Differential Diagnosis
- Single Most Likely Diagnosis
- Pulmonary Embolism (PE): The patient's complaint of chest pain worsening with deep breaths (pleuritic chest pain) and elevated WBC (13.4) and D-dimer (0.30) levels suggest a possible pulmonary embolism. Although the D-dimer is not significantly elevated, it is still a consideration given the clinical presentation.
- Other Likely Diagnoses
- Pneumonia: The elevated WBC count and pleuritic chest pain could also indicate pneumonia, especially if there are other symptoms such as fever, cough, or sputum production.
- Pleuritis: Inflammation of the pleura could cause chest pain that worsens with deep breathing. The elevated WBC count could indicate an infectious or inflammatory cause.
- Acute Coronary Syndrome: Although the troponin level is very low (0.01), it's not entirely negative, and chest pain is a common symptom of acute coronary syndrome. However, the worsening of pain with deep breaths is less typical for this condition.
- Do Not Miss Diagnoses
- Aortic Dissection: This is a life-threatening condition that can cause chest pain, which may be described as tearing or ripping. It's crucial to consider this diagnosis, even though the initial presentation might not strongly suggest it, due to its high mortality rate if missed.
- Pulmonary Embolism with Hemodynamic Instability: Even though the initial presentation does not indicate hemodynamic instability, any delay in diagnosing a significant pulmonary embolism could lead to severe consequences, including death.
- Myocardial Infarction: Despite the low troponin level, myocardial infarction is a condition that should not be missed due to its potential for severe outcomes. Further cardiac enzyme tests and ECGs would be necessary to rule out this condition.
- Rare Diagnoses
- Pneumothorax: Although less likely without a history of trauma or underlying lung disease, a pneumothorax could cause pleuritic chest pain. The lack of significant findings on the initial labs does not rule out this possibility entirely.
- Pericarditis: Inflammation of the pericardium can cause chest pain that may improve with sitting up and leaning forward, but it can also present with pleuritic chest pain. The ECG and further imaging would be necessary to consider this diagnosis.