Differential Diagnosis
- Single most likely diagnosis
- Acute bronchitis or viral pneumonia: The presence of mild nonspecific bilateral perihilar ground-glass and reticulonodular opacities on the chest x-ray, along with rales and wheezes on physical exam, suggests a respiratory infection. The symptoms are more pronounced on the right, which could indicate a localized infection.
- Other Likely diagnoses
- Asthma exacerbation: The presence of wheezes on physical exam could indicate an asthma exacerbation, especially if the patient has a history of asthma.
- Chronic obstructive pulmonary disease (COPD) exacerbation: Similar to asthma, the presence of wheezes and rales could indicate a COPD exacerbation, especially in patients with a history of smoking or COPD.
- Pulmonary edema: The ground-glass and reticulonodular opacities could be indicative of pulmonary edema, especially if the patient has a history of heart failure or other cardiac conditions.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pneumocystis jirovecii pneumonia (PCP): Although less likely, PCP can present with similar symptoms and radiographic findings, especially in immunocompromised patients.
- Influenza pneumonia: Influenza can cause severe pneumonia, especially in certain populations such as the elderly or those with underlying medical conditions.
- Sarcoidosis: Although rare, sarcoidosis can present with similar radiographic findings and respiratory symptoms.
- Rare diagnoses
- Lymphangitic carcinomatosis: A rare condition characterized by the spread of cancer to the lymphatic vessels in the lungs, which can cause similar radiographic findings.
- Eosinophilic pneumonia: A rare condition characterized by the accumulation of eosinophils in the lungs, which can cause similar respiratory symptoms and radiographic findings.
- Cryptogenic organizing pneumonia (COP): A rare condition characterized by the presence of organizing pneumonia in the lungs, which can cause similar respiratory symptoms and radiographic findings.