Differential Diagnosis for Pericardial Effusion
Single Most Likely Diagnosis
- Acute Pericarditis: This is the most likely diagnosis given the presentation of chest pain worsened by leaning forward, pericardial friction rub heard on inspiration, and a positive Ewart's sign. These symptoms are classic for acute pericarditis, which is an inflammation of the pericardium, the sac surrounding the heart.
Other Likely Diagnoses
- Pericardial Effusion: While the question presents with pericardial effusion, the additional symptoms suggest an inflammatory process. However, pericardial effusion itself can cause chest pain and Ewart's sign due to the accumulation of fluid in the pericardial space.
- Myopericarditis: This condition involves inflammation of both the myocardium (heart muscle) and the pericardium. Symptoms can overlap with acute pericarditis, and the presence of a pericardial friction rub supports this diagnosis.
Do Not Miss Diagnoses
- Cardiac Tamponade: Although less likely given the presence of a pericardial friction rub (which is more characteristic of pericarditis), cardiac tamponade is a life-threatening condition that can present with chest pain and Ewart's sign due to the compression of the heart by fluid in the pericardial space. It's crucial to consider this diagnosis due to its high mortality if not promptly treated.
- Pulmonary Embolism: While the symptoms provided are more suggestive of pericardial disease, pulmonary embolism can cause chest pain and, in rare cases, a pericardial effusion if it leads to pulmonary hypertension. It's a critical diagnosis not to miss due to its high mortality rate.
Rare Diagnoses
- Uremic Pericarditis: This condition occurs in patients with severe renal failure and can present with pericardial effusion and chest pain. It's less likely without a history of renal disease but should be considered in patients with known kidney issues.
- Tuberculous Pericarditis: A rare cause of pericarditis in areas where tuberculosis is common. It can present with chronic pericardial effusion and might be considered in patients from endemic areas or with a history of tuberculosis exposure.