Differential Diagnosis for 73-year-old Female
- Single most likely diagnosis
- Hemorrhagic complication from the pleural catheter: The recent change in drainage from the pleural catheter to dark red blood, coupled with the patient's hypotensive state, strongly suggests a hemorrhagic complication. The patient's history of a recent thoracentesis and the presence of a pleural catheter increase the risk of such complications.
- Other Likely diagnoses
- Infection (e.g., pneumonia, empyema): The elevated WBC count of 51.9 with neutrophilic predominance and elevated bands suggests an infectious process. Given the patient's recent history of thoracentesis and the presence of a pleural catheter, an infection related to these interventions is plausible.
- Malignant pleural effusion: Although the patient is not currently on chemotherapy, her history of breast cancer and the recent hemorrhagic pleural effusion could indicate a malignant pleural effusion, especially if the cancer has metastasized to the pleura.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pulmonary embolism: Despite the denial of shortness of breath and chest pain, pulmonary embolism remains a critical diagnosis to consider, especially in a patient with a history of recent immobilization (e.g., during IV therapy) and cancer. The hypotension and tachycardia (if present) could be indicative of a large pulmonary embolism.
- Sepsis: The high WBC count and hypotension could also be indicative of sepsis, which is a life-threatening condition requiring immediate intervention. The source of sepsis could be related to the pleural catheter, the recent thoracentesis, or another unidentified source.
- Rare diagnoses
- Pleural angiosarcoma: Although extremely rare, this diagnosis could be considered given the patient's hemorrhagic pleural effusion. However, it would be much less likely than other diagnoses listed here.
- Pleural endometriosis: If the patient has a history of endometriosis, pleural endometriosis could be a rare cause of her hemorrhagic effusion, especially if it coincides with her menstrual cycle (if applicable). However, this would be an uncommon diagnosis.