Differential Diagnosis for Coughing up Red Blood with RUQ Pain

Single Most Likely Diagnosis

• Pulmonary Embolism (PE): The combination of coughing up red blood (hemoptysis), pain in the right upper quadrant (RUQ) radiating to the back, shortness of breath, and low blood pressure (95/57) suggests a pulmonary embolism, especially in a patient on Plavix, which indicates a history of vascular disease or risk factors for thrombosis. The hemoglobin level (Hb 119) is near the lower limit of normal, which could be consistent with some blood loss or anemia of chronic disease.

Other Likely Diagnoses

• Pneumonia: Could present with hemoptysis, chest pain, and shortness of breath. The RUQ pain radiating to the back might be less typical but could be seen with a right upper lobe pneumonia.
• Gastroesophageal Reflux Disease (GERD) or Peptic Ulcer Disease: While less likely to cause hemoptysis, severe GERD or a bleeding peptic ulcer could potentially lead to coughing up blood if there's aspiration of gastric contents. The RUQ pain would fit, but the shortness of breath and low blood pressure are less typical.
• Liver or Biliary Pathology: Given the RUQ pain, conditions like cholecystitis or liver abscess could be considered, though they would less commonly cause hemoptysis directly.

Do Not Miss Diagnoses

• Aortic Dissection: Although less common, an aortic dissection could present with severe, radiating pain and could lead to hemoptysis if there's involvement of the aorta near the pulmonary arteries. It's a life-threatening condition that requires immediate diagnosis and treatment.
• Esophageal Rupture: Could present with chest pain and potentially hemoptysis if there's bleeding into the airways. It's a rare but critical condition.
• Cardiac Tamponade: Could cause shortness of breath and hypotension, and if there's associated pulmonary edema, could potentially lead to hemoptysis.

Rare Diagnoses

• Goodpasture Syndrome: An autoimmune disease that can cause both renal failure and pulmonary hemorrhage, presenting with hemoptysis. It's rare but should be considered in the differential for unexplained hemoptysis.
• Wegener's Granulomatosis (Granulomatosis with Polyangiitis): A form of vasculitis that can affect the lungs and kidneys, presenting with hemoptysis among other symptoms. It's rare and would require specific diagnostic testing to confirm.
• Arteriovenous Malformation (AVM): Could potentially cause hemoptysis if located in the lung, but this would be a rare cause of the patient's symptoms.