Differential Diagnosis

The patient's symptoms of wheeziness and tightness after leaving the hospital against medical advice (AMA) suggest a range of possible diagnoses. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis
  • Asthma exacerbation: The patient's symptoms of wheeziness and tightness are classic for asthma, especially if the patient has a history of asthma. The recent hospitalization could have been for an asthma exacerbation, and leaving AMA might have interrupted necessary treatment.
• Other Likely Diagnoses
  • Chronic obstructive pulmonary disease (COPD) exacerbation: Similar to asthma, COPD can cause wheezing and tightness, especially in patients with a history of smoking or exposure to lung irritants.
  • Pneumonia: Although the patient was recently hospitalized, it's possible that pneumonia was not fully treated or that a new infection developed, causing the current symptoms.
  • Pulmonary embolism (PE): While less likely given the symptoms, a PE could cause wheezing and tightness, especially if the patient has risk factors such as recent immobilization or a history of clotting disorders.
• Do Not Miss Diagnoses
  • Cardiac tamponade: Although rare, cardiac tamponade can cause wheezing and tightness due to the compression of the heart and lungs. It's a life-threatening condition that requires immediate attention.
  • Pneumothorax: A collapsed lung can cause sudden onset of wheezing and tightness, and it's a medical emergency that needs prompt treatment.
  • Anaphylaxis: A severe allergic reaction can cause wheezing, tightness, and other systemic symptoms, and it requires immediate intervention with epinephrine and other supportive measures.
• Rare Diagnoses
  • Bronchiolitis obliterans: A rare condition characterized by inflammation and obstruction of the small airways, which can cause wheezing and tightness.
  • Eosinophilic pneumonia: A rare condition caused by the accumulation of eosinophils in the lungs, leading to inflammation and symptoms such as wheezing and tightness.
  • Sarcoidosis: A rare autoimmune disease that can affect the lungs and cause symptoms such as wheezing and tightness, although it's typically a more chronic condition.