What is the diagnosis for a patient complaining of shortness of breath (SOB) with a history of asthma, normal D-dimer, and clear lungs, but with evidence of airway disease and mild hyperbilirubinemia?

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Last updated: April 12, 2025 • View editorial policy

Differential Diagnosis for Shortness of Breath (SOB) in a Patient with Asthma History

Single Most Likely Diagnosis

  • Asthma exacerbation: Given the patient's history of asthma and the presence of airway disease with wall thickening and mild mucus plugging in the lower lobes on the CT scan, an asthma exacerbation is the most likely cause of the patient's shortness of breath.

Other Likely Diagnoses

  • Chronic obstructive pulmonary disease (COPD) exacerbation: Although the patient has a history of asthma, the presence of airway disease and wall thickening could also suggest COPD, especially if the patient has a history of smoking or other risk factors.
  • Bronchitis: The mild mucus plugging and airway disease seen on the CT scan could also be consistent with bronchitis, which could be causing the patient's shortness of breath.
  • Pulmonary hypertension: Although the CT scan did not show any acute findings, pulmonary hypertension could be a contributing factor to the patient's shortness of breath, especially if the patient has a history of lung disease or other risk factors.

Do Not Miss Diagnoses

  • Pulmonary embolism (PE): Although the CT scan did not show any evidence of a pulmonary embolus, a negative CT scan does not completely rule out PE, especially if the patient has a high clinical suspicion (e.g., recent travel, immobility, cancer). The low D-dimer level makes this less likely, but it is still important to consider.
  • Cardiac tamponade: The CT scan did not show a large pericardial effusion, but a small effusion could still be causing cardiac tamponade, which is a life-threatening condition.
  • Pneumonia: Although the lungs appear generally clear of acute findings, pneumonia could still be present, especially if the patient has a history of immunocompromised state or other risk factors.

Rare Diagnoses

  • Interstitial lung disease: The CT scan showed airway disease, but it is possible that the patient has an underlying interstitial lung disease that is contributing to their shortness of breath.
  • Lymphangitic carcinomatosis: The CT scan did not show any pathologic adenopathy, but it is possible that the patient has lymphangitic carcinomatosis, which is a rare condition characterized by the spread of cancer to the lymphatic vessels in the lungs.
  • Eosinophilic pneumonia: The patient's asthma history and the presence of airway disease could suggest eosinophilic pneumonia, which is a rare condition characterized by the accumulation of eosinophils in the lungs.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.