Differential Diagnosis for 75-year-old Female with Syncopal Episode
Single Most Likely Diagnosis
- Pulmonary Embolism (PE): Given the patient's history of atrial fibrillation, recent onset of cough, and previous episodes of syncope, PE is a strong consideration. The presence of nodules on chest imaging could be indicative of chronic or recurrent PE. The patient's symptoms of appetite loss, weight loss, and ongoing cough also align with possible chronic thromboembolic disease.
Other Likely Diagnoses
- Cardiac Causes: Given her history of atrial fibrillation, CAD, and hypertension, other cardiac causes such as cardiac tamponade, severe valvular disease, or heart failure could be contributing to her symptoms.
- Dehydration/Malnutrition: The patient's reported loss of appetite and weight loss could lead to dehydration, potentially exacerbating her symptoms, including syncope.
- Chronic Obstructive Pulmonary Disease (COPD) or Other Pulmonary Conditions: The chronic cough and history of lung nodules could suggest a chronic pulmonary condition, which might contribute to her symptoms, especially if there's an acute exacerbation.
Do Not Miss Diagnoses
- Aortic Dissection: Although less likely given the lack of specific symptoms like tearing chest pain, it's crucial to rule out aortic dissection due to its high mortality rate. The patient's history of hypertension increases her risk.
- Pneumonia or Sepsis: Despite being afebrile and without leukocytosis, pneumonia or sepsis could present atypically in elderly patients. The dry and sometimes productive cough raises concern for an infectious process.
- Cancer: The weight loss, loss of appetite, and lung nodules could be indicative of malignancy, either primary lung cancer or metastatic disease from another site.
Rare Diagnoses
- Pulmonary Vasculitis: Conditions like Wegener's granulomatosis or other forms of vasculitis could explain the lung nodules and systemic symptoms but are less common.
- Chronic Thromboembolic Pulmonary Hypertension (CTEPH): This condition could be a sequela of recurrent or chronic pulmonary emboli and would explain the patient's symptoms of cough, weight loss, and syncope.
- Sarcoidosis: Given the mention of calcific granulomatous disease and lung nodules, sarcoidosis is a rare but possible diagnosis that could explain the patient's systemic symptoms and imaging findings.