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 often used to prevent DVT. However, the presence of left posterior calf pain is a classic symptom of DVT. The d-dimer level is slightly elevated, which could indicate a thrombotic event, although it's not conclusively high. The fact that the patient is already on anticoagulation therapy might affect the d-dimer level.
- Other Likely Diagnoses
- Early Pneumonia: The CTA mentions a small patchy airspace opacity in the lingula, and it's noted that early pneumonia is difficult to exclude. The patient's symptoms of shortness of breath and the presence of bilateral pleural effusions could support this diagnosis.
- Pulmonary Infarction or Other Pulmonary Conditions: Although the CTA did not identify a pulmonary embolism, the patient's shortness of breath and the findings on the CTA (bilateral pleural effusions and airspace opacity) could suggest other pulmonary issues, possibly related to the nonspecific splenic hypodensity or as a complication of DVT.
- Do Not Miss Diagnoses
- Pulmonary Embolism (PE): Despite the CTA not showing a pulmonary artery embolism, PE is a critical diagnosis that must be considered due to the patient's symptoms of shortness of breath. The d-dimer is not significantly elevated, but clinical judgment is crucial, especially if there's a high clinical suspicion.
- Sepsis: The patient's low hematocrit, slightly elevated troponin, and the presence of bilateral pleural effusions could indicate a systemic infection or sepsis, especially if the pneumonia is not caught early.
- Splenic Infarction or Abscess: The nonspecific splenic hypodensity with slow growth from a prior study could indicate a splenic infarction or abscess, which would be a serious condition requiring prompt attention.
- Rare Diagnoses
- Thrombophlebitis or Other Vascular Conditions: Although less common, other vascular conditions could explain the calf pain and shortness of breath, especially in the context of anticoagulant therapy.
- Atypical Presentations of Inflammatory or Autoimmune Diseases: Conditions like vasculitis or systemic lupus erythematosus could potentially explain some of the patient's symptoms and lab findings, although these would be less common and require further investigation to diagnose.