Differential Diagnosis for Cough Syncope and Pleuritic Pain
Single Most Likely Diagnosis
- Pulmonary Embolism (PE): Although no fever is present, the combination of cough syncope (fainting due to coughing) and pleuritic pain (sharp pain when breathing) 5 days after cold symptoms began is highly suggestive of a pulmonary embolism, especially if the patient has been relatively immobile or has other risk factors for PE.
Other Likely Diagnoses
- Pneumonia: Could present with cough and pleuritic pain, though typically fever would be expected. Atypical pneumonia might not always present with fever, especially in older adults or those with compromised immune systems.
- Pleurisy: Inflammation of the pleura can cause sharp chest pain that worsens with breathing or coughing. It can occur without fever, especially if it's not due to an infectious cause.
- Acute Bronchitis: While less likely to cause pleuritic pain, severe cases could potentially lead to cough syncope, especially if the cough is very violent.
Do Not Miss Diagnoses
- Aortic Dissection: A life-threatening condition that can cause severe, tearing chest pain and potentially syncope. It's less likely given the context of recent cold symptoms but must be considered due to its high mortality rate if missed.
- Cardiac Tamponade: Can cause chest pain and syncope due to impaired heart function. It's a rare complication of viral pericarditis, which could follow a viral upper respiratory infection.
- Pneumothorax: Especially a tension pneumothorax, which is a medical emergency. It can cause sudden onset of pleuritic pain and could lead to syncope due to decreased cardiac output.
Rare Diagnoses
- Lung Cancer: Metastatic disease or a primary tumor could cause pleuritic pain and cough, though this would be an unusual presentation without other symptoms like weight loss or hemoptysis.
- Pulmonary Arteriovenous Malformation (AVM): Could potentially cause pleuritic pain and cough, especially if there's associated hemoptysis, though this is quite rare.
- Mitral Valve Prolapse with Severe Mitral Regurgitation: Though not directly related to cold symptoms, it could cause chest pain and syncope in rare cases, especially if there's associated arrhythmia.