Differential Diagnosis for Harsh Barking Cough in a 70-year-old
Single Most Likely Diagnosis
- Acute Laryngitis or Laryngotracheitis: This condition is characterized by inflammation of the larynx and trachea, often due to viral infections. The harsh barking cough, particularly in an elderly individual, could be indicative of this condition, especially if it's accompanied by hoarseness and difficulty speaking.
Other Likely Diagnoses
- Chronic Obstructive Pulmonary Disease (COPD) Exacerbation: COPD can cause a chronic cough, and an exacerbation could lead to a harsher cough. However, the barking quality might not be as typical for COPD as for other conditions.
- Asthma: Although asthma is more commonly associated with wheezing, a cough can be a predominant symptom, especially in elderly patients where the presentation might be atypical.
- Pneumonia: Certain types of pneumonia, especially those caused by bacteria or viruses, can present with a cough that might be described as harsh or barking, especially if there's involvement of the upper airways.
Do Not Miss Diagnoses
- Epiglottitis: This is a life-threatening condition that requires immediate attention. It involves inflammation of the epiglottis and can cause severe respiratory distress, a muffled voice, and a harsh cough. Although less common, it's critical not to miss this diagnosis.
- Foreign Body Aspiration: Especially in elderly patients, aspiration of a foreign body can lead to sudden onset of respiratory symptoms, including a harsh cough. This is a medical emergency.
- Lung Cancer: While less likely to present with a barking cough, lung cancer can cause a variety of respiratory symptoms, including cough. Given the age of the patient, it's essential to consider this in the differential, especially if there's a history of smoking.
Rare Diagnoses
- Pertussis (Whooping Cough): Although primarily a disease of childhood, pertussis can occur in adults, especially if vaccination status is incomplete. The cough can be harsh and have a characteristic whoop, though this might be less common in adults.
- Tracheal or Bronchial Stenosis: Narrowing of the trachea or bronchi can cause respiratory symptoms, including a harsh cough. This could be due to various causes, including tumors, infections, or trauma.
- Relapsing Polychondritis: A rare autoimmune disorder that can cause inflammation of the cartilaginous structures, including those in the respiratory tract, leading to symptoms like a harsh cough.