What’s the Diagnosis?
by Yash Pandya
History of Present Illness:
Dori is a 75-year-old female who arrives at the Emergency Department with pain in her chest area, which has been getting progressively worse for the past week. Dori has pain on the left side of her chest that feels sharp every time she takes a deep breath. Consequently, she also has some difficulty breathing. Upon inspection, no significant findings are visible: there is no inflammation, no pain on palpation and no pus formation is detected.
Dori suffers from hypertension and dementia. She is in the hospital with her daughter who states that her mother was on blood pressure medication in the past but discontinued them several years ago. Dori has no known allergies and takes no medications presently.
Dori is conscious, alert and oriented. She has a Heart Rate of 65—strong and regular. Respiratory Rate is 16—unlabored. Blood Pressure is 135/85, SpO2 of 98% on room air. Her lung sounds are clear and equal bilaterally on auscultation. EKG shows a normal sinus rhythm.
What’s wrong with Dori?
Dori suffers from costochondritis, a condition defined as the inflammation of the cartilage that connects each rib to the breastplate (or sternum). This condition is often confused with a heart attack due to its common symptoms of chest pain and difficulty breathing. The key feature that distinguishes costochondritis is inflammation in the affected chest area. However, this patient is a particularly unusual presentation, showing no signs of redness or pain on palpation of the chest. It is possible that this is atypical or the condition has not progressed enough to display these symptoms.
Costochondritis can be caused by several factors, some of which include trauma to the chest, infection, physical strain or a tumor. It is most commonly seen in females over the age of 40 years or in children presenting with chest pain. The condition is also known to specifically affect one side of the chest, often involving more than one level of the rib cage. The treatment for costochondritis involves the use of anti-inflammatories, steroids, pain medications, antibiotics (if infection is suspected), heat/cold pack application and rest.