to tumor growth or metastasis to the chest wall or pleura.
- Sarcoidosis: An inflammatory disease that can affect multiple organs in the body, including the lungs, leading to chest pain among other symptoms.
- Tietze's Syndrome: A rare condition characterized by inflammation of the cartilages and surrounding tissues of the ribs, similar to costochondritis but can involve the upper ribs and may mimic more serious conditions.
Each of these diagnoses has a different set of implications for patient management and outcome, emphasizing the importance of a thorough diagnostic evaluation to determine the underlying cause of the chest tightness.