Shortness of Air-Differential Dx List

SHORTNESS OF AIR

DIFFERENTIAL DIAGNOSIS LIST

NOTE: This does not include every cause of shortness of air. These are just common causes that could potential be the source of the SOA. There are many other causes to consider.

  1. Pneumonia: Febrile. May have crackles, wheezes, rhonchi on exam, pain between shoulder blades or upper back. Ongoing cold and or cough for weeks. Extreme fatigue. Purulent, sometimes brown sputum. Sputum, blood cultures, and respiratory panel are often ordered to rule out causative bacteria/virus
  2. Pulmonary embolism: Often sudden. May have feeling of impending doom. May have had calf or leg pain recently. History of clots/PE. Recent plane, road trip, bed rest, surgery. Drop in 02 saturation. Elevated d-dimer. CT of chest with contrast if high suspicions or d-dimer elevated
  3. Bronchitis: Recent URI. Wheezing, low grade temp, nasal drainage, chest tightness
  4. COPD exacerbation: CXR may reveal hyper inflated lungs. Increased thickness of sputum. Abnormal ABG (C02 high- but may be in chronically high). Usually smoker, hx of smoking, or exposure. Barrel chesting, Clubbing of finger nails. Wheezes. Dyspnea with exertion
  5. CHF: May see JVD, lower extremity edema, lungs sound wet. May complain of recent sudden increase in weight. An echocardiogram will see a decreased ejection fraction. Dyspnea with exertion. BNP likely elevated.
  6. Myocardial Infarction: Chest pain, jaw pain. May have left arm numbers tingling. May have nausea. BP & heart rate may be elevated. May be tachycardia. EKG may see Nstemi/ Stemi (ST-elevation). Often will see elevated lipids. Cardiac Enzymes may not be elevated early on but generally 4-6 hours after initial and may be elevated several hours later. Family history myocardial infarction, heart disease. Risk factor often present: Smoker, hypertension, hyperlipidemia, diabetes, CAD.
  7. Pneumothorax: Recent chest trauma. Likely has severe dyspnea. Asymmetrical chest expansion. Dropping 02 saturation. Tachycardia. CXR and or Ct of chest may reveal findings of this. Potentially trace shifted to contralateral side.

REFERENCE:
1. Epocrates: Myocardial Infarction & Pneumothorax. May 2016