Differential Diagnosis for Acute Onset Sharp Left Sided Chest Pain
Single Most Likely Diagnosis
- Costochondritis: This condition, also known as Tietze's syndrome, is characterized by sharp pain in the chest wall, particularly over the costochondral junctions. The pain is often exacerbated by movement, deep breathing, or pressure on the affected area. Given the sharp nature of the pain and its worsening when laying on the left side, costochondritis is a plausible explanation.
Other Likely Diagnoses
- Musculoskeletal strain: The acute onset of sharp chest pain, especially if it worsens with movement or certain positions, could be due to a musculoskeletal strain. This could involve the intercostal muscles or other chest wall structures.
- Precordial catch syndrome: This condition presents with sharp, stabbing chest pain that can be exacerbated by deep breathing or movement. It is more common in younger individuals and can be related to stress or anxiety.
- Gastroesophageal reflux disease (GERD): Although GERD typically presents with a burning type of chest pain, it can sometimes cause sharp pain, especially if there is associated esophageal spasm.
Do Not Miss Diagnoses
- Pulmonary embolism (PE): Although less likely in a young individual without risk factors, PE can present with acute onset chest pain and must be considered due to its high mortality rate if missed.
- Myocardial infarction (MI): While rare in a 22-year-old without risk factors, MI can occur and is a diagnosis that cannot be missed due to its severe consequences.
- Pneumothorax: Spontaneous pneumothorax can occur in tall, thin males without a clear precipitant and presents with acute chest pain and shortness of breath.
- Aortic dissection: This is a rare but life-threatening condition that can present with severe, tearing chest pain. It is essential to consider in any patient with acute chest pain, regardless of age.
Rare Diagnoses
- Pericarditis: Inflammation of the pericardium can cause sharp, stabbing chest pain that may improve with sitting up and leaning forward. It is less common but should be considered in the differential diagnosis.
- Esophageal rupture or perforation: This is a rare but serious condition that can present with severe chest pain following vomiting or other esophageal trauma.
- Mitral valve prolapse: While often asymptomatic, mitral valve prolapse can cause chest pain, usually described as sharp or stabbing, though this is less common.