A healthy 27-year-old woman presents with chest pain that worsens with chest wall palpation; there is no dyspnea or systemic symptoms. What is the most likely diagnosis?

• A. Costochondritis
• B. Angina pectoris
• C. Esophageal spasm
• D. Pulmonary embolism

Answer: (A)

This question tests recognizing a noncardiac, musculoskeletal cause of chest pain based on physical findings. Chest wall pain that worsens with palpation and is localized to the chest wall points to inflammation of the costochondral joints—costochondritis. In this scenario, the patient is young and otherwise healthy, with no dyspnea or systemic symptoms, which fits a benign musculoskeletal source rather than heart or lung problems.

Angina would suggest myocardial ischemia and typically presents with exertional chest pressure that may radiate, often in patients with cardiovascular risk factors; it’s not usually reproducible with chest palpation. Esophageal spasm can mimic cardiac pain but is more often associated with swallowing difficulties or regurgitation and isn’t defined by chest wall tenderness on palpation. Pulmonary embolism presents with acute pleuritic chest pain plus dyspnea, tachycardia, and potential hypoxia, usually in someone with risk factors or recent immobilization or surgery.

So the localized, reproducible chest wall tenderness without systemic symptoms makes costochondritis the most likely diagnosis. Treatment is usually supportive—NSAIDs and rest—with an emphasis on avoiding unnecessary cardiac workup when red flags are absent.