ZocdocAnswersCostochondritis or Pulmonary Embolis?

Question

Costochondritis or Pulmonary Embolis?

I need a second opinion: Do I have Costochondritis?... Or could it actually be a Pulmonary Embolus? I'm a fit 32 y.o. male and I was diagnosed with Costochondritis, but I fear it may actually be Pulmonary Embolis. Does a Pulmonary Embolis actually hurt when pressing on the ribs the way Costochondritis would? Or would it be too deep to be felt by pressing on the ribs? My X Rays came back clean, and my oxygen level reading was at 99% (at 2700ft above sea level). My only concern was that prior to this pain, I felt a deep pain in my left buttocks for two days straight, which I feared could've been a DVT. Could just as easily been a pulled muscle, but it's too coincidental and I've never really felt that kind of pain before in that location. I can breathe normally, but when I try to take a deep breath there is a sharp pain under my ribs below my right nipple. I otherwise feel fine. Should I be concerned & get checked again?

Answer

While it is always good to be conscious about your health and be involved in the decisions and your health care in general, it is important to appreciate the fact that so many of these diagnosis are made only through a long history of seeing patients who are both normal and those who have serious problems. You are exactly right that the symptoms that you have described could be due to an embolus from a DVT, and it sounds like you were thorough and discussed your concerns with a doctor. Because determining if a patient has had a PE is hard, even for a doctor, your doctor will usually use a points system to determine if you are at high risk of a DVT spreading to become a PE, or if you are at low risk. This risk stratification will then suggest the value of additional testing. That is because none of our tests are perfect, and most will give both false negatives (the test says no PE even though you have one) and false positives (the test says yes to a PE, but you don't have one). Based on the information you have provided, the odds of you having a PE are quite low, but there is still some risk. Please speak to your doctor.

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