Differential Diagnosis for Disseminated Thrombus, Aortic Irregularities, and Multiple Lung Consolidations

Single Most Likely Diagnosis

• Pulmonary Embolism (PE) with Saddle Embolus: This condition is highly likely as it can cause disseminated thrombi, aortic irregularities due to the pressure and possible infarction, and multiple lung consolidations due to pulmonary infarcts. The presence of a saddle embolus, which is a large thrombus straddling the bifurcation of the pulmonary artery, can lead to these widespread effects.

Other Likely Diagnoses

• Disseminated Intravascular Coagulation (DIC): This condition involves both widespread clotting and bleeding and can lead to the formation of thrombi in various parts of the body, including the lungs and aorta. It can also cause lung consolidations due to hemorrhage or infarction.
• Antiphospholipid Syndrome (APS): APS can cause arterial and venous thrombosis, including in the lungs and aorta, leading to the observed symptoms. It is also associated with multiple lung consolidations due to recurrent pulmonary emboli or infarctions.
• Marfan Syndrome with Aortic Dissection: While less common, Marfan syndrome can lead to aortic dissection, which may cause irregularities in the aorta. Additionally, the condition can increase the risk of pulmonary embolism due to cardiac complications, leading to lung consolidations.

Do Not Miss Diagnoses

• Aortic Dissection: Although it might not directly cause disseminated thrombi, an aortic dissection can lead to aortic irregularities and, if it involves the aortic arch, can cause multiple lung consolidations due to compromised blood flow or emboli. Missing this diagnosis could be fatal.
• Sepsis with Thrombosis: Sepsis can lead to a pro-coagulant state, resulting in disseminated thrombi and lung consolidations due to pneumonia or acute respiratory distress syndrome (ARDS). The aortic irregularities might be less direct but could be related to the inflammatory response or embolic events.

Rare Diagnoses

• Behçet's Disease: This rare condition can cause both arterial and venous thrombosis, including in the lungs and aorta, and can lead to lung consolidations. However, it is less common and typically presents with additional symptoms like oral and genital ulcers.
• Churg-Strauss Syndrome (Eosinophilic Granulomatosis with Polyangiitis): This is a rare autoimmune condition that can cause vasculitis, leading to thrombosis and lung consolidations. Aortic involvement is less common but can occur, especially in the context of systemic vasculitis.