Differential Diagnosis for 41-year-old Male Smoker
The patient presents with upper abdominal pain, persistent cough, shortness of breath, and intermittent wheezing. Considering his significant past medical history of asthma, COPD, chronic back pain, and depression, the following differential diagnoses are possible:
- Single most likely diagnosis
- Musculoskeletal strain or costochondritis: The patient's upper abdominal pain worsens with movement, which could be related to musculoskeletal strain from persistent coughing. His history of chronic back pain also supports this possibility.
- Other Likely diagnoses
- Pulmonary exacerbation of COPD or asthma: The patient's symptoms of persistent cough, shortness of breath, and intermittent wheezing could indicate a pulmonary exacerbation of his underlying COPD or asthma.
- Gastroesophageal reflux disease (GERD): Although the patient is taking Pepcid AC with no improvement, GERD could still be a possible cause of his upper abdominal pain, especially if his coughing is triggering reflux.
- Pneumonia: The patient's symptoms of cough, shortness of breath, and wheezing could also be indicative of pneumonia, especially in a smoker with a history of COPD.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pneumothorax: A spontaneous pneumothorax could occur in a patient with COPD, especially if he has a history of lung disease. This would be a medical emergency.
- Pulmonary embolism: Although less likely, a pulmonary embolism could present with sudden onset of shortness of breath, chest pain, and cough. This would be a life-threatening condition.
- Cardiac ischemia or myocardial infarction: The patient's upper abdominal pain could be referred pain from cardiac ischemia or myocardial infarction, especially if he has underlying cardiovascular disease.
- Rare diagnoses
- Diaphragmatic rupture or hernia: A diaphragmatic rupture or hernia could occur due to severe coughing, leading to abdominal pain and respiratory symptoms.
- Esophageal rupture or perforation: Although rare, an esophageal rupture or perforation could occur due to severe vomiting or coughing, leading to severe abdominal pain and respiratory symptoms.