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 Impossible is not a fact, its an opinion 

DIFFERENTIAL DIAGNOSIS OF CHEST PAIN

May 6, 2010 by hdurina84

Just getting started , will keep  updating these differentials with rule in and rule out criteria.

 

 

SKIN : 


Herpes Zoster 
  • No ECG changes
  • Burning pain
  • Headache , fever
  • Rash appears after a couple of days
  • Localized paraesthesia before rash
MUSCLES :


Epidemic pleurodynia (acute viral infection of skeletal muscle)

  • Viral Prodrome
  • Sudden onset sharp stabbing, catching Chest Pain with sweating
  • Paroxysmal episode
  • Fever (over 38 degrees Celsius)
  • Cutaneous Hyperesthesia over involved muscles
  • EKG and XRAY are normal
  • Viral Cultures positive(stool and throat : coxackie/echovirus)
Intercostal Neuralgia
  • Due to nerve compression in ribcage area /thorax-abdomen region
  • left sided pain in chest/back
  • painful breathing/coughing/laughing
  • tingling/ numbness
  • atrophy/paralysis.

Trauma causing contusion
  • H/o chest injury.

Trichinosis
  • Eating undercooked meat/pork
  • fever , chills , profuse sweating
  • pain while breathing/chewing
  • chest pain as the parasite lodges itself in the diaphargm
  • may have abdominal cramping ,diarrhoea

Dermatomysositis
  • Skin Rash
  • Symmetric proximal muscle weaknness accompanied by pain( feels like pain after strenuos exercise)
  • Gottron's sign is an erythematous, scaly eruption occurring in symmetric fashion over the MCP and interphalangeal joints
  • dysphagia


RIB AND CARTILAGE :


Tietz syndrome
  • Inflammation of the costal cartilages
  • Acute chest pain
  • Tenderness on palpation
  • Swelling of cartilages which may be palpable on examination

Fracture 
  • h/o of trauma
  • rub bruising
  • difficulty breathing
  • rib swelling/chest wall deformity


PLEURA :

Pulmonary embolism



  • Tachypnoea, hypoxaemia, hypocarbia
  • No pulmonary congestion on chest x-ray, which is often normal
  • Clinical presentation may resemble hyperventilation.
  • Arterial oxygen pressure (PaO2) decreased or normal, partial arterial pressure of carbon dioxide (PaCO2) decreased
  • Pain is not often marked.
  • D-dimer assay positive; negative result excludes pulmonary embolism

Pleuritis 
  • pain aggravated with breathing
  • stabbing sensation of pain
  • shortness of breath
  • friction rub on auscultation with each breath
TB
  • Cough 
  • Fever
  • loss of weight
  • loss of appetite
  • hemoptysis
  • night sweats



Empyema
  • fever
  • cough
  • SOB
  • bad breath
  • hemoptysis
  • greenish yellow foul smelling sputum
  • fatigue

Mesenthelioma
  • exposure to asbestos
  • chest wall pain
  • pleural effusion
  • fatigue
  • anemia
  • wheezing /hoarseness/cough
  • hemoptysis

LUNG :


pneumonia

pneumothorax

carcinoma

PERICARDIUM


pericarditis
rheumatic fever
uremia

MYOCARDIUM


M.I. 
myocarditis
post-infarction syndrome
angina

contusion

post commisurotomy syndrome

AORTA 


aneurysm
aortitis
aortic rupture

ESOPHAGUS :


ulcer
esophagitis
carcinoma
diverticulum
hiatal hernia
rupture


MEDIASTINUM


mediastinitis
hodgkins
substernal throiditis
dermoid cyst



THORACIC VERTEBRA


osteomyelitis
potts disease
osteoporosis
osteoarthritis

fracture

herniated disc

SPINAL CORD :


tumor
tuberculosis
neuralgia
transverse myelitis
syphilis

 

Case Discussion: 

Namaste!

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