Difficulties in differential diagnosis of diseases with dyspnea: a mini-review and a case report

Dyspnea is a common and complex symptom that occurs in various physiological and pathological conditions associated with disorders of the respiratory, cardiovascular, or neuromuscular systems. In this article, we discuss the main causes and mechanisms of dyspnea development, types of respiratory failure, and approaches to differential diagnosis. The presented clinical case describes the difficulties in diagnosing and treating a 91-year-old patient complaining of progressive dyspnea. Despite a history of hypertension and impaired glucose tolerance, initial examinations did not reveal signs of heart failure or a significant heart disease. Chest computed tomography revealed a large hernia of the esophageal opening of the diaphragm with dislocation of abdominal organs into the chest cavity, as well as hyperkyphosis, aggravating restrictive disorders of the lung function. These changes explain the patient’s dyspnea as a consequence of a decrease in the lung volume and mechanical limitation of their mobility.