Differential Diagnosis for Pursed Lip Breathing and Tenderness Along Costal Margin

• Single Most Likely Diagnosis
  • Chronic Obstructive Pulmonary Disease (COPD): Pursed lip breathing is a characteristic feature of COPD, as it helps to increase lung volume and slow down breathing, making it easier to breathe. Tenderness along the costal margin can be due to the use of accessory muscles for breathing, which are often engaged in COPD patients.
• Other Likely Diagnoses
  • Asthma: Similar to COPD, asthma can cause difficulty breathing, leading to pursed lip breathing. Costal margin tenderness could be due to coughing or the use of accessory muscles.
  • Pneumonia: Severe pneumonia can cause significant respiratory distress, leading to pursed lip breathing. Costal margin tenderness might be due to the inflammatory process or the use of accessory muscles.
  • Pulmonary Embolism: While less common, a large pulmonary embolism can cause sudden onset of respiratory distress, potentially leading to pursed lip breathing. Costal margin tenderness could be due to associated musculoskeletal strain or pleuritic chest pain.
• Do Not Miss Diagnoses
  • Pneumothorax: A spontaneous pneumothorax can cause sudden onset of respiratory distress and chest pain, which might be referred to the costal margin. Pursed lip breathing could be a response to the distress.
  • Cardiac Ischemia: Myocardial infarction can cause respiratory distress and chest pain, potentially leading to pursed lip breathing. The pain might be referred to the costal margin.
• Rare Diagnoses
  • Cystic Fibrosis: This genetic disorder can cause chronic respiratory infections and difficulty breathing, potentially leading to pursed lip breathing. Costal margin tenderness could be due to chronic coughing or the use of accessory muscles.
  • Diaphragmatic Hernia: A diaphragmatic hernia can cause respiratory distress and chest pain, potentially leading to pursed lip breathing. The pain might be referred to the costal margin due to the herniation of abdominal contents into the thoracic cavity.