Differential Diagnosis for 75-year-old Male with Persistent Wheezing
- Single Most Likely Diagnosis
- Gastroesophageal Reflux Disease (GERD): Although the patient denies acid reflux or heartburn, the recent Heller myotomy and partial fundoplication could have altered the normal anatomy and physiology of the esophagus, potentially leading to reflux that triggers wheezing, especially when lying down. The worsening of symptoms at night and with walking could be related to positional effects on reflux.
- Other Likely Diagnoses
- Aspiration Pneumonia: Given the patient's recent esophageal surgery, there's a possibility of aspiration, especially if the surgery has affected the coordination of swallowing. This could lead to recurrent pneumonia, presenting with wheezing.
- Bronchitis: The patient's age and the fact that wheezing worsens with activity and at night could suggest a chronic bronchitis, possibly exacerbated by environmental factors within the prison setting.
- Do Not Miss Diagnoses
- Pulmonary Embolism: Although less likely given the chronic nature of the symptoms, pulmonary embolism can present with wheezing, especially in older adults, and is critical to diagnose due to its high mortality rate if untreated.
- Cardiac Failure: Heart failure can cause wheezing due to pulmonary edema, and the worsening of symptoms when lying down (orthopnea) is a classic sign. Given the patient's age, cardiac issues should always be considered.
- Rare Diagnoses
- Eosinophilic Esophagitis: This condition could potentially cause wheezing if there's an allergic component triggering both esophageal and respiratory symptoms, though it's less common and would typically be associated with difficulty swallowing.
- Churg-Strauss Syndrome: A rare autoimmune condition that can cause asthma-like symptoms, including wheezing, along with other systemic symptoms. It's unlikely but should be considered if other diagnoses are ruled out and there are other systemic symptoms present.