Differential Diagnosis for Right-Sided Chest Pain Present Only on Expiration

Immediate Life-Threatening Causes to Exclude First

Pulmonary embolism presents with acute dyspnea and pleuritic chest pain, with tachycardia present in >90% of patients, according to the American College of Cardiology 1, 2
The American College of Cardiology recommends obtaining ECG within 10 minutes and measuring cardiac troponin as soon as possible to evaluate for pulmonary embolism 1, 2
Right-sided pneumothorax can present with pain during any phase of respiration, and chest radiography is essential for diagnosis, as suggested by the American College of Cardiology 1, 2

Pericarditis presents with sharp, pleuritic chest pain that worsens when supine and improves when leaning forward, with friction rub on examination and fever being characteristic findings, according to the American College of Cardiology 1, 2
Pneumonia presents with localized pleuritic pain, fever, productive cough, regional dullness to percussion, and egophony, and chest radiography is diagnostic, as recommended by the American College of Cardiology 1, 3

A focused cardiovascular examination for murmurs, friction rub, S3, pulse differentials, and blood pressure differentials is essential, as suggested by the American College of Cardiology 5
The American College of Cardiology recommends ECG within 10 minutes of presentation to identify STEMI, pericarditis patterns, or signs of pulmonary embolism 1, 4, 3
Chest radiography is necessary to evaluate for pneumothorax, pneumonia, pleural effusion, or widened mediastinum, according to the American College of Cardiology 3

If ECG shows ST elevation or new ischemic changes, immediate transfer by EMS is required, as recommended by the American College of Cardiology 4
If cardiac testing is negative and chest wall tenderness is present, treat as costochondritis with anti-inflammatory medications, as suggested by the American College of Cardiology 3