Differential Diagnosis for Maria Barragan
Single Most Likely Diagnosis
- Chronic Bronchitis: Given Maria's history of a productive cough that has been ongoing for months, with a brief period of improvement followed by worsening, chronic bronchitis is a strong consideration. The fact that her cough is productive with clear yellow sputum and worsens at night, especially when lying down, supports this diagnosis. Although she denies a history of smoking, chronic bronchitis can also be caused by other irritants and conditions.
Other Likely Diagnoses
- Gastroesophageal Reflux Disease (GERD): Maria's symptoms of a chronic cough that worsens at night, particularly when lying down, could be indicative of GERD. The fact that she sleeps in a sitting position surrounded by pillows suggests she may be trying to alleviate symptoms of reflux.
- Postnasal Drip: Given her initial improvement with Robitussin and the possibility of pollen exposure, postnasal drip due to allergic rhinitis or sinusitis could be contributing to her cough.
- Heart Failure: Although Maria has a history of hypertension and hyperlipidemia, which are risk factors for heart failure, her lack of symptoms such as shortness of breath, chest pain, or edema makes this less likely. However, the worsening cough, especially at night, could be a sign of congestive heart failure.
Do Not Miss Diagnoses
- Lung Cancer: Although Maria denies a history of smoking, her age and history of carotid body paraganglioma (a type of neuroendocrine tumor) increase her risk for other cancers, including lung cancer. A persistent and worsening cough, especially with a history of recent hypoxia and pneumonia, necessitates consideration of lung cancer.
- Pulmonary Embolism: Given Maria's history of recent hospitalization and immobilization, there is a risk of pulmonary embolism, which could present with a cough, especially if it's worsening and accompanied by other symptoms like shortness of breath or chest pain.
- Tuberculosis (TB): Although less common, TB can present with a chronic cough and should be considered, especially if Maria has been exposed to someone with TB or has risk factors such as immunocompromised status.
Rare Diagnoses
- Sarcoidosis: This is a systemic granulomatous disease that can affect the lungs and present with a chronic cough among other symptoms. It's less likely but should be considered if other diagnoses are ruled out.
- Bronchiectasis: A condition characterized by permanent dilation of parts of the airways, which can lead to a chronic productive cough. It's less common and usually associated with a history of recurrent infections or specific underlying conditions.