Differential Diagnosis for Elevated D-Dimer, Ovarian Mass, and Difficulty Breathing

• Single Most Likely Diagnosis

  • Pulmonary Embolism (PE) with Ovarian Tumor: The combination of an elevated D-dimer, difficulty breathing, and an ovarian mass suggests a possible pulmonary embolism, especially if the ovarian mass is malignant and has led to a hypercoagulable state. The D-dimer is often elevated in conditions of thrombosis, and PE is a well-known cause of sudden onset of difficulty breathing.

• Other Likely Diagnoses

  • Ovarian Cancer with Thrombosis: Ovarian cancer can increase the risk of thrombosis due to its effects on blood clotting factors. An ovarian mass identified in this context could be malignant, and the elevated D-dimer could indicate thrombosis, which might not necessarily be a pulmonary embolism but could still contribute to the patient's symptoms.
  • Deep Vein Thrombosis (DVT) with Pulmonary Embolism: While DVT itself might not directly cause difficulty breathing, if it leads to a pulmonary embolism, it could explain all the symptoms. The ovarian mass could be incidental or contribute to a hypercoagulable state.

• Do Not Miss Diagnoses

  • Disseminated Intravascular Coagulation (DIC): This is a condition characterized by both widespread clotting and bleeding in the vascular system. It can be triggered by malignancy, among other causes, and could explain the elevated D-dimer and difficulty breathing if there's associated pulmonary involvement.
  • Torsion of Ovarian Mass: Although less directly related to the elevated D-dimer, a torsion of an ovarian mass can cause severe pain and potentially lead to systemic symptoms, including difficulty breathing due to pain or associated complications.

• Rare Diagnoses

  • Ovarian Tumor with Secondary Thrombocytosis: Some ovarian tumors can produce substances that stimulate platelet production, leading to thrombocytosis and an increased risk of thrombosis. This could explain the elevated D-dimer and difficulty breathing if a pulmonary embolism occurs.
  • Lymphoma or Other Malignancies: Other malignancies, including lymphoma, can increase the risk of thrombosis and could potentially explain the combination of symptoms if there's metastasis to the ovaries or lungs.