Differential Diagnosis for Pulmonary Embolism in an Elderly Patient
Single Most Likely Diagnosis
- A. Mitral Stenosis: This condition is often associated with atrial fibrillation, which significantly increases the risk of thrombus formation and subsequent pulmonary embolism. Mitral stenosis, particularly when due to rheumatic heart disease, is a well-known risk factor for pulmonary embolism due to the increased risk of atrial fibrillation and thrombus formation in the left atrium.
Other Likely Diagnoses
- Aortic Stenosis: While less directly linked to pulmonary embolism compared to mitral stenosis, severe aortic stenosis can lead to reduced cardiac output, increased risk of atrial fibrillation, and thus indirectly increase the risk of thromboembolic events, including pulmonary embolism.
- Pulmonary Stenosis: This condition is less commonly associated with pulmonary embolism in adults, especially when compared to left-sided valvular diseases like mitral stenosis. However, it can contribute to right ventricular dysfunction and potentially increase the risk of thrombus formation in the right heart, especially in the context of other predisposing factors.
Do Not Miss Diagnoses
- Atrial Fibrillation: Not listed as an option but crucial to consider, as it is a significant risk factor for pulmonary embolism due to the formation of thrombi in the left atrium. The presence of atrial fibrillation, regardless of the underlying cardiac lesion, significantly increases the risk of pulmonary embolism.
- Deep Vein Thrombosis (DVT): While not a cardiac lesion, DVT is a critical "do not miss" diagnosis in the context of pulmonary embolism, as it is a common source of emboli. The question focuses on cardiac lesions, but in clinical practice, DVT would be a primary consideration.
Rare Diagnoses
- Other Cardiac Anomalies: Rare cardiac conditions, such as paradoxical embolism through a patent foramen ovale, or emboli from other unusual sources like cardiac tumors (e.g., myxoma), are less common but should be considered in the differential diagnosis, especially if more common causes are ruled out.