Differential Diagnosis for Acute-Onset Dyspnea Post-Cesarean Delivery
- Single Most Likely Diagnosis
- Transfusion-Related Acute Lung Injury (TRALI): This condition is a leading cause of acute respiratory distress following a transfusion, especially in the context of recent blood product administration, as seen in this patient who received 2 units of packed red blood cells. The presence of bilateral infiltrates on the chest x-ray and acute onset of dyspnea and hypoxemia shortly after transfusion supports this diagnosis.
- Other Likely Diagnoses
- Pulmonary Edema: This could be due to fluid overload from the transfusion and the general anesthesia, or it might be cardiogenic if there was an undiagnosed cardiac issue exacerbated by the pregnancy and the stress of surgery. However, the absence of cardiac murmurs or elevated jugular venous pressure makes this less likely.
- Aspiration of Gastric Contents: Although the patient was intubated, the risk of aspiration, especially during emergency situations or if the intubation was not perfectly secure, could lead to a chemical pneumonitis. The presence of bilateral crackles and the timing post-emergence from anesthesia are consistent with this possibility.
- Do Not Miss Diagnoses
- Pulmonary Embolism (PE): Although less likely given the immediate postoperative context and the presence of other more plausible explanations, a PE is a potentially fatal condition that must be considered, especially in a postpartum patient who has risk factors for thromboembolism.
- Amniotic Fluid Embolism (AFE): This rare but highly lethal condition can occur during labor or immediately postpartum and can present with sudden onset of dyspnea, hypoxia, and cardiovascular collapse. The recent cesarean delivery and the emergency nature of the procedure increase the risk.
- Rare Diagnoses
- Acute Respiratory Distress Syndrome (ARDS) due to Other Causes: While the patient's presentation could fit with ARDS, the specific context (recent transfusion and surgery) points more towards TRALI or other causes listed above. Other rare causes of ARDS, such as direct lung injury from a specific disease process, would be less likely in this scenario.
- Allergic Reaction or Anaphylaxis: Although less likely given the description, an allergic reaction to something administered during surgery (e.g., antibiotics, anesthetic agents) could present with respiratory distress and hypoxia. However, the presence of fever and the specific pattern of pulmonary infiltrates make this less probable.