Differential Diagnosis for Sudden Onset Chest Tightness with Inhalation, Bilateral Leg Weakness, and Chills
- Single Most Likely Diagnosis
- Pulmonary Embolism (PE): This condition is characterized by sudden onset chest pain that worsens with inhalation (pleuritic chest pain), which aligns with the symptoms described. Bilateral leg weakness could be indicative of a preceding deep vein thrombosis (DVT), a common source of pulmonary emboli. Chills could accompany the systemic response to the embolic event.
- Other Likely Diagnoses
- Acute Coronary Syndrome (ACS): Although more commonly associated with exertional chest pain, ACS can present atypically, especially in women, with pain triggered by inhalation. Bilateral leg weakness is less typical but could be seen in the context of systemic illness or as a manifestation of decreased cardiac output leading to fatigue.
- Pneumonia: Community-acquired pneumonia can present with sudden onset of chest tightness, chills, and systemic symptoms like fever and malaise. Leg weakness could be due to severe infection leading to systemic inflammation and muscle weakness.
- Do Not Miss Diagnoses
- Aortic Dissection: A life-threatening condition that can present with sudden, severe chest pain that may radiate to the back and is often described as tearing in nature. Although less common, it's crucial to consider due to its high mortality rate if missed. Bilateral leg weakness could result from involvement of the aorta supplying the lower limbs.
- Spinal Cord Infarction or Compression: This could explain bilateral leg weakness and, if the upper thoracic spine is involved, might also cause chest tightness due to sensory disturbances. Chills could be part of a systemic response to acute neurological injury.
- Rare Diagnoses
- Guillain-Barré Syndrome: An autoimmune disorder that can cause ascending paralysis, starting with leg weakness. It might be accompanied by chest tightness if the diaphragm or intercostal muscles are involved early in the disease course. Chills could be part of an antecedent infection triggering the syndrome.
- Sarcoidosis: A systemic granulomatous disease that can affect the lungs, causing chest symptoms, and the nervous system, leading to muscle weakness. It's less likely but should be considered in the differential due to its potential to cause a wide range of systemic symptoms.