Differential Diagnosis for a 46-year-old Woman with Shortness of Breath and Pleuritic Chest Pain

• Single Most Likely Diagnosis
  • Pulmonary Embolism (PE): The patient's symptoms of shortness of breath, pleuritic chest pain, and palpitations, especially on exertion, along with the findings of a pleural effusion on the CT scan and an elevated D-dimer, strongly suggest PE. The recent hospitalization for a kidney stone and ureteral stent placement could be a predisposing factor for venous thromboembolism due to immobilization.
• Other Likely Diagnoses
  • Pneumonia: Although the lungs are clear bilaterally except for a few right-sided basilar crackles, and the patient has a nonproductive cough, pneumonia could still be a consideration, especially given the mild fever and the presence of a pleural effusion.
  • Pleurisy: The right-sided pleuritic chest pain and the presence of a pleural effusion could also suggest pleurisy, possibly related to the recent ureteral stent placement or another inflammatory process.
  • Pericarditis: The pleuritic chest pain and palpitations could also be indicative of pericarditis, although the absence of a pericardial friction rub and specific ECG changes makes this less likely.
• Do Not Miss Diagnoses
  • Aortic Dissection: Although less likely given the patient's presentation, aortic dissection is a life-threatening condition that could present with chest pain and shortness of breath. The absence of classic tearing chest pain and a normal blood pressure does not rule out this diagnosis entirely.
  • Cardiac Tamponade: Given the patient's symptoms of shortness of breath and palpitations, cardiac tamponade, which could be a complication of pericarditis or other conditions, must be considered, especially if there are signs of cardiac compromise.
  • Pneumothorax: The presence of pleuritic chest pain and a pleural effusion could also raise the concern for a pneumothorax, especially if the patient's condition worsens or if there are signs of respiratory distress.
• Rare Diagnoses
  • Pulmonary Arteriovenous Malformation: This could be a consideration in patients with recurrent or unexplained pulmonary emboli, but it is less likely given the patient's presentation and the absence of other suggestive findings.
  • Vasculitis (e.g., Wegener's Granulomatosis): Although rare, vasculitis could present with a wide range of symptoms including pulmonary and renal involvement, but the diagnosis would require more specific findings and laboratory results.
  • Metastatic Disease: Given the patient's recent history of a kidney stone, the possibility of a malignancy causing a pleural effusion or other symptoms is rare but should be considered if other diagnoses are ruled out and the patient's condition does not improve with treatment.