Differential Diagnosis for a 33-year-old Woman with Mucous Plug in the Bronchii and Air Trapping Areas
- Single most likely diagnosis:
- Asthma with mucoid impaction: The patient's history of asthma and the presence of mucous plugs in the bronchii of the upper lobes, along with air trapping areas, are consistent with asthma exacerbation, particularly with mucoid impaction. The increasing frequency of asthma crises supports this diagnosis.
- Other Likely diagnoses:
- Chronic bronchitis: This condition could also lead to mucous plugs and air trapping due to chronic inflammation and mucus production in the bronchial tubes.
- Bronchiectasis: A condition characterized by damaged, dilated bronchial tubes that can lead to recurrent infections, mucous plugging, and air trapping.
- Cystic fibrosis: Although less common in adults presenting for the first time, cystic fibrosis can cause bronchiectasis, mucous plugging, and air trapping, especially if the diagnosis was missed in childhood.
- Do Not Miss diagnoses:
- Allergic bronchopulmonary aspergillosis (ABPA): A serious condition that can occur in asthmatic patients, characterized by an allergic reaction to Aspergillus fungi, leading to bronchiectasis, mucous plugging, and worsening asthma symptoms.
- Tuberculosis: Although less likely, tuberculosis can cause upper lobe infiltrates and should be considered, especially if the patient has risk factors or symptoms such as weight loss, fever, or night sweats.
- Rare diagnoses:
- Primary ciliary dyskinesia: A rare genetic disorder affecting the cilia in the respiratory tract, leading to recurrent respiratory infections, bronchiectasis, and potentially mucous plugging.
- Bronchial atresia: A congenital condition where a bronchus is blocked, which can lead to mucous plugging and air trapping in the affected area.