Differential Diagnosis
The patient presents with a complex set of symptoms including cough, shortness of breath (SOB), chest tightness, feverish feelings, nausea/vomiting (N/V), headache (H/A), and fatigue. Given the negative COVID-19 and influenza tests, the differential diagnosis can be categorized as follows:
- Single Most Likely Diagnosis
- Acute Bronchitis: This is a likely diagnosis given the patient's symptoms of cough, SOB, and chest tightness. The dry, non-productive cough and the absence of blood or significant sputum production further support this diagnosis. The feverish feelings and fatigue are also consistent with acute bronchitis.
- Other Likely Diagnoses
- Pneumonia: Although the patient's symptoms could suggest pneumonia, the lack of productive cough and the nature of the chest pain (dull, tight achiness) make it less likely. However, pneumonia should still be considered, especially given the fever and worsening symptoms.
- Acute Asthma Exacerbation: The patient's symptoms of SOB, chest tightness, and cough could be indicative of an asthma exacerbation, especially if the patient has a history of asthma. The absence of wheezing does not rule out asthma.
- Gastroesophageal Reflux Disease (GERD): The patient's symptoms of chest tightness radiating to the throat and N/V could suggest GERD, especially if the symptoms worsen with lying down or after eating.
- Do Not Miss Diagnoses
- Pulmonary Embolism (PE): Although less likely, PE is a critical diagnosis that must be considered due to its high mortality rate if missed. The patient's symptoms of sudden onset of chest pain and SOB could be indicative of a PE, especially if there are risk factors such as recent travel, immobility, or family history.
- Myocardial Infarction (MI): The patient's symptoms of chest tightness and SOB could also suggest an MI, especially in older patients or those with risk factors for cardiovascular disease.
- Pneumothorax: A spontaneous pneumothorax could present with sudden onset of chest pain and SOB, and is a diagnosis that should not be missed due to its potential for serious complications.
- Rare Diagnoses
- Lung Cancer: Although unlikely in the acute setting, lung cancer could present with cough, SOB, and chest pain, especially in patients with a history of smoking.
- Sarcoidosis: This rare autoimmune disease could present with cough, SOB, and chest pain, although it is less likely given the acute onset of symptoms.
- Eosinophilic Pneumonia: This rare condition could present with cough, SOB, and chest pain, especially if the patient has a history of asthma or atopy.