Differential Diagnosis
- Single most likely diagnosis
- Asthma exacerbation: Given the patient's history of asthma and the presence of upper airway disease, an asthma exacerbation is the most likely diagnosis. The lack of acute intrathoracic findings on the CTA and unremarkable CBC and CMP support this diagnosis.
- Other Likely diagnoses
- Chronic obstructive pulmonary disease (COPD) exacerbation: Although the patient has a history of asthma, COPD could also be a consideration, especially if the patient has a history of smoking or other risk factors.
- Pneumonia: Although the CTA shows no acute intrathoracic findings, pneumonia could still be a possibility, especially if the patient has symptoms such as fever, cough, or shortness of breath.
- Pulmonary embolism (PE) (low probability): The d-dimer is low, which makes PE less likely, but it is not entirely ruled out, especially if the patient has risk factors such as recent travel, surgery, or family history.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pulmonary embolism (high-risk): Although the d-dimer is low, a high-risk PE could still be present, especially if the patient has symptoms such as sudden onset of shortness of breath or chest pain.
- Cardiac tamponade: The troponin is slightly elevated, which could indicate cardiac involvement. Cardiac tamponade is a life-threatening condition that requires immediate attention.
- Aortic dissection: The CTA shows no acute intrathoracic findings, but an aortic dissection could still be present, especially if the patient has symptoms such as severe chest pain or hypertension.
- Rare diagnoses
- Cystic fibrosis: Although rare, cystic fibrosis could be a consideration, especially if the patient has a history of recurrent respiratory infections or other symptoms such as malabsorption or infertility.
- Alpha-1 antitrypsin deficiency: This is a rare genetic disorder that could cause lung disease, especially if the patient has a family history or other symptoms such as liver disease.