Differential Diagnosis for Shortness of Breath in a 32-Week Pregnant Patient with a History of PE

• Single Most Likely Diagnosis
  • Pulmonary Embolism (PE): Given the patient's history of PE after a tummy tuck due to prolonged immobility, and now being pregnant (a hypercoagulable state) and having recent surgery (tummy tuck), the risk factors for another PE are high. The symptoms of shortness of breath without worsening on ambulation and a history of similar conditions increase the likelihood.
• Other Likely Diagnoses
  • Respiratory Infection: Although the patient has an O2 saturation of 98%, a respiratory infection could still cause shortness of breath, especially in a pregnant patient whose respiratory system is already under more stress.
  • Cardiomyopathy or Heart Failure: Pregnancy can exacerbate or reveal underlying heart conditions. The increased heart rate (tachycardia) could be indicative of heart failure or cardiomyopathy, especially in the context of pregnancy.
  • Anemia: Given the patient's recent surgery and pregnancy, anemia could be a contributing factor to shortness of breath, as both conditions can lead to decreased red blood cell mass or hemoglobin levels.
• Do Not Miss Diagnoses
  • Amniotic Fluid Embolism (AFE): Although rare, AFE is a catastrophic condition that can occur during pregnancy, especially in the context of recent surgery or other predisposing factors. It presents with sudden onset of shortness of breath, hypotension, and potentially cardiac arrest.
  • Placenta Previa or Abruption: These conditions can cause significant maternal and fetal distress. While they might not directly cause shortness of breath, they can lead to significant blood loss and subsequent respiratory distress.
  • Pneumothorax: Especially in the context of recent surgery or as a complication of PE, pneumothorax is a life-threatening condition that requires immediate diagnosis and treatment.
• Rare Diagnoses
  • Thrombocytopenia or other coagulopathies: Despite hematology stating no thrombophilia, other coagulopathies or thrombocytopenia could still be present, contributing to the patient's condition, especially in the context of pregnancy and recent surgery.
  • Pulmonary Hypertension: This could be a contributing factor to shortness of breath, especially if the patient has underlying conditions that predispose her to pulmonary hypertension. However, it would be less likely given the acute presentation and recent surgery.