Differential Diagnosis for Exertional SOB in a 67M with Sore Throat and History of COPD, Prior Leiomyosarcoma
- Single Most Likely Diagnosis
- COPD exacerbation: Given the patient's history of COPD, an exacerbation is a common cause of exertional shortness of breath (SOB), and the sore throat could be a trigger or a concurrent infection.
- Other Likely Diagnoses
- Pneumonia: The sore throat and exertional SOB could be indicative of a respiratory infection such as pneumonia, especially in a patient with a compromised respiratory system due to COPD.
- Pulmonary embolism (PE): Although less common, PE should be considered, especially given the patient's history of cancer, which increases the risk of thromboembolic events.
- Cardiac ischemia or heart failure: Exertional SOB can also be a symptom of cardiac issues, and the patient's age and history of radiation therapy (which can affect cardiac function) make this a plausible consideration.
- Do Not Miss Diagnoses
- Pulmonary metastasis: Given the patient's history of leiomyosarcoma, it's crucial not to miss the possibility of pulmonary metastases, which could cause exertional SOB.
- Radiation pneumonitis: The patient's history of radiation therapy increases the risk of radiation pneumonitis, a potentially severe condition that could present with exertional SOB and a history of sore throat if there's an associated infection.
- Pneumothorax: Especially in a patient with COPD, a pneumothorax could be catastrophic and must be ruled out, particularly if there's any suspicion based on symptoms or physical examination findings.
- Rare Diagnoses
- Lymphangitic carcinomatosis: A rare condition where cancer spreads to the lymphatic vessels in the lungs, causing SOB. Given the patient's cancer history, it's a rare but possible consideration.
- Pulmonary vasculitis: Conditions like Wegener's granulomatosis or other forms of vasculitis could present with SOB and systemic symptoms like sore throat, though they are less common.
- Thromboembolic disease in the setting of tumor thrombus: Although rare, if the patient's cancer has recurred, there's a possibility of tumor thrombus causing thromboembolic events.