Differential Diagnosis
- Single most likely diagnosis
- Pulmonary embolism (PE): The patient's symptoms of shortness of breath (SOB), especially when lying down (orthopnea) and on exertion, along with a recent invasive procedure (endoscopy), increase the risk for PE. Although the patient denies chest pain (CP), it's not a universal symptom in PE.
- Other Likely diagnoses
- Aspiration pneumonia: Given the patient's recent endoscopy and symptoms of vomiting, cough, and SOB, aspiration pneumonia is a plausible diagnosis. The procedure could have led to aspiration of stomach contents into the lungs.
- Gastroesophageal reflux disease (GERD) exacerbation: The patient's vomiting and difficulty breathing, especially when lying down, could be related to GERD, which might have been exacerbated by the endoscopy or other factors.
- Anesthesia-related complications: Although less common, complications from the anesthesia used during the endoscopy, such as respiratory depression or an allergic reaction, could explain the patient's symptoms.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Cardiac tamponade: Although the patient denies CP, cardiac tamponade can present with SOB, especially when lying down, and could be a complication of the endoscopy if there was accidental puncture of the heart.
- Pneumothorax: A potential complication of endoscopy, especially if there was an accidental puncture of the lung or esophagus, pneumothorax would require immediate attention.
- Rare diagnoses
- Esophageal perforation: A rare but serious complication of endoscopy, esophageal perforation could lead to mediastinitis, abscess formation, and severe infection, presenting with SOB, vomiting, and chest pain.
- Anaphylaxis: A severe allergic reaction to the anesthesia, medications, or materials used during the endoscopy, anaphylaxis is rare but life-threatening and requires immediate recognition and treatment.