Differential Diagnosis for Pulmonary Embolism with Associated Findings
Single Most Likely Diagnosis
- Pulmonary Infarction: Given the presence of a pulmonary embolism (PE) in the right posterior basal segment pulmonary artery and the associated findings of right posterior basal subsegmental atelectasis/consolidation, pulmonary infarction is a highly plausible outcome. The lack of evidence for acute heart strain but suspicion of chronic right heart failure supports this, as it suggests the heart's ability to compensate for the increased pressure is compromised, potentially leading to infarction of lung tissue due to the embolism.
Other Likely Diagnoses
- Pneumonia: The presence of subsegmental atelectasis/consolidation and a small pleural effusion could also suggest an infectious process such as pneumonia, especially in the context of a compromised lung segment due to the PE.
- Chronic Right Heart Failure: Although suspected, the chronic nature of right heart failure could be contributing to the patient's presentation, including the potential for increased susceptibility to pulmonary emboli and the development of pleural effusions.
Do Not Miss Diagnoses
- Saddle Pulmonary Embolism: Although the study mentions a PE in a specific segment, it's crucial not to miss a more central or "saddle" PE, which could have a higher mortality rate and requires immediate intervention.
- Disseminated Intravascular Coagulation (DIC): In the context of a PE, especially if there's suspicion of pulmonary infarction or if the patient has a predisposition to coagulopathy, DIC is a potentially life-threatening condition that must be considered.
- Septic Pulmonary Embolism: If there's a source of infection, septic pulmonary emboli could be a consideration, especially with the presence of consolidation and pleural effusion, necessitating a search for an infectious source.
Rare Diagnoses
- Pulmonary Arteriovenous Malformation (PAVM): Although rare, if there's a history suggestive of recurrent or unexplained pulmonary emboli, the possibility of a PAVM should be considered, as these can be a source of paradoxical emboli.
- Tumor Embolism: In cases where a primary malignancy is known or suspected, tumor embolism to the lungs could mimic or complicate the presentation of a pulmonary embolism, especially if there are multiple or recurrent embolic events.