Differential Diagnosis for 90-year-old Male with Acute Dyspnea and Pharyngitis
- Single Most Likely Diagnosis
- Acute bronchitis: This is the most likely diagnosis given the patient's presentation with acute dyspnea, pharyngitis, and scattered expiratory wheezing throughout lung fields. The negative chest X-ray and the absence of other alarming symptoms also support this diagnosis.
- Other Likely Diagnoses
- COPD exacerbation: Although the patient's history of COPD is not explicitly mentioned, the presence of hypertension and hyperlipidemia, along with the symptoms of dyspnea and wheezing, make this a plausible diagnosis. However, the lack of a reported smoking history or previous COPD diagnosis makes it less likely.
- Asthma exacerbation: This could be a consideration, especially given the wheezing and dyspnea. However, the patient's age and the absence of a reported asthma history make this less likely.
- Heart failure with cardiac asthma: Despite the negative chest X-ray, heart failure cannot be entirely ruled out, especially in a patient with hypertension and hyperlipidemia. However, the absence of other symptoms such as orthopnea or edema makes this less likely.
- Do Not Miss Diagnoses
- Pneumonia: Although the chest X-ray is negative, pneumonia, especially viral or atypical, should be considered, especially given the patient's age and symptoms. The influenza and COVID-19 swab results will be crucial in ruling out these viral causes.
- Pulmonary embolism: This is a critical diagnosis to consider, especially in a patient with risk factors such as hypertension and hyperlipidemia. The absence of other symptoms like chest pain or syncope does not entirely rule out this diagnosis.
- Acute coronary syndrome: Given the patient's history of hypertension and hyperlipidemia, an acute coronary syndrome could present atypically with dyspnea and should not be missed.
- Rare Diagnoses
- Interstitial lung disease: This could be a consideration, especially if the patient has a history of exposure to certain substances or if other diagnoses are ruled out. However, the acute presentation makes this less likely.
- Vasculitis: Conditions like Churg-Strauss syndrome or granulomatosis with polyangiitis could present with asthma-like symptoms and should be considered if other diagnoses are ruled out and the patient's condition does not improve with standard treatment.