Differential Diagnosis for Patient with Granulomatosis and Respiratory Symptoms
Single Most Likely Diagnosis
- Wegener's Granulomatosis (Granulomatosis with Polyangiitis): The patient's known history of granulomatosis, combined with symptoms of pain upon deep breathing and radiographic findings of diffuse small airway thickening and subtle reticular opacities, suggests an exacerbation or active disease process of Wegener's granulomatosis. This condition is known for its involvement of the respiratory tract and can present with a wide range of pulmonary symptoms and radiographic abnormalities.
Other Likely Diagnoses
- Sarcoidosis: Given the patient's history of granulomatosis, sarcoidosis is a plausible diagnosis. It can cause similar radiographic findings, including small airway thickening and reticular opacities, and often presents with respiratory symptoms.
- Chronic Eosinophilic Pneumonia: This condition can cause diffuse lung infiltrates and may present with symptoms similar to those experienced by the patient. However, the lack of consolidation on the CXR makes this less likely.
- Bronchiectasis: The presence of diffuse small airway thickening could suggest bronchiectasis, especially if the patient has a history of recurrent infections or chronic inflammation.
Do Not Miss Diagnoses
- Pulmonary Embolism: Although the CXR does not show significant abnormalities suggestive of a pulmonary embolism, this diagnosis must be considered due to the patient's symptom of pain upon deep breathing, which could be indicative of a pulmonary embolism. The consequences of missing this diagnosis can be fatal.
- Pneumonia (atypical or viral): Despite the lack of consolidation on the CXR, atypical or viral pneumonias can present with subtle radiographic findings and should be considered, especially if the patient's symptoms worsen or do not respond to initial treatment.
Rare Diagnoses
- Lymphangitic Carcinomatosis: This rare condition involves the spread of cancer to the lymphatic vessels of the lung and can cause diffuse small airway thickening and reticular opacities. It is less likely given the patient's history but should be considered if other diagnoses are ruled out and the patient's condition progresses.
- Idiopathic Pulmonary Fibrosis (IPF): While IPF typically presents with more pronounced fibrotic changes on imaging, early or atypical cases could potentially mimic the patient's radiographic findings. However, the patient's known history of granulomatosis makes this less likely.