Differential Diagnosis for a 55yo Smoker with Cough, Chest Pain, Drooping of Left Eyelid, and Reduced Pupil Size
Single Most Likely Diagnosis
- Pancoast Tumor: This is the most likely diagnosis given the combination of symptoms. A Pancoast tumor is a type of lung cancer that arises in the apex of the lung and can cause shoulder and chest pain, cough, and symptoms related to the compression or invasion of nearby structures, such as the sympathetic nervous system, leading to Horner's syndrome (drooping eyelid and reduced pupil size).
Other Likely Diagnoses
- Lung Cancer with Metastasis: While not as specific to the constellation of symptoms as a Pancoast tumor, other types of lung cancer could metastasize to areas that cause similar symptoms, including Horner's syndrome.
- Thoracic Aortic Aneurysm or Dissection: These conditions can cause chest pain and, if large enough or if they compress nearby structures, could potentially lead to neurological symptoms, though Horner's syndrome would be less common.
Do Not Miss Diagnoses
- Pulmonary Embolism: Although less directly linked to the specific neurological symptoms, pulmonary embolism is a critical diagnosis to consider in any patient with chest pain, especially if there's a history of smoking, which increases the risk of both pulmonary embolism and lung cancer.
- Acute Coronary Syndrome: Chest pain in a smoker warrants consideration of cardiac causes, including myocardial infarction, which could have different presentations and might not always follow the classic pattern.
Rare Diagnoses
- Lambert-Eaton Myasthenic Syndrome (LEMS): This is an autoimmune disorder that can cause muscle weakness and is associated with small cell lung cancer. While it could explain some neurological symptoms, it doesn't directly account for the Horner's syndrome or the specific pattern of chest pain and cough.
- Sympathetic Nerve Tumors or Other Neurogenic Tumors: Rare tumors affecting the sympathetic nervous system could potentially cause Horner's syndrome but would be less likely to cause the combination of cough and chest pain seen in this patient.