Differential Diagnosis
- Single most likely diagnosis:
- Pulmonary Embolism (PE): The patient's symptoms of chest pain, trouble breathing, and a D-dimer test result of 1.74, although not extremely high, in combination with the ER doctor's dismissal despite abnormal blood and urinalysis results, warrant consideration of PE, especially given the recent change in activity level due to moving.
- Other Likely diagnoses:
- Costochondritis: The initial diagnosis of "locked up" ribs could be indicative of costochondritis, an inflammation of the cartilage that connects the ribs to the breastbone, which can cause chest pain and breathing difficulties.
- Musculoskeletal strain: The recent move could have resulted in overexertion, leading to a musculoskeletal strain that affects breathing and causes chest pain.
- Pneumonia or other respiratory infections: The patient's symptoms of trouble breathing and chest pain, along with abnormal urinalysis, could suggest a respiratory infection.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Aortic dissection: Although less likely, aortic dissection is a life-threatening condition that can cause chest pain and breathing difficulties, and must be considered, especially if the patient has risk factors such as hypertension.
- Cardiac conditions (e.g., myocardial infarction): The patient's symptoms and abnormal test results could also indicate a cardiac issue, which would be critical to diagnose and treat promptly.
- Rare diagnoses:
- Pneumothorax: A collapsed lung could cause chest pain and breathing difficulties, although it might be less likely without a clear history of trauma.
- Thoracic spine fracture or herniated disk: These conditions could cause chest pain and breathing difficulties due to nerve compression or structural issues affecting the thoracic cavity.