Wheeze and fever

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Karina Zavaleta, MD [2], Iqra Qamar M.D.[3], Anmol Pitliya, M.B.B.S. M.D.[4]

Differential diagnosis of Wheeze and Fever

Etiology on the basis of anatomy Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam Labs Pulmonary function testing Imaging
Onset Cough Dyspnea Fever Slurred speech Cyanosis Auscultation Chest imaging Other Gold standard
Extrathoracic upper airway diseases Epiglottitis (supraglottitis)[1][2][3][4][5] Acute – + + + –
  • Normal function
  • Clear chest
  • Tripod posture
  • Drooling
  • Tenderness of the anterior part of the neck
Relapsing polychondritis [6][7][8][9][10][11][12] Acute + + + – –
  • Variable flow volume loop
  • Tracheal narrowing
  • Cartilaginous calcification, bronchial wall thickness, and tracheal narrowing is observed on CT
  • MRI can distinguish fibrosis from inflammation

Mc Adam criteria:[11]

  • Involvement of cartilage of ears, ribs, nose, and eyes
Retropharyngeal abscess[14][15][16] Subacute – + + + –
  • Normal function
  • Neck CT or presence of pus during the surgical procedure[18]
Etiology on the basis of anatomy Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam Labs Pulmonary function testing Imaging
Onset Cough Dyspnea Fever Slurred speech Cyanosis Auscultation Chest imaging Other Gold standard
Central airway diseases

(Intrathoracic upper airway obstruction)

Mediastinal mass/lymphadenopathy[19][20] Chronic + + + – –
  • Size, location, and density of the mass can be observed
  • In chest CT, location, size, tissue characteristic, and relationship with other structures of the mass is observed
  • Information of posterior mediastinal mass can be provided in chest or spine MRI [22]
Lower airway obstruction Bronchiolitis[23][24][25][26][27] Acute + + + – + For bacterial infection in neonates:
  • Hyperinflation
  • Mosaic attenuation
  • Increased bronchial wall[28]
  • Clinical diagnosis
Parasitic infection with VLM (eg, Ascaris, Strongyloides, filaria)[29][30][31][32] Acute + + + – –
  • Not specific
  • Bilateral peribronchial infiltration
  • Parenchymal infiltration
  • Subpleural nodules, ground–glass opacities observed on chest CT [34]
  • Larve on biopsy

References

  1. ↑ 1.0 1.1 Glynn F, Fenton JE (May 2008). "Diagnosis and management of supraglottitis (epiglottitis)". Curr Infect Dis Rep. 10 (3): 200–4. PMID 18510881.
  2. ↑ Mayo-Smith MF, Spinale JW, Donskey CJ, Yukawa M, Li RH, Schiffman FJ (December 1995). "Acute epiglottitis. An 18-year experience in Rhode Island". Chest. 108 (6): 1640–7. PMID 7497775.
  3. ↑ Frantz TD, Rasgon BM, Quesenberry CP (November 1994). "Acute epiglottitis in adults. Analysis of 129 cases". JAMA. 272 (17): 1358–60. PMID 7933397.
  4. ↑ Guldfred LA, Lyhne D, Becker BC (August 2008). "Acute epiglottitis: epidemiology, clinical presentation, management and outcome". J Laryngol Otol. 122 (8): 818–23. doi:10.1017/S0022215107000473. PMID 17892608.
  5. ↑ Hébert PC, Ducic Y, Boisvert D, Lamothe A (January 1998). "Adult epiglottitis in a Canadian setting". Laryngoscope. 108 (1 Pt 1): 64–9. PMID 9432069.
  6. ↑ Rafeq S, Trentham D, Ernst A (September 2010). "Pulmonary manifestations of relapsing polychondritis". Clin. Chest Med. 31 (3): 513–8. doi:10.1016/j.ccm.2010.04.004. PMID 20692543.
  7. ↑ Ernst A, Rafeq S, Boiselle P, Sung A, Reddy C, Michaud G, Majid A, Herth F, Trentham D (April 2009). "Relapsing polychondritis and airway involvement". Chest. 135 (4): 1024–1030. doi:10.1378/chest.08-1180. PMID 19017885. Vancouver style error: initials (help)
  8. ↑ Eng J, Sabanathan S (April 1991). "Airway complications in relapsing polychondritis". Ann. Thorac. Surg. 51 (4): 686–92. PMID 2012438.
  9. ↑ Tillie-Leblond I, Wallaert B, Leblond D, Salez F, Perez T, Remy-Jardin M, Vanhille P, Brouillard M, Marquette C, Tonnel AB (May 1998). "Respiratory involvement in relapsing polychondritis. Clinical, functional, endoscopic, and radiographic evaluations". Medicine (Baltimore). 77 (3): 168–76. PMID 9653428.
  10. ↑ Riha RL, Douglas NJ (January 2004). "Obstructive sleep apnoea/hypopnoea as the initial presentation of relapsing polychondritis". Int. J. Clin. Pract. 58 (1): 97–9. PMID 14994981.
  11. ↑ 11.0 11.1 McAdam LP, O'Hanlan MA, Bluestone R, Pearson CM (May 1976). "Relapsing polychondritis: prospective study of 23 patients and a review of the literature". Medicine (Baltimore). 55 (3): 193–215. PMID 775252.
  12. ↑ Damiani JM, Levine HL (June 1979). "Relapsing polychondritis--report of ten cases". Laryngoscope. 89 (6 Pt 1): 929–46. PMID 449538.
  13. ↑ Behar JV, Choi YW, Hartman TA, Allen NB, McAdams HP (January 2002). "Relapsing polychondritis affecting the lower respiratory tract". AJR Am J Roentgenol. 178 (1): 173–7. doi:10.2214/ajr.178.1.1780173. PMID 11756115.
  14. ↑ Page NC, Bauer EM, Lieu JE (March 2008). "Clinical features and treatment of retropharyngeal abscess in children". Otolaryngol Head Neck Surg. 138 (3): 300–6. doi:10.1016/j.otohns.2007.11.033. PMID 18312875.
  15. ↑ Craig FW, Schunk JE (June 2003). "Retropharyngeal abscess in children: clinical presentation, utility of imaging, and current management". Pediatrics. 111 (6 Pt 1): 1394–8. PMID 12777558.
  16. ↑ Cmejrek RC, Coticchia JM, Arnold JE (December 2002). "Presentation, diagnosis, and management of deep-neck abscesses in infants". Arch. Otolaryngol. Head Neck Surg. 128 (12): 1361–4. PMID 12479720.
  17. ↑ Knorr TL, Sinha V. PMID 28722903. Missing or empty |title= (help)
  18. ↑ Lazor JB, Cunningham MJ, Eavey RD, Weber AL (December 1994). "Comparison of computed tomography and surgical findings in deep neck infections". Otolaryngol Head Neck Surg. 111 (6): 746–50. doi:10.1177/019459989411100608. PMID 7991254.
  19. ↑ Kawahara K, Miyawaki M, Anami K, Moroga T, Yamamoto S, Tokuishi K, Yamashita S, Kumamoto T (January 2012). "A patient with mediastinal mature teratoma presenting with paraneoplastic limbic encephalitis". J Thorac Oncol. 7 (1): 258–9. doi:10.1097/JTO.0b013e318236eade. PMID 22173664.
  20. ↑ Stover DG, Eisenberg R, Johnson DH (November 2010). "Anti-N-methyl-D-aspartate receptor encephalitis in a young woman with a mature mediastinal teratoma". J Thorac Oncol. 5 (11): 1872–3. doi:10.1097/JTO.0b013e3181eba81d. PMID 20975383.
  21. ↑ Shamberger RC, Holzman RS, Griscom NT, Tarbell NJ, Weinstein HJ, Wohl ME (September 1995). "Prospective evaluation by computed tomography and pulmonary function tests of children with mediastinal masses". Surgery. 118 (3): 468–71. PMID 7652680.
  22. ↑ Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L (February 2013). "A diagnostic approach to the mediastinal masses". Insights Imaging. 4 (1): 29–52. doi:10.1007/s13244-012-0201-0. PMC 3579993. PMID 23225215.
  23. ↑ Hall CB, Long CE, Schnabel KC (September 2001). "Respiratory syncytial virus infections in previously healthy working adults". Clin. Infect. Dis. 33 (6): 792–6. doi:10.1086/322657. PMID 11512084.
  24. ↑ Glezen WP, Taber LH, Frank AL, Kasel JA (June 1986). "Risk of primary infection and reinfection with respiratory syncytial virus". Am. J. Dis. Child. 140 (6): 543–6. PMID 3706232.
  25. ↑ Falsey AR, Walsh EE (July 2000). "Respiratory syncytial virus infection in adults". Clin. Microbiol. Rev. 13 (3): 371–84. PMC 88938. PMID 10885982.
  26. ↑ O'Shea MK, Ryan MA, Hawksworth AW, Alsip BJ, Gray GC (August 2005). "Symptomatic respiratory syncytial virus infection in previously healthy young adults living in a crowded military environment". Clin. Infect. Dis. 41 (3): 311–7. doi:10.1086/431591. PMID 16007526.
  27. ↑ Wald TG, Miller BA, Shult P, Drinka P, Langer L, Gravenstein S (February 1995). "Can respiratory syncytial virus and influenza A be distinguished clinically in institutionalized older persons?". J Am Geriatr Soc. 43 (2): 170–4. PMID 7836643.
  28. ↑ 28.0 28.1 Devakonda A, Raoof S, Sung A, Travis WD, Naidich D (April 2010). "Bronchiolar disorders: a clinical-radiological diagnostic algorithm". Chest. 137 (4): 938–51. doi:10.1378/chest.09-0800. PMID 20371529.
  29. ↑ Marchand E, Reynaud-Gaubert M, Lauque D, Durieu J, Tonnel AB, Cordier JF (September 1998). "Idiopathic chronic eosinophilic pneumonia. A clinical and follow-up study of 62 cases. The Groupe d'Etudes et de Recherche sur les Maladies "Orphelines" Pulmonaires (GERM"O"P)". Medicine (Baltimore). 77 (5): 299–312. PMID 9772920.
  30. ↑ Johkoh T, Müller NL, Akira M, Ichikado K, Suga M, Ando M, Yoshinaga T, Kiyama T, Mihara N, Honda O, Tomiyama N, Nakamura H (September 2000). "Eosinophilic lung diseases: diagnostic accuracy of thin-section CT in 111 patients". Radiology. 216 (3): 773–80. doi:10.1148/radiology.216.3.r00se01773. PMID 10966710.
  31. ↑ Mayo JR, Müller NL, Road J, Sisler J, Lillington G (October 1989). "Chronic eosinophilic pneumonia: CT findings in six cases". AJR Am J Roentgenol. 153 (4): 727–30. doi:10.2214/ajr.153.4.727. PMID 2773727.
  32. ↑ Ebara H, Ikezoe J, Johkoh T, Kohno N, Takeuchi N, Kozuka T, Ishida O (1994). "Chronic eosinophilic pneumonia: evolution of chest radiograms and CT features". J Comput Assist Tomogr. 18 (5): 737–44. PMID 8089322.
  33. ↑ Rubinsky-Elefant G, Hirata CE, Yamamoto JH, Ferreira MU (January 2010). "Human toxocariasis: diagnosis, worldwide seroprevalences and clinical expression of the systemic and ocular forms". Ann Trop Med Parasitol. 104 (1): 3–23. doi:10.1179/136485910X12607012373957. PMID 20149289.
  34. ↑ Sakai S, Shida Y, Takahashi N, Yabuuchi H, Soeda H, Okafuji T, Hatakenaka M, Honda H (June 2006). "Pulmonary lesions associated with visceral larva migrans due to Ascaris suum or Toxocara canis: imaging of six cases". AJR Am J Roentgenol. 186 (6): 1697–702. doi:10.2214/AJR.04.1507. PMID 16714661.

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