Differential Diagnosis for a 73-year-old Female with Chest Tightness and Dry Cough
- Single most likely diagnosis:
- Acute bronchitis: This is a common condition in older adults, especially during respiratory virus seasons, characterized by a dry cough and chest tightness without wheezing, fitting the patient's presentation.
- Other Likely diagnoses:
- Gastroesophageal reflux disease (GERD): Can cause chest tightness and dry cough, especially if the patient has a history of GERD or symptoms worsen with eating or at night.
- Asthma: Although wheezing is not present, asthma can sometimes present with a dry cough and chest tightness, especially in older adults or those with a history of asthma.
- Chronic obstructive pulmonary disease (COPD): Given the patient's age, COPD could be a consideration, especially if there's a history of smoking or exposure to lung irritants.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Pulmonary embolism (PE): Although less likely given the lack of systemic symptoms like fever or tachycardia, PE is a critical diagnosis to consider due to its high mortality rate if untreated.
- Myocardial infarction (MI): Chest tightness can be a symptom of MI, especially in women, who may not always present with the classic symptom of chest pain.
- Pneumonia: Despite normal vitals and the absence of wheezing, atypical pneumonia (e.g., caused by Mycoplasma pneumoniae) can present with dry cough and chest tightness.
- Rare diagnoses:
- Sarcoidosis: A systemic disease that can affect the lungs, causing symptoms like dry cough and chest tightness, though it's less common in this age group without other systemic symptoms.
- Interstitial lung disease: Conditions like idiopathic pulmonary fibrosis can cause chronic dry cough and chest tightness, but these are less likely without a history of progressive symptoms or exposures.
- Lung cancer: Although rare as an initial presentation with these symptoms alone, it's a consideration in older adults, especially with a history of smoking or other risk factors.