What is the diagnosis for a patient with a history of asthma and hypertension, presenting with a 2-day history of cough and shortness of breath, with chest X-ray showing no acute cardiopulmonary findings but low lung volumes, Computed Tomography Angiography (CTA) chest revealing mild bilateral bronchial wall thickening, and laboratory results indicating elevated D-dimer (D-dimer), normal Brain Natriuretic Peptide (BNP) and slightly elevated troponin, along with hematuria and bacteriuria?

Differential Diagnosis

• Single most likely diagnosis
  • Acute bronchitis: The patient's symptoms of cough and shortness of breath (SOB) for 2 days, along with the CTA chest findings of mild bilateral bronchial wall thickening, are consistent with acute bronchitis. The patient's history of asthma also supports this diagnosis, as asthmatics are more prone to bronchitis.
• Other Likely diagnoses
  • Asthma exacerbation: Given the patient's history of asthma, an exacerbation of asthma could explain the symptoms of cough and SOB. The low lung volumes on chest X-ray also support this diagnosis.
  • Urinary tract infection (UTI): The urinalysis results showing RBC, bacteria, and blood in the urine suggest a possible UTI. The patient's symptoms do not directly point to a UTI, but it could be a coincidental finding.
  • Congestive heart failure (CHF): Although the BNP is low, the patient's history of high blood pressure and the CTA chest findings of mild bilateral bronchial wall thickening could be related to CHF. However, the lack of acute cardiopulmonary findings on chest X-ray and the low BNP make this less likely.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Pulmonary embolism (PE): Although the D-dimer is elevated at 1.91, it is not significantly high. However, given the patient's symptoms of SOB and cough, PE should be considered, especially since it can be deadly if missed.
  • Pneumonia: The patient's symptoms and CTA chest findings could also be consistent with pneumonia. Although the chest X-ray does not show acute cardiopulmonary findings, pneumonia should be considered, especially in a patient with a history of asthma.
• Rare diagnoses
  • Sarcoidosis: This is a rare diagnosis that could explain the bronchial wall thickening on CTA chest. However, it would require further testing and is less likely given the patient's acute presentation.
  • Interstitial lung disease: This is another rare diagnosis that could explain the low lung volumes on chest X-ray. However, it would require further testing and is less likely given the patient's acute presentation.