Differential Diagnosis for Chest Pain in a 73-year-old Patient with Multiple Myeloma
Single Most Likely Diagnosis
- Pulmonary Embolism (PE): Given the patient's history of multiple myeloma and recent treatment with Carvykti (a monoclonal antibody), there is an increased risk of thromboembolic events. The patient's age and cancer diagnosis also contribute to a higher risk of PE.
Other Likely Diagnoses
- Myocardial Infarction (MI): Although less likely than PE in this context, MI remains a common cause of chest pain in the elderly and should be considered, especially given the patient's age and potential for cardiovascular comorbidities.
- Pneumonia: Patients with multiple myeloma are at increased risk of infections due to immunosuppression. Pneumonia can cause chest pain and should be considered, especially if there are symptoms such as fever, cough, or shortness of breath.
- Fracture or Bone Pain: Multiple myeloma can cause bone lesions, which may lead to fractures or bone pain. Given the patient's recent treatment and underlying disease, this is a plausible cause of chest pain.
Do Not Miss Diagnoses
- Aortic Dissection: Although less common, aortic dissection is a life-threatening condition that requires immediate attention. The patient's age and potential for hypertension increase the risk, making it crucial not to miss this diagnosis.
- Pulmonary Hemorrhage: Given the patient's recent treatment with Carvykti and underlying multiple myeloma, there is a risk of bleeding complications, including pulmonary hemorrhage, which would be catastrophic if not promptly addressed.
- Cardiac Tamponade: This condition, which can be caused by various factors including malignancy, is life-threatening and requires immediate diagnosis and treatment.
Rare Diagnoses
- Spontaneous Pneumothorax: While less common, spontaneous pneumothorax can occur, especially in patients with lung disease or those on certain medications. It's a rare but potential cause of chest pain in this patient.
- Mediastinal Mass or Lymphadenopathy: Given the patient's history of multiple myeloma, there is a possibility, although rare, of a mediastinal mass or significant lymphadenopathy causing chest pain.