Differential Diagnosis for Cough, Chest Congestion, and Shortness of Breath

Single Most Likely Diagnosis

• Acute Bronchitis: This is the most likely diagnosis given the patient's symptoms of a persistent cough, chest congestion, and shortness of breath with exertion. The onset of symptoms 2 weeks ago and the nature of the cough (dry and constant) along with the feeling of phlegm building up in the chest are typical for acute bronchitis. The condition often follows a viral upper respiratory infection and can cause the symptoms described.

Other Likely Diagnoses

• Asthma: This could be a consideration, especially with symptoms of shortness of breath with exertion and cough. However, asthma typically presents with wheezing, variable symptoms, and often a personal or family history of atopy.
• Chronic Obstructive Pulmonary Disease (COPD): Although less likely in someone without a significant smoking history or other risk factors, COPD could present with chronic cough, phlegm production, and shortness of breath, especially with exertion.
• Pneumonia: Could be a consideration if the patient had a fever, chills, or other systemic symptoms, but the description does not strongly suggest pneumonia.

Do Not Miss Diagnoses

• Pulmonary Embolism (PE): Although the symptoms do not classically suggest PE (e.g., sudden onset, pleuritic chest pain), any shortness of breath, especially if new or worsening, warrants consideration of PE due to its high mortality if missed.
• Cardiac Conditions (e.g., Heart Failure): Shortness of breath with exertion could be a sign of heart failure or other cardiac conditions. These are critical to diagnose early due to their significant impact on morbidity and mortality.
• Lung Cancer: In smokers or those with a significant smoking history, persistent cough and shortness of breath could be signs of lung cancer. Early detection is crucial for treatment outcomes.

Rare Diagnoses

• Cystic Fibrosis: Typically presents in childhood, but mild forms can be diagnosed later in life. It causes chronic cough, phlegm production, and recurrent respiratory infections.
• Interstitial Lung Disease: A broad category of diseases that cause scarring of the lung tissue, leading to symptoms like cough and shortness of breath. These are less common and often have specific exposures or associations (e.g., occupational exposures, autoimmune diseases).
• Tuberculosis (TB): Can cause chronic cough, phlegm production, and shortness of breath, especially in individuals from endemic areas or with specific risk factors (e.g., immunocompromised).