Differential Diagnosis

• Single most likely diagnosis
  • Asthma exacerbation: The patient's wheezing on exam and findings consistent with reactive airways disease on CXR suggest an asthma exacerbation, especially given the patient's use of Duonebs (a combination inhaler often used for asthma).
• Other Likely diagnoses
  • Acute bronchitis: The patient's symptoms and CXR findings could also be consistent with acute bronchitis, particularly if the patient has a viral or atypical infection.
  • Pneumonia (viral or atypical): The CXR findings of a central viral or atypical process could indicate pneumonia, which would explain the patient's distress and wheezing.
  • Chronic obstructive pulmonary disease (COPD) exacerbation: If the patient has a history of COPD, the current symptoms and CXR findings could represent an exacerbation of COPD.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Pneumocystis jirovecii pneumonia (PCP): Although less likely, PCP can present with similar symptoms and CXR findings, and is a life-threatening condition if not treated promptly, especially in immunocompromised patients.
  • Pulmonary embolism: While the CXR findings do not specifically suggest pulmonary embolism, it is a potentially life-threatening condition that can present with acute distress and wheezing, and should be considered in the differential diagnosis.
  • Foreign body aspiration: If the patient has a history of choking or aspiration, a foreign body in the airway could cause wheezing and distress, and is a medical emergency.
• Rare diagnoses
  • Cystic fibrosis exacerbation: If the patient has a history of cystic fibrosis, the current symptoms and CXR findings could represent an exacerbation of cystic fibrosis.
  • Eosinophilic pneumonia: This rare condition can present with wheezing, distress, and abnormal CXR findings, although it is less likely than other diagnoses on the list.