What is the cause of Laurie's weight gain, left-sided chest pain, and persistent phlegm production, despite regular exercise and a cautious diet, with a history of Chronic Obstructive Pulmonary Disease (COPD) and previously noted high-normal thyroid level, now presenting with occasional shortness of breath?

Differential Diagnosis for Laurie

• Single most likely diagnosis
  • COPD exacerbation: Given Laurie's history of COPD, the symptoms of persistent phlegm production, occasional shortness of breath, and pain in the left lung area are consistent with an exacerbation of COPD. The recent weight gain could be attributed to increased inflammation and decreased mobility due to the exacerbation.
• Other Likely diagnoses
  • Pulmonary infection: The symptoms of phlegm production, shortness of breath, and pain in the lung area could also be indicative of a pulmonary infection, which is a common complication in patients with COPD.
  • Pleurisy: The pain in the left lung area, particularly under the breast and near the shoulder blade, could be indicative of pleurisy, which is inflammation of the pleura and can be caused by a variety of factors, including infection or COPD.
  • Thyroid dysfunction: Although Laurie is not on thyroid medication, the previous blood work indicating a high-normal thyroid level, combined with the weight gain despite cautious diet and exercise, could suggest a thyroid dysfunction, such as hypothyroidism.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Lung cancer: Although less likely, lung cancer is a potentially deadly diagnosis that must be considered, especially in patients with a history of COPD. The symptoms of persistent phlegm production, shortness of breath, and pain in the lung area could be indicative of lung cancer.
  • Pulmonary embolism: A pulmonary embolism is a life-threatening condition that must be considered, especially in patients with shortness of breath and chest pain. Although less likely, it is a diagnosis that cannot be missed.
• Rare diagnoses
  • Sarcoidosis: A rare inflammatory disease that can affect the lungs and cause symptoms such as shortness of breath, chest pain, and weight gain.
  • Cystic fibrosis: A rare genetic disorder that can cause respiratory symptoms such as persistent phlegm production and shortness of breath, although it is typically diagnosed at a younger age.