Recurrent Chest Pain in Young Adult with Costochondritis Diagnosis

Case at a Glance

A 23-year-old female with obesity presents with chronic, intermittent chest pain spanning several years. Recent imaging revealed lung base atelectasis/scarring, and she was diagnosed with costochondritis by her primary care physician.

Patient's Story

The patient reports experiencing chest, rib, and upper back pain for several years with an intermittent pattern - symptoms may resolve completely then return for weeks at a time. Pain intensity ranges from mild to moderate (6/10 on pain scale). She describes the current episode as severe pain in the left shoulder-chest region that has progressed to involve the middle chest, back, and clavicular area. The patient also reports intermittent dizziness. Previous episodes sometimes responded to ibuprofen 600mg, but current symptoms are refractory to anti-inflammatory medication.

Initial Assessment

Physical examination by primary care physician revealed findings consistent with costochondritis. Patient is a 23-year-old female with BMI of approximately 42 (weight 250 lbs, height 5'4"). She has no smoking history. Vital signs were stable during office visit.

The Diagnostic Journey

Patient has sought emergency care multiple times over the past year. Two previous emergency department visits for chest pain included EKG monitoring, which showed normal cardiac rhythm. Most recent ED visit for abdominal pain included CT imaging, which incidentally revealed scattered atelectasis and scarring at the lung bases. Primary care follow-up resulted in clinical diagnosis of costochondritis based on symptom pattern and physical examination findings.

Final Diagnosis

Costochondritis with underlying pulmonary changes (scattered atelectasis/scarring at lung bases)

Treatment Plan

Conservative management with ibuprofen 600mg for anti-inflammatory effect. Patient advised to use acetaminophen as adjunctive pain control. Instructions provided to seek emergency care if symptoms worsen significantly. Follow-up scheduled with primary care physician for ongoing management of chronic pain syndrome.

Outcome and Follow-up

Patient continues to experience pain episodes despite initial treatment. Emergency care team advised that acute evaluation would focus on ruling out emergent conditions, with likely discharge and primary care follow-up for chronic pain management. Ongoing monitoring planned for pulmonary findings and pain control optimization.