Differential Diagnosis for Shortness of Breath in a 38-year-old Primigravid Woman
- Single most likely diagnosis
- Pulmonary edema: This is the most likely cause given the patient's history of gestational hypertension, which can lead to preeclampsia. Preeclampsia is a significant risk factor for pulmonary edema due to capillary leak and increased vascular permeability. The patient's symptoms of shortness of breath, crackles over both lung bases, and significantly elevated blood pressure support this diagnosis.
- Other Likely diagnoses
- Pulmonary thromboembolism: Given the patient's history of deep vein thrombosis and the current pregnancy, which increases the risk of thromboembolic events, pulmonary thromboembolism is a plausible diagnosis. However, the presence of crackles and the context of gestational hypertension make pulmonary edema more likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Amniotic fluid embolism: Although less likely given the absence of more typical symptoms such as sudden onset of hypotension, hypoxia, and often cardiac arrest, amniotic fluid embolism is a catastrophic condition that must be considered in any pregnant woman presenting with acute respiratory distress.
- Pulmonary thromboembolism (also listed under other likely diagnoses due to its relatively higher likelihood in this patient, but included here for emphasis on not missing it due to its potential deadliness).
- Rare diagnoses
- Idiopathic pulmonary fibrosis: This is unlikely given the acute presentation and the patient's age, as well as the lack of prior respiratory symptoms or diagnosis.
- Elevated intraabdominal pressure: While pregnancy can increase intraabdominal pressure, this would not typically cause the acute respiratory symptoms described without other significant abdominal findings.
- Progesterone-induced hyperventilation: Progesterone can cause an increase in respiratory rate, but it would not account for the severity of symptoms, including crackles and significant hypertension.
- Pulmonary metastases: There is no history of cancer provided, making this an unlikely diagnosis in this context.