Differential Diagnosis for SOB
- Single most likely diagnosis
- Asthma exacerbation: Given the patient's history of asthma and the presence of airway disease with wall thickening and mild mucous plugging in the lower lobes on the CTA chest, an asthma exacerbation is the most likely cause of the patient's shortness of breath (SOB).
- 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 patient's symptoms and CTA findings could also be consistent with bronchitis, which could be acute or chronic.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pulmonary embolism (PE): Although the CTA chest did not show an acute pulmonary embolus, it is essential to consider PE in any patient with SOB, as it can be life-threatening if missed. The D-dimer level is below the typical threshold for concern, but clinical judgment should prevail.
- Cardiac tamponade: Although the CTA chest did not show a large pericardial effusion, cardiac tamponade can occur with smaller effusions, especially if they are rapidly accumulating. This diagnosis is critical to consider, as it can be life-threatening.
- Rare diagnoses
- Sarcoidosis: This condition can cause airway disease and pulmonary symptoms, but it is less likely given the patient's history of asthma and the absence of other suggestive findings.
- Eosinophilic pneumonia: This rare condition can cause pulmonary symptoms and airway disease, but it is unlikely given the patient's presentation and the absence of other suggestive findings, such as eosinophilia on the CBC.