Differential Diagnosis for 37 yo Male with Right Sided Chest Pain and Worsening Pleural Effusion

• Single Most Likely Diagnosis
  • Pulmonary Embolism (PE): This is a highly likely diagnosis given the acute onset of chest pain and the rapid expansion of a pleural effusion. PE can cause pleuritic chest pain and can lead to pulmonary infarction, which may result in a pleural effusion.
• Other Likely Diagnoses
  • Pneumonia: Bacterial or viral pneumonia can cause pleuritic chest pain and pleural effusion. The worsening effusion could indicate a complicated pneumonia, such as a parapneumonic effusion.
  • Malignancy (e.g., Lung Cancer, Lymphoma): Malignancies can cause pleural effusions, and the rapid expansion could be due to tumor growth or metastasis.
  • Trauma: If there's a history of recent trauma, a hemothorax could be considered, although the context doesn't strongly suggest this.
• Do Not Miss Diagnoses
  • Aortic Dissection: Although less common, an aortic dissection can cause sudden, severe chest pain and can lead to a pleural effusion if there's leakage into the thoracic cavity. Missing this diagnosis could be fatal.
  • Esophageal Perforation: This is a medical emergency that can cause severe chest pain and pleural effusion. It's less likely but critical not to miss due to its high mortality rate if not promptly treated.
  • Pulmonary Arteriovenous Malformation (PAVM) Rupture: Rare, but can cause hemothorax and should be considered in the appropriate clinical context.
• Rare Diagnoses
  • Lymphangioleiomyomatosis (LAM): A rare lung disease that can cause pleural effusions, but it's much less common and typically seen in women.
  • Eosinophilic Pneumonia: Can cause pleural effusions but is less common and might have other distinguishing features such as eosinophilia.
  • Pleural Endometriosis: Extremely rare and typically associated with catamenial pneumothorax in women, but could theoretically cause a pleural effusion in rare cases.