Differential Diagnosis for 49-year-old Female with Back Pain and Respiratory Distress
Single Most Likely Diagnosis
- Pulmonary Embolism (PE): The patient's presentation of back pain, hypoxia (pulse ox of 70 on air), hypotension (blood pressure of 90/56), and tachycardia (heart rate of 120) is highly suggestive of a pulmonary embolism. The acute onset of symptoms and the combination of respiratory and cardiovascular instability point towards this diagnosis.
Other Likely Diagnoses
- Pneumonia: Given the patient's hypoxia and tachycardia, pneumonia is a possible diagnosis, especially if the back pain is referred pain from the lungs.
- Cardiac Conditions (e.g., Myocardial Infarction): The patient's hypotension and tachycardia could also indicate a cardiac issue, such as a myocardial infarction, which can sometimes present with back pain.
- Sepsis: Although less directly linked to back pain, sepsis can cause hypotension, tachycardia, and hypoxia, and should be considered, especially if there's a suspected source of infection.
Do Not Miss Diagnoses
- Aortic Dissection: This is a life-threatening condition that can present with back pain and hypotension. Although less common, missing this diagnosis could be fatal.
- Spinal Epidural Abscess: A serious condition that can cause back pain and, if not promptly treated, can lead to neurological deficits or sepsis.
- Pneumothorax: A large pneumothorax could explain the hypoxia and might cause back pain if the patient is experiencing referred pain.
Rare Diagnoses
- Osteoporotic Compression Fracture: While back pain is a common symptom, the acute onset of hypoxia and hypotension makes this a less likely primary diagnosis.
- Pancreatitis: Could potentially cause back pain but would not typically cause the degree of hypoxia and hypotension seen in this patient without other significant abdominal symptoms.
- Retroperitoneal Hemorrhage: A rare condition that could cause back pain and hypotension but would typically have other associated symptoms or signs.