Differential Diagnosis for the Patient's Condition

The patient's presentation with carcinoma esophagus, oligometastases to adrenal glands, right lung consolidation, left lung collapse, and sudden onset of high blood pressure and tachycardia after a CT scan with contrast (CECT) suggests a complex clinical scenario. Here's a differential diagnosis organized into the requested categories:

• Single Most Likely Diagnosis
  • Pulmonary Embolism (PE): The sudden onset of high blood pressure and tachycardia, especially after a procedure that may involve prolonged immobilization or contrast administration, raises a high suspicion for PE. The patient's cancer diagnosis and recent imaging procedure increase the risk for thromboembolic events.
• Other Likely Diagnoses
  • Contrast-Induced Nephropathy: Although the patient is non-hypertensive, the sudden increase in blood pressure could be related to contrast-induced nephropathy, especially if there was pre-existing renal impairment. This condition can lead to acute kidney injury.
  • Adrenal Insufficiency: Metastases to the adrenal glands could lead to adrenal insufficiency, which might present with hypotension, but in the context of sudden hypertension and tachycardia, an acute adrenal crisis due to the sudden shift or procedure-related stress should be considered.
  • Pneumothorax: The lung collapse and consolidation could be complicated by a pneumothorax, especially if there was a procedure-related injury or if the tumor eroded into the pleural space.
• Do Not Miss Diagnoses
  • Cardiac Tamponade: Although less likely, cardiac tamponade due to metastatic involvement of the heart or pericardium could present with sudden hypotension, but in the context of hypertension, it's crucial not to miss this potentially fatal condition.
  • Aortic Dissection: Given the sudden onset of high blood pressure and the presence of a malignancy that could potentially weaken the aortic wall, an aortic dissection, although rare, is a diagnosis that must not be missed due to its high mortality rate.
• Rare Diagnoses
  • Phaeochromocytoma: If the adrenal metastases are from a different primary site or if there's a second primary tumor, phaeochromocytoma could explain the sudden onset of hypertension. However, this would be an unusual presentation in the context of known esophageal carcinoma.
  • Thyroid Storm: If the patient has a history of thyroid disease or if there are metastases to the thyroid, a thyroid storm could present with sudden hypertension and tachycardia, although this is less directly related to the described scenario.

Each of these diagnoses requires careful consideration of the patient's clinical presentation, history, and the results of diagnostic tests to determine the most appropriate course of action.