Differential Diagnosis for 89-year-old Male with Chest Pain
- Single most likely diagnosis:
- Pulmonary Embolism (PE): Given the patient's recent history of heart ablation and surgery for skin cancer, he is at increased risk for venous thromboembolism. The chest pain associated with deep breathing (pleuritic chest pain) is a classic symptom of PE.
- Other Likely diagnoses:
- Pericarditis: The patient's recent heart ablation increases the risk of pericarditis, which can cause chest pain that worsens with deep breathing. The absence of nausea, vomiting, or radiation of pain does not rule out this diagnosis.
- Pneumonia: The patient's symptoms of pleuritic chest pain and recent history of surgery increase the risk of pneumonia, which can cause similar symptoms.
- Myocardial Infarction (MI): Although the patient has a history of CAD and recent chest pain, the lack of radiation of pain, nausea, or vomiting makes this diagnosis less likely. However, it is still a possibility, especially given the patient's significant cardiac history.
- 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 requires immediate attention. The patient's history of hypertension and CAD increases the risk, and the presence of chest pain warrants consideration of this diagnosis.
- Pulmonary Hemorrhage: Given the patient's recent surgery and anticoagulation therapy (likely for A-fib), pulmonary hemorrhage is a rare but potentially life-threatening condition that should not be missed.
- Rare diagnoses:
- Pneumothorax: The patient's recent surgery and pleuritic chest pain increase the risk of pneumothorax, although it is less likely.
- Costochondritis: This is an inflammatory condition of the cartilage that connects the ribs to the sternum, which can cause chest pain that worsens with deep breathing. However, it is less likely given the patient's recent medical history and surgery.