Differential Diagnosis
- Single most likely diagnosis
- Pulmonary embolus: The patient's symptoms of shortness of breath, pleuritic chest pain, and diaphoresis, combined with the recent history of surgery (cholecystectomy), make pulmonary embolus a highly likely diagnosis. The presence of tachycardia, tachypnea, and nonspecific ST- and T-wave changes on the ECG also support this diagnosis.
- Other Likely diagnoses
- Atelectasis: The patient's chest x-ray shows atelectasis of the right lower lobe, which could be causing the patient's symptoms. However, atelectasis alone may not fully explain the severity of the patient's symptoms.
- Pneumonia: The patient's symptoms of shortness of breath, pleuritic chest pain, and fever, combined with the presence of crackles in the base of the right lung, make pneumonia a possible diagnosis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Acute myocardial infarction: Although the patient's ECG shows nonspecific ST- and T-wave changes, acute myocardial infarction is a potentially life-threatening condition that must be considered, especially in a patient with risk factors such as recent surgery and tachycardia.
- Pericarditis: The patient's symptoms of chest pain and fever, combined with the presence of nonspecific ST- and T-wave changes on the ECG, make pericarditis a possible diagnosis that should not be missed.
- Rare diagnoses
- Pulmonary infarction: Although less likely, pulmonary infarction could be a possible diagnosis if the patient has a pulmonary embolus that has caused infarction of a portion of the lung.
- Fat embolism: This is a rare but potentially life-threatening condition that can occur after surgery, especially in patients with long bone fractures or other trauma. However, the patient's symptoms and laboratory results do not strongly suggest this diagnosis.