Differential Diagnosis for Left Posterior Calf Pain and Shortness of Breath
Single Most Likely Diagnosis
- Deep Vein Thrombosis (DVT): The patient is taking Xarelto, which is an anticoagulant, but the presence of left posterior calf pain is highly suggestive of DVT, especially given the patient's shortness of breath, which could indicate a pulmonary embolism (PE) if the clot were to dislodge. The d-dimer level is slightly elevated, which, although not diagnostic on its own, supports this diagnosis in the context of clinical symptoms.
Other Likely Diagnoses
- Muscle Strain or Trauma: The patient's complaint of left posterior calf pain could also be due to a muscle strain or trauma, which might not fully explain the shortness of breath but could be a contributing factor if the patient has been less mobile due to pain, potentially increasing the risk of thrombosis.
- Pulmonary Embolism (PE): While the d-dimer is not significantly elevated, and the BNP is mildly elevated, a PE should still be considered, especially with the symptom of shortness of breath. The fact that the patient is on Xarelto might suggest a failure of anticoagulation or a new event.
- Anemia: With a hematocrit of 34.4, the patient is anemic, which could contribute to shortness of breath. The cause of the anemia would need to be investigated.
Do Not Miss Diagnoses
- Pulmonary Embolism (PE) with Delayed Presentation: Even though the d-dimer is not significantly elevated, a high-risk PE could present atypically, and missing this diagnosis could be fatal. The patient's shortness of breath and the fact that they are on anticoagulation therapy mandate a thorough evaluation for PE.
- Aortic Dissection: Although less likely given the presentation, aortic dissection can cause severe pain and shortness of breath. It's a diagnosis that must be considered and ruled out due to its high mortality rate if missed.
- Cardiac Ischemia: The slightly elevated troponin could indicate cardiac ischemia, which needs to be evaluated further, especially in the context of shortness of breath and the patient's anticoagulation therapy.
Rare Diagnoses
- Thrombophlebitis: Inflammation of veins due to a blood clot, which could cause calf pain and potentially shortness of breath if it leads to a PE.
- Compartment Syndrome: A condition resulting from increased pressure within a muscle compartment, which could cause severe pain but is less likely to cause shortness of breath directly.
- Neoplastic Processes: Rarely, neoplastic processes could cause both calf pain (due to metastasis or direct invasion) and shortness of breath (due to metastasis to the lungs or other mechanisms), but this would be an uncommon initial presentation.