Differential Diagnosis for a 73-year-old Female with Chest Tightness and Dry Cough
Single most likely diagnosis
- Gastroesophageal Reflux Disease (GERD): Given the symptoms of chest tightness and dry cough without wheezing, GERD is a common cause, especially in the absence of fever or other respiratory findings. The summer timeframe does not specifically point towards an infectious cause, making GERD a plausible explanation.
Other Likely diagnoses
- Asthma: Although no wheezing is noted on exam, asthma can present with cough and chest tightness, especially in older adults where the classic wheezing may not always be present.
- Chronic Obstructive Pulmonary Disease (COPD): COPD could be considered, especially if the patient has a history of smoking or exposure to lung irritants. However, the lack of wheezing and the acute onset might make this less likely.
- Allergic Rhinitis or Postnasal Drip: These conditions can cause a dry cough, and while more common in spring, some allergens like mold can persist into summer.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pulmonary Embolism (PE): Although the patient has normal vitals and no specific risk factors are mentioned, PE is a critical diagnosis to consider due to its high mortality rate if missed. The presentation can sometimes be subtle, with chest pain or cough being the only symptoms.
- Cardiac Ischemia: Chest tightness can be a symptom of cardiac ischemia, and in older adults, atypical presentations of myocardial infarction are more common. The absence of fever and normal vitals does not rule out this diagnosis.
- Pneumonia: Even though the patient has a normal temperature, pneumonia should be considered, especially if there's any concern for aspiration or if the patient is immunocompromised.
Rare diagnoses
- Sarcoidosis: This is an autoimmune disease that can affect the lungs and cause symptoms like dry cough and chest tightness. It's less common but should be considered if other diagnoses are ruled out.
- Interstitial Lung Disease: A broad category of diseases affecting the lung tissue, which can present with cough and chest tightness. These are generally less common and might require more specific diagnostic testing to identify.
- Lung Cancer: Although rare as an initial presentation with these symptoms alone, it's a diagnosis that cannot be overlooked, especially in older adults with a history of smoking or other risk factors.