Differential Diagnosis

The patient's symptoms of fever, cough, right-sided chest pain, and pleural effusion, along with a history of recent travel to Albania, guide the differential diagnosis. Here are the considerations:

• Single Most Likely Diagnosis

  • G) Pulmonary tuberculosis: This is the most likely diagnosis given the patient's symptoms (fever, cough, chest pain), physical examination findings (decreased breath sounds at the right lung base), and radiographic findings (right pleural effusion and hilar adenopathy). The recent travel to Albania, a country with a higher incidence of tuberculosis, further supports this diagnosis.

• Other Likely Diagnoses

  • E) Pulmonary aspergillosis: This could be considered, especially if the patient has an underlying condition that predisposes him to fungal infections. However, the lack of specific risk factors (e.g., immunocompromised state, asthma) makes it less likely than tuberculosis.
  • F) Pulmonary hemorrhage: Although less likely, it could present with similar symptoms, especially if there's an underlying condition such as vasculitis or a bleeding disorder. The presence of a pleural effusion could be consistent with this, but the overall clinical picture is more suggestive of an infectious or inflammatory process.

• Do Not Miss Diagnoses

  • B) Cystic fibrosis: While less likely given the patient's age and lack of previous respiratory issues, cystic fibrosis can present at any age and should be considered, especially with respiratory symptoms and findings suggestive of bronchiectasis or recurrent infections.
  • Pneumothorax (C): Although the patient's symptoms and the x-ray description do not directly suggest pneumothorax, it's a critical diagnosis to consider due to the potential for rapid deterioration. The presence of shallow respirations and decreased breath sounds could be consistent with this, but the described radiographic findings point more towards an effusion and adenopathy.

• Rare Diagnoses

  • A) α1-Antitrypsin deficiency: This is a rare genetic disorder that can lead to lung disease, typically presenting with panacinar emphysema. It's less likely given the acute presentation and the specific radiographic findings.
  • D) Pulmonary alveolar proteinosis: A rare condition characterized by the accumulation of surfactant-like protein and phospholipids in the alveoli, leading to respiratory failure. The clinical presentation and radiographic findings do not strongly support this diagnosis.