Differential Diagnosis for a 72-year-old Female with Cough and Associated Symptoms

The patient presents with a cough productive of sputum, body aches, stomachache from coughing, and a burning chest sensation when coughing. These symptoms, combined with the worsening of cough when lying down and a negative chest x-ray, guide the differential diagnosis.

• Single Most Likely Diagnosis

  • Acute Bronchitis: This is the most likely diagnosis given the patient's symptoms of cough with sputum production, body aches, and the absence of findings suggestive of pneumonia on the chest x-ray. Acute bronchitis is a common condition characterized by inflammation of the bronchial tubes, often caused by a viral infection.

• Other Likely Diagnoses

  • Gastroesophageal Reflux Disease (GERD): The burning chest sensation when coughing could be indicative of GERD, especially if the stomachache is related to coughing, which might exacerbate reflux.
  • Chronic Obstructive Pulmonary Disease (COPD) Exacerbation: Although less likely without a history of COPD, an exacerbation could present with increased cough and sputum production, especially in a smoker or someone with a history of lung disease.
  • Asthma: Could be considered if the patient has a history of asthma or if there are symptoms suggestive of bronchospasm, though the absence of wheezing or shortness of breath makes this less likely.

• Do Not Miss Diagnoses

  • Pneumonia: Despite a negative chest x-ray, pneumonia cannot be entirely ruled out, especially if the x-ray was taken early in the course of the disease or if the patient has a compromised immune system. Clinical judgment should guide the need for further evaluation or empiric antibiotic treatment.
  • Pulmonary Embolism: Although less likely given the absence of risk factors or symptoms such as leg swelling, pulmonary embolism is a critical diagnosis not to miss due to its high mortality rate. The presence of chest pain and cough could be indicative of a pulmonary embolism, especially if there are other risk factors.
  • Cardiac Conditions (e.g., Heart Failure): Could present with cough, especially if lying down worsens symptoms (orthopnea), though the absence of lower extremity edema and a negative chest x-ray makes this less likely.

• Rare Diagnoses

  • Interstitial Lung Disease: Unlikely without other symptoms such as progressive shortness of breath or specific findings on the physical exam, but could be considered in the differential if other diagnoses are ruled out.
  • Tuberculosis: Should be considered if the patient has risk factors (e.g., exposure history, immunocompromised state), though it is less likely given the acute presentation.
  • Lung Cancer: Although rare as a cause of acute cough, it should be considered in the differential, especially in smokers or those with a significant smoking history, and if the cough is persistent or worsening over time.