Differential Diagnosis for 59 yo Female with SOB and Change in Phonation
- Single most likely diagnosis:
- Vocal cord paralysis: Given the patient's history of thyroidectomy, which can lead to injury of the recurrent laryngeal nerve, and her symptoms of change in phonation and shortness of breath (SOB), vocal cord paralysis is a highly plausible diagnosis. The absence of stridor and a normal posterior pharynx does not rule out this condition, as the presentation can vary.
- Other Likely diagnoses:
- Chronic obstructive pulmonary disease (COPD) exacerbation: The patient's history of nicotine dependence increases her risk for COPD. An exacerbation could explain her SOB, and while COPD wouldn't directly cause a change in phonation, it's a common condition in smokers that needs consideration.
- Laryngitis: Inflammation of the larynx could cause a change in phonation and, if severe, could lead to some respiratory distress. However, the absence of other symptoms like a sore throat makes this less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
- Laryngeal cancer: Although less likely, given the patient's smoking history, laryngeal cancer is a critical diagnosis not to miss. It could present with changes in phonation and, in advanced stages, could cause respiratory symptoms.
- Pulmonary embolism: This is a life-threatening condition that can cause sudden onset of SOB and hypoxia. While it doesn't directly explain the change in phonation, it's a diagnosis that must be considered due to its high mortality if untreated.
- Rare diagnoses:
- Relapsing polychondritis: A rare autoimmune disorder that can cause inflammation of the cartilaginous structures, including those in the larynx and trachea, potentially leading to respiratory symptoms and changes in phonation.
- Amyloidosis involving the larynx: A rare condition where amyloid deposits in the larynx could potentially cause vocal cord dysfunction leading to changes in phonation and possibly respiratory symptoms.