Differential Diagnosis for 71 YOF with Wheeze Only When Laying Down

• Single Most Likely Diagnosis
  • Gastroesophageal Reflux Disease (GERD): This condition is a common cause of wheezing that worsens when lying down due to the reflux of stomach acid into the esophagus, which can irritate the airways and trigger wheezing.
• Other Likely Diagnoses
  • Asthma: Although asthma can cause wheezing at any time, some patients may experience symptoms that worsen in the supine position due to increased pressure on the diaphragm or reflux.
  • Chronic Obstructive Pulmonary Disease (COPD): Similar to asthma, COPD symptoms can worsen when lying down due to increased difficulty in breathing and potential for reflux.
  • Heart Failure: Congestive heart failure can lead to orthopnea (shortness of breath when lying down), which might be misinterpreted as wheezing. The fluid redistribution when lying down can exacerbate pulmonary congestion.
• Do Not Miss Diagnoses
  • Pulmonary Embolism: Although less common, a pulmonary embolism can cause sudden onset of dyspnea and wheezing, which might worsen when lying down due to increased pulmonary vascular resistance and potential for further clot dislodgement.
  • Cardiac Tamponade: This is a life-threatening condition where fluid accumulation in the pericardial sac compresses the heart, leading to severe respiratory distress that could be mistaken for wheezing, especially if it worsens with position changes.
• Rare Diagnoses
  • Vocal Cord Dysfunction: This condition can mimic asthma or other respiratory diseases, causing wheezing or stridor, and might be exacerbated by certain positions, including lying down.
  • Tracheobronchomalacia: A rare condition characterized by the softening of the trachea and bronchi, which can lead to wheezing and respiratory distress, potentially worsening with position changes due to airway collapse.