Differential Diagnosis

Given the information that the patient had no chest pain, we can consider the following differential diagnoses:

• Single most likely diagnosis
  • Pulmonary Embolism (PE) without typical symptoms: Although chest pain is a common symptom of PE, it's not universally present. Some patients, especially the elderly or those with underlying lung disease, may not exhibit typical symptoms, making it crucial to consider PE in the differential diagnosis of any patient with unexplained shortness of breath or other atypical presentations.
• Other Likely diagnoses
  • Asthma or Chronic Obstructive Pulmonary Disease (COPD) exacerbation: Both conditions can cause significant respiratory distress without chest pain, especially if the exacerbation is triggered by factors other than physical exertion or known allergens.
  • Pneumonia: Community-acquired or hospital-acquired pneumonia can present with a variety of symptoms, including cough, fever, and shortness of breath, without necessarily including chest pain.
  • Anxiety or Panic Disorder: These conditions can cause significant respiratory symptoms, including shortness of breath and a feeling of choking, without any underlying cardiopulmonary disease.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Aortic Dissection: Although typically associated with severe, tearing chest pain, some patients may not exhibit this classic symptom, especially if the dissection is limited or occurs in a less typical location.
  • Cardiac Tamponade: This condition, characterized by fluid accumulation in the pericardial sac, can lead to cardiac compression and impaired filling. It may present with shortness of breath, hypotension, and jugular venous distension without chest pain.
  • Pneumothorax: A spontaneous or traumatic pneumothorax can cause sudden onset of shortness of breath and may not always be accompanied by chest pain, especially if the pneumothorax is small.
• Rare diagnoses
  • Pulmonary Vasculitis: Conditions like Wegener's granulomatosis or other forms of vasculitis can affect the pulmonary vessels and cause a variety of symptoms, including shortness of breath, without chest pain.
  • Lymphangitic Carcinomatosis: Metastatic cancer to the lungs can cause shortness of breath and other respiratory symptoms without chest pain, due to the infiltration of tumor cells into the lymphatic vessels of the lung.