Differential Diagnosis

• Single most likely diagnosis
  • Chronic pulmonary aspergillosis: This condition is a likely diagnosis given the patient's history of left lung fungal infection. Incomplete treatment due to insurance issues could have led to chronicity, and the symptoms of congestion with expiration notes are consistent with this diagnosis. The lack of distress with deep breathing and denial of pain, shortness of breath (SOB), cough, or sputum production does not rule out chronic pulmonary aspergillosis, as it can present with a range of symptoms.
• Other Likely diagnoses
  • Bronchiectasis: This condition could be a complication of the untreated fungal infection, leading to chronic congestion and possibly expiration notes due to airway damage.
  • Chronic obstructive pulmonary disease (COPD): Although the patient denies symptoms like cough or sputum production, COPD could still be considered, especially if the patient has a history of smoking or other risk factors. The congestion with expiration could be indicative of obstructive lung disease.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Pulmonary embolism: Although the patient denies pain or SOB, pulmonary embolism can sometimes present atypically, and it is crucial to consider this diagnosis due to its high mortality rate if missed.
  • Lung cancer: Given the history of a fungal infection and incomplete treatment, it's essential to consider the possibility of an underlying malignancy, especially if the patient has risk factors such as smoking.
• Rare diagnoses
  • Allergic bronchopulmonary aspergillosis (ABPA): This is a rare condition that occurs in people with asthma or cystic fibrosis, characterized by an allergic reaction to Aspergillus fungi. It could be considered if the patient has a history of asthma or other predisposing conditions.
  • Pulmonary alveolar proteinosis: A rare condition characterized by the accumulation of surfactant-like protein and phospholipids in the alveoli, which could potentially present with chronic congestion and respiratory symptoms.