Differential Diagnosis

The patient's presentation is complex, with a combination of respiratory, gastrointestinal, and cardiovascular symptoms. Here's a breakdown of potential diagnoses:

• Single Most Likely Diagnosis

  • Pulmonary Embolism (PE) with possible infarction: The patient's initial symptoms of productive cough, easy fatigability, and chest pains that worsen with coughing could indicate a pulmonary issue. The subsequent development of palpitations and shortness of breath, especially after stopping prescribed medications, strongly suggests a cardiovascular complication such as PE, which could have been precipitated by immobility or other factors. The left lower quadrant abdominal pain and hematoma could be related to a pulmonary infarction causing referred pain or a separate thrombotic event.

• Other Likely Diagnoses

  • Pneumonia: The initial symptoms of productive cough and chest pain could suggest pneumonia, especially if the cough was productive. However, the absence of fever and the progression of symptoms make this less likely.
  • Gastrointestinal issues (e.g., diverticulitis, inflammatory bowel disease): The epigastric pain, crampy in character, followed by left lower quadrant abdominal pain and bloatedness, could indicate a gastrointestinal problem. The temporary relief with antibiotics and NSAIDs suggests an infectious or inflammatory cause.
  • Musculoskeletal issues: The chest pain and left lower quadrant pain could have a musculoskeletal origin, especially if related to coughing. However, the systemic nature of the symptoms and the development of palpitations and shortness of breath make this less likely.

• Do Not Miss Diagnoses

  • Aortic dissection: Although less likely given the patient's age and lack of typical risk factors (e.g., hypertension, Marfan syndrome), the combination of chest pain, abdominal pain, and palpitations could suggest an aortic dissection, which is a medical emergency.
  • Cardiac tamponade: The development of palpitations and shortness of breath could indicate cardiac tamponade, especially if there was a significant decrease in cardiac output. This would be a rare complication but is critical to diagnose promptly.
  • Sepsis: Given the initial symptoms and the progression to systemic symptoms like palpitations and shortness of breath, sepsis from any source (pulmonary, gastrointestinal, etc.) must be considered, especially if the patient's condition deteriorates.

• Rare Diagnoses

  • Vasculitis (e.g., Wegener's granulomatosis): The combination of respiratory and gastrointestinal symptoms, along with the development of systemic symptoms, could rarely suggest a vasculitic process.
  • Eosinophilic pneumonia: The patient's respiratory symptoms, especially if associated with eosinophilia, could suggest eosinophilic pneumonia, although this would be an uncommon diagnosis.
  • Abdominal aortic aneurysm: The abdominal pain and hematoma could, in rare cases, be associated with an abdominal aortic aneurysm, especially if the patient has risk factors such as smoking or hypertension.