Differential Diagnosis for 50-year-old Female with NVD, Abdominal Pain, Right Flank Pain, Left Arm Tingling, and SOB

• Single Most Likely Diagnosis
  • Pulmonary Embolism (PE): This is considered due to the combination of shortness of breath (SOB), recent onset of symptoms, and the presence of non-specific symptoms like abdominal pain and flank pain, which can sometimes be associated with PE, especially if the embolism is large and causing strain on the right heart.
• Other Likely Diagnoses
  • Deep Vein Thrombosis (DVT) with or without PE: Given the recent onset of symptoms and the presence of non-specific pain, DVT should be considered, especially if there's any history of immobility or other risk factors.
  • Acute Coronary Syndrome (ACS): The left arm tingling and shortness of breath could suggest cardiac involvement, making ACS a consideration, especially in a 50-year-old female with potential risk factors for cardiovascular disease.
  • Pneumonia: Could explain the shortness of breath and possibly the abdominal pain if it's referred pain from the diaphragm, but the flank pain and arm tingling are less typical.
• Do Not Miss Diagnoses
  • Aortic Dissection: Although less common, this is a critical diagnosis to consider due to the high mortality rate if missed. The combination of severe abdominal or back pain, flank pain, and shortness of breath could be indicative of an aortic dissection, especially if there's a history of hypertension.
  • Pulmonary Hypertension: Could explain the shortness of breath and potentially some of the other symptoms if there's associated right heart strain, but it's less likely to cause acute flank pain or arm tingling without other specific symptoms.
  • Cardiac Tamponade: Another critical condition that could present with shortness of breath and potentially abdominal or flank pain due to increased pressure effects, but it's less common and usually associated with more specific signs like hypotension and muffled heart sounds.
• Rare Diagnoses
  • Thoracic Aortic Aneurysm: Similar to aortic dissection, this could cause severe pain and potentially some of the other symptoms if it's large enough to compress or erode into surrounding structures, but it's less common.
  • Spontaneous Coronary Artery Dissection (SCAD): A rare cause of ACS, more common in women without typical cardiovascular risk factors, presenting with sudden onset of symptoms like chest pain or arm tingling.
  • Vasculitis (e.g., Takayasu Arteritis, Giant Cell Arteritis): These conditions can cause a wide range of symptoms including pain, shortness of breath, and neurological symptoms due to inflammation of blood vessels, but they are relatively rare and usually have other specific findings.