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Pulmonary
Pleuritis
Empyema thoracis
Pulmonary infarction
Pulmonary embolism
Pneumonia
Pleural effusion
Pneumothorax
Systemic lupus erythemetosis
Mesothelioma
Tracheobronchitis
Mediastinal emphysema

Cardiovascular
Angina Pectoris
Myocardial Infarction
Dissection of Aortic Aneurysm
Mitral Valve Prolapse
Valvular heart disease
Pericarditis
Hypertrophic Cardiomyopathy
Severe pulmonary hypertension
Cardiac arrhythmia
Cocaine toxicity

Chest Wall
Costocondritis – Tietze syndrome
Breast abscess
Rib fracture
Chest wall injury
Chest wall or rib malignancy
Myalgia
Herpes zoster infection
Neuritis-radiculitis
Cervical radiculitis
Compression of brachial plexus by cervical ribs - Thoracic outlet obstruction
Tendinitis or bursitis of left shoulder joint
Sickle cell disease

Gastrointestinal
Oesophagitis
Gastro esophageal reflux disorder
Peptic Ulcer
Esophageal Motility disorders
Biliary Colic
Pancreatitis
Gastointestinal perforation

Assess patients hemodynamic stability. If the patient is stable a detailed history followed by physical examination would help to limit the number of differentials. Investigations like ECG, Chest X ray, ECHO, Cardiac enzyme levels will rule in or rule out the commonest causes. If the patient is unstable, effort must be taken to rule out the critical etiologies like aortic dissection, myocardial infarction, pneumothorax, pulmonary embolism and infarction, cardiac arrhythmia, GI perforation, pancreatitis etc.