Differential Diagnosis for Pulmonary Hypertension, Pericardial Effusion, and Acute Pulmonary Embolism (PE)
Single Most Likely Diagnosis
- Pulmonary Thromboembolism with Pulmonary Hypertension and Pericardial Effusion: This condition is the most likely diagnosis because a large acute pulmonary embolism can lead to acute right ventricular failure, which in turn can cause pulmonary hypertension and pericardial effusion due to increased pressure and fluid overload.
Other Likely Diagnoses
- Chronic Thromboembolic Pulmonary Hypertension (CTEPH): This condition could explain the pulmonary hypertension and, if complicated by a new acute PE, could also account for the pericardial effusion.
- Pulmonary Arterial Hypertension (PAH) with Acute PE: PAH can lead to right heart failure, which may result in pericardial effusion, and an acute PE could exacerbate the condition.
- Cardiac Sarcoidosis: This condition can cause both pulmonary hypertension and pericardial effusion, and while less common, it could also be associated with an increased risk of thromboembolic events.
Do Not Miss Diagnoses
- Disseminated Intravascular Coagulation (DIC): Although less likely, DIC can lead to both thrombotic events (like PE) and bleeding complications, potentially causing pericardial effusion and exacerbating pulmonary hypertension.
- Malignancy with Thrombosis and Cardiac Involvement: Certain malignancies can increase the risk of thromboembolic events and directly involve the heart, leading to pericardial effusion and potentially causing or exacerbating pulmonary hypertension.
- Acute Coronary Syndrome with Right Ventricular Infarction: This condition can lead to acute right heart failure, pulmonary hypertension, and pericardial effusion, especially if there is involvement of the right coronary artery.
Rare Diagnoses
- Lymphangioleiomyomatosis (LAM): A rare lung disease that can cause pulmonary hypertension and potentially increase the risk of spontaneous pneumothorax and other complications, including pericardial effusion, though its association with acute PE is less common.
- Pulmonary Veno-Occlusive Disease (PVOD): A rare condition that can cause pulmonary hypertension and potentially lead to pericardial effusion, though it is less commonly associated with acute thromboembolic events.
- Eisenmenger Syndrome with Acute PE: A congenital heart defect that can reverse shunt direction due to pulmonary hypertension, potentially leading to complications like pericardial effusion if an acute PE occurs.