Differential Diagnosis for 25-year-old Male with Severe Shortness of Breath and Pleuritic Chest Pain
- Single most likely diagnosis:
- Pulmonary Embolism (PE): The patient's recent long-haul flight increases the risk of deep vein thrombosis (DVT), which can lead to PE. The symptoms of severe shortness of breath, pleuritic chest pain, low-grade fever, and low blood pressure are consistent with a large PE. The patient's leg pain, attributed to stress and long work hours, could be a DVT.
- Other Likely diagnoses:
- Pneumonia: The patient's symptoms of shortness of breath, pleuritic chest pain, and low-grade fever could be indicative of pneumonia. However, the recent long-haul flight and leg pain make PE a more likely diagnosis.
- Acute Coronary Syndrome (ACS): Although less common in a 25-year-old, ACS should be considered, especially with the patient's symptoms of chest pain and shortness of breath. However, the pleuritic nature of the chest pain and the patient's age make this less likely.
- Do Not Miss diagnoses:
- Cardiac Tamponade: This is a life-threatening condition that can cause shortness of breath, chest pain, and hypotension. Although less likely, it is crucial to consider and rule out with echocardiography.
- Pneumothorax: A spontaneous pneumothorax can cause severe shortness of breath, pleuritic chest pain, and hypotension. This diagnosis should be considered, especially in a tall, thin male.
- Sepsis: The patient's symptoms of shortness of breath, chest pain, and hypotension could be indicative of sepsis, especially with a possible source of infection (e.g., pneumonia). It is essential to consider and rule out sepsis.
- Rare diagnoses:
- Pulmonary Arterial Hypertension (PAH): This is a rare condition that can cause shortness of breath, chest pain, and hypotension. However, it is less likely in this scenario, given the patient's age and recent long-haul flight.
- Vasculitis (e.g., Wegener's granulomatosis): This is a rare condition that can cause shortness of breath, chest pain, and hypotension. However, it is less likely in this scenario, given the patient's age and lack of other systemic symptoms.