Differential Diagnosis

• Single most likely diagnosis:
  • Aspiration pneumonia: The patient's history of aspiration pneumonia, current symptoms of productive cough and vomiting, and CT scan findings concerning for aspiration pneumonia make this the most likely diagnosis.
• Other Likely diagnoses:
  • Cystitis: The abnormal urinalysis in the context of a chronic indwelling Foley catheter and CT scan findings suggest a urinary tract infection.
  • Gastritis and enteritis: The patient's symptoms of vomiting and CT scan findings concerning for gastritis and enteritis support these diagnoses.
  • Proctitis: The CT scan findings also suggest proctitis, which could be related to the patient's history of aspiration pneumonia and current symptoms.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Sepsis: The patient's elevated white blood cell count, tachypnea, and history of multidrug-resistant organisms make sepsis a potentially life-threatening condition that should not be missed.
  • Pulmonary embolism: Although the patient's symptoms are more suggestive of aspiration pneumonia, a pulmonary embolism could be a deadly condition that needs to be considered, especially given the patient's history of hyperlipidemia and recent hospitalizations.
  • Meningitis or cerebral abscess: The patient's history of ruptured AVM and current headache symptom could suggest a central nervous system infection, which would be deadly if missed.
• Rare diagnoses:
  • Brain abscess or empyema: Although rare, the patient's history of ruptured AVM and current symptoms could suggest a brain abscess or empyema, especially if the patient has a history of multidrug-resistant organisms.
  • Pulmonary tuberculosis: The patient's productive cough and history of aspiration pneumonia could suggest pulmonary tuberculosis, although this would be a rare diagnosis in this context.