Differential Diagnosis for Shortness of Breath with Pleuritic Chest Pain
- The following differential diagnosis is organized into categories to guide the diagnostic process for a patient presenting with shortness of breath and pleuritic chest pain.
Single Most Likely Diagnosis
- Pulmonary Embolism (PE): This is often considered the single most likely diagnosis for shortness of breath accompanied by pleuritic chest pain due to its significant prevalence and the classic presentation of sharp, stabbing chest pain that worsens with deep breathing or coughing.
Other Likely Diagnoses
- Pneumonia: Pneumonia can cause pleuritic chest pain, especially if the infection involves the pleura. It is a common cause of shortness of breath and can be associated with fever, cough, and other respiratory symptoms.
- Pleuritis: Inflammation of the pleura (pleuritis) can cause sharp chest pain that worsens with breathing. It can be due to various causes, including infectious, autoimmune, or traumatic etiologies.
- Acute Trauma: Trauma to the chest can lead to pleuritic pain due to rib fractures or direct injury to the lung or pleura.
Do Not Miss Diagnoses
- Pulmonary Embolism (PE): Although listed as the single most likely diagnosis, it's crucial to reiterate PE here due to its high mortality rate if missed. It's essential to consider PE in all patients with shortness of breath and pleuritic chest pain.
- Aortic Dissection: A life-threatening condition where the inner layer of the aorta tears. It can present with severe, tearing chest pain and shortness of breath. Although less common, missing this diagnosis can be fatal.
- Spontaneous Pneumothorax: A sudden collapse of the lung can cause severe pleuritic chest pain and shortness of breath. It's more common in tall, thin males and can be life-threatening if not promptly treated.
Rare Diagnoses
- Pulmonary Vasculitis: Conditions like Wegener's granulomatosis or other forms of vasculitis can cause pleuritic chest pain and shortness of breath, but they are less common.
- Lymphangitic Carcinomatosis: Metastatic cancer spreading to the lymphatic vessels in the lungs can cause shortness of breath and pleuritic pain, but this is a rare presentation.
- Autoimmune Disorders: Certain autoimmune disorders, such as systemic lupus erythematosus (SLE), can cause pleuritis and shortness of breath, but these are less common causes of the presenting symptoms.