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==Differential Diagnosis==
==Differential Diagnosis==
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{{ddx|Hodgkin's lymphoma}}


Evidence of "HODGKINS DISEASE"  (COMMON)   
=====Clinical manifestations=====
* Mental nerve neuropathy  
The following clinical manifestations (if present) would support this disease:
* Alcohol intolerance  
mental nerve neuropathy  
* Exfoliative dermatitis
alcohol intolerance  
* Epitrochlear lymph node enlargement  
dermatitis, exfoliative
* Inguinal lymph node enlargement  
epitrochlear lymph node enlargement  
* Hepatomegaly
inguinal lymph node enlargement  
* Liver mass  
hepatomegaly
* Superior vena cava obstruction  
liver mass  
* Inferior vena cava obstruction  
superior vena cava obstruction  
* Femoral lymph node enlargement  
inferior vena cava obstruction  
* Popliteal lymph node enlargement  
femoral lymph node enlargement  
* Pemberton sign positive  
popliteal lymph node enlargement  
* Pel-Ebstein fever
Pemberton sign positive  
* Chylous ascites
fever, Pel-Ebstein  
* Axillary lymph node enlargement  
ascites, chylous
* Erythema multiforme  
axillary lymph node enlargement  
* Erythema nodosum  
erythema multiforme  
* Hepatosplenomegaly
erythema nodosum  
* Mesenteric lymph node enlargement  
hepatosplenomegaly
* Paraplegia
mesenteric lymph node enlargement  
* Pruritus
paraplegia
* Spinal cord compression  
pruritus
* Spleen enlargement  
spinal cord compression  
* Urinary tract obstruction  
spleen enlargement  
* Generalized diffuse lymph node enlargement  
urinary tract obstruction  
* Airway compression or obstruction  
generalized diffuse lymph node enlargement  
* Cryptococcosis
airway compression or obstruction  
* Bone pain  
cryptococcosis
* Cervical lymph node enlargement  
bone pain  
* Recurrent fever
cervical lymph node enlargement  
* Recurrent infection  
fever, recurrent
* Fixed lymph node
recurrent infection  
* Neck mass  
lymph node, fixed
* Night sweats  
neck mass  
* Malaise
night sweats  
* Supraclavicular lymph node enlargement  
anergy
* Sweating increase  
supraclavicular lymph node enlargement  
* Fever unknown origin  
sweating increase  
* Remittent fever  
fever unknown origin  
* Painless lymphadenopathy  
fever, remittent
* Regional lymph node enlargement
painless lymphadenopathy  
 
regional lymph node enlargement  
=====Laboratory abnormalities=====
* Nucleated red cells  
The following lab data (if present) would be useful in establishing the presence of the disease:
* Hypogammaglobulinemia
nucleated red cells  
* Pancytopenia
retroperitoneal lymph node enlargement  
* Lymphocytes decreased
hypogammaglobulinemia
* Granulomas on biopsy
pancytopenia
 
lymphocytes decreased
=====Radiographic features=====
abdominal ultrasound, biliary tract dilatation  
* Retroperitoneal lymph node enlargement  
granulomas on biopsy
* Biliary tract dilatation on abdominal ultrasound
bone lesion  
* Bone lesion  
chest xray mediastinal mass, adenopathy, or widening  
* Mediastinal mass,adenopathy, or widening on chest xray
chest xray mediastinal mass middle
* Middle mediastinal mass on chest xray 
mediastinal lymph node enlargement  
* Mediastinal lymph node enlargement  
chest xray mediastinal mass anterior
* Anterior mediastinal mass on chest radiograph
bone marrow granulomas
* Increased uptake on abdomen gallium scan
gallium scan, increased uptake, abdomen
* Ivory vertebra  
ivory vertebra  
* Increased uptake on mediastinum gallium scan
gallium scan increased uptake, mediastinum


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{{ddx|Sarcoidosis}}
=====Clinical manifestations=====
* Corneal deposit
* Corneal opacity
* Parotid gland swelling
* Polyneuropathy
* Cranial nerve paralysis
* Airway compression or obstruction
* Retinal granuloma
* Erythema nodosum
* Uveitis
* Ankle pain
* Facial paralysis
* Salivary gland swelling
* Massive splenomegaly
* Cryptococcosis
* Generalized rash, papules (elevated, <0.5cm)
* Iridocyclitis
* Iritis
* Dry cough
* Night sweats
* Spleen enlargement
* Bilateral uveitis 
* Generalized diffuse lymph node enlargement
* Polyarthritis


=====Laboratory abnormalities=====
* Hypercalcemia
* Increased lymphocytes in pleural effusion
* Decreased Lymphocytes
* Hypercalciuria
* Mild-moderate elevation  of alkaline phosphatase 
* PFT's: restrictive defect
* PFT's: diffusion capacity decreased
* Elevated serum angiotensin-converting enzyme
* Increased vitamin D, 1,25-dihydroxy


Evidence of "SARCOIDOSIS"  (COMMON)   
=====Radiographic features=====
* Heart conduction abnormality on electrocardiographic  
The following clinical manifestations (if present) would support this disease:
* Atrioventricular block
corneal deposit
* Retroperitoneal lymph node enlargement
corneal opacity
* Lung cyst on chest radiography
parotid gland swelling
* Interstitial infiltrate ( incl. reticulonodular )on chest radiography
polyneuropathy
* Increased mediastinal uptake on gallium scan
cranial nerve paralysis
* Increased lung uptake on gallium scan  
airway compression or obstruction
* Mediastinal lymph node enlargement  
retinal granuloma
* Bone marrow granulomas
erythema nodosum
* Mediastinal mass, adenopathy, or widening on chest radiography
uveitis
* Granulomas on biopsy  
ankle pain
* Hilar lymph node enlargement on chest radiography
facial paralysis
salivary gland swelling
splenomegaly, massive
cryptococcosis
generalized rash, papules (elevated, <0.5cm)
iridocyclitis
iritis
cough, dry
night sweats
spleen enlargement
uveitis, bilateral
generalized diffuse lymph node enlargement
polyarthritis
The following lab data (if present) would be useful in establishing the presence of the disease:
heart conduction abnormality, electrocardiographic  
atrioventricular block  
hypercalcemia
retroperitoneal lymph node enlargement  
pleural effusion, lymphocytes increased
CXR lung cyst  
lymphocytes decreased
chest xray interstitial infiltrate ( incl. reticulonodular )  
hypercalciuria
alkaline phosphatase, mild-moderate elevation
gallium scan increased uptake, mediastinum
gallium scan increased uptake, lungs
PFT's: restrictive defect
PFT's: diffusion capacity decreased
mediastinal lymph node enlargement  
bone marrow granulomas  
serum angiotensin-converting enzyme elevated
vitamin D, 1,25-dihydroxy, increased
chest xray mediastinal mass, adenopathy, or widening  
granulomas on biopsy  
chest xray hilar lymph node enlargement  


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Evidence of "LYMPHOCYTIC LYMPHOMA"  (COMMON)   
{{ddx|Lymphocytic lymphoma}}
The following clinical manifestations (if present) would support this disease:
mental nerve neuropathy
dermatitis, exfoliative
extremity paralysis, lower
gout
esophageal candidiasis
abdominal mass
biliary tract obstruction
breast mass
epitrochlear lymph node enlargement
erythema multiforme
erythema nodosum
esophageal obstruction
facial edema
gastric obstruction
thyroid nodule
hepatosplenomegaly
intestinal obstruction
intussusception
liver mass
mesenteric lymph node enlargement
mucous membrane bleeding
night sweats
paraplegia
pruritus
anergy
spinal cord compression
stool clay color
stool color yellow
superior vena cava obstruction
supraclavicular lymph node enlargement
testicular mass
urinary tract obstruction
inferior vena cava obstruction
generalized diffuse lymph node enlargement
splenomegaly, massive
femoral lymph node enlargement
popliteal lymph node enlargement
airway compression or obstruction
cryptococcosis
recurrent infection
lymph node, fixed
neck mass
spleen enlargement
fever unknown origin
regional lymph node enlargement
painless lymphadenopathy
cancer
lymphoma  
non-Hodgkin lymphoma
The following lab data (if present) would be useful in establishing the presence of the disease:
IVP bladder mass or abnormal shape
hypercalcemia, extreme (>14 mg/dl)
bone destruction
kidney mass
mediastinal lymph node enlargement
prolonged bleeding time
ESR markedly increased
retroperitoneal lymph node enlargement
hypogammaglobulinemia
bone lesion
pancytopenia
lymphocytes decreased
chest xray mediastinal mass, adenopathy, or widening
chest xray mediastinal mass anterior
pleural effusion, exudate
bone marrow plasma cells increased
cryoglobulinemia
abdominal ultrasound, biliary tract dilatation
pleural effusion, lymphocytes increased
pleural effusion, chylous
malignant ascites
gallium scan increased uptake, mediastinum
gallium scan, increased uptake, abdomen
vitamin D, 1,25-dihydroxy, increased


----
=====Clinical manifestations=====
* Mental nerve neuropathy
* Exfoliative dermatitis
* Lower extremity paralysis
* Gout
* Esophageal candidiasis
* Abdominal mass
* Biliary tract obstruction
* Breast mass
* Epitrochlear lymph node enlargement
* Erythema multiforme
* Erythema nodosum
* Esophageal obstruction
* Facial edema
* Gastric obstruction
* Thyroid nodule
* Hepatosplenomegaly
* Intestinal obstruction
* Intussusception
* Liver mass
* Mesenteric lymph node enlargement
* Mucous membrane bleeding
* Night sweats
* Paraplegia
* Pruritus
* Anergy
* Spinal cord compression
* Stool clay color
* Stool color yellow
* Superior vena cava obstruction
* Supraclavicular lymph node enlargement
* Testicular mass
* Urinary tract obstruction
* Inferior vena cava obstruction
* Generalized diffuse lymph node enlargement
* Massive splenomegaly 
* Femoral lymph node enlargement
* Popliteal lymph node enlargement
* Airway compression or obstruction
* Cryptococcosis
* Recurrent infection
* Fixed lymph node
* Neck mass
* Spleen enlargement
* Fever unknown origin
* Regional lymph node enlargement
* Painless lymphadenopathy
* Cancer
* Lymphoma
* Non-Hodgkin lymphoma


=====Laboratory abnormalities=====
* Extreme hypercalcemia  (>14 mg/dl)
* Prolonged bleeding time
* Markedly increased ESR 
* Hypogammaglobulinemia
* Pancytopenia
* Lymphocytes decreased
* Pleural effusion (Exudate) 
* Bone marrow plasma cells increased
* Lymphocytes increased in pleural effusion 
* Pleural effusion (Chylous)
* Malignant ascites
* Cryoglobulinemia
* Vitamin D, 1,25-dihydroxy increased


=====Radiographic features=====
* Bladder mass or abnormal shape on IVP
* Bone destruction
* Kidney mass
* Mediastinal lymph node enlargement
* Bone lesion
* Retroperitoneal lymph node enlargement
* Mediastinal mass, adenopathy, or widening on chest radiography
* Anterior mediastinal mass on chest radiography
* Biliary tract dilatation on abdominal ultrasound
* Increased mediastinal uptake on gallium scan
* Increased abdominal uptake on gallium scan
   
   
The following clinical manifestations (if present) would support this disease:
prison inmate
retinal granuloma
erythema nodosum
Haiti
immunosuppressive therapy
weight loss, severe
corticosteroid use
chest pain, pleuritic
dyspnea, progressive
fever unknown origin
retinitis
tuberculosis exposure
The following lab data (if present) would be useful in establishing the presence of the disease:
pancytopenia
PPD positive
nucleated red cells
gallium scan, increased uptake, abdomen
abdominal CT: multiple hypodense liver lesions
bone marrow granulomas
AFB smear positive
chest xray multiple pulmonary nodules, non-calcified
granulomas on biopsy
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Evidence of "INFECTIOUS MONONUCLEOSIS"  (COMMON)
{{ddx|Miliary tuberculosis}}
The following clinical manifestations (if present) would support this disease:


optic neuritis
=====Clinical manifestations=====
epitrochlear lymph node enlargement
* Prison inmate
periorbital edema
* Retinal granuloma
pharyngeal petechia
* Erythema nodosum
spleen enlargement
* Travel history (Haiti)
spleen palpable
* Immunosuppressive therapy
tonsillitis
* Severe weight loss
abdominal tenderness, left upper quadrant
* Corticosteroid use
axillary lymph node enlargement
* Pleuritic chest pain
inguinal lymph node enlargement
* Progressive dyspnea
mesenteric lymph node enlargement
* Fever unknown origin
pharyngeal exudate
* Retinitis
pharyngeal erythema
* Tuberculosis exposure
spleen tenderness
tonsillar exudate
generalized diffuse lymph node enlargement
cervical lymph node enlargement
pharyngeal swelling
sore throat


The following lab data (if present) would be useful in establishing the presence of the disease:
=====Laboratory abnormalities=====
 
* Pancytopenia
SGPT (ALT), marked elevation
* PPD positive
SGPT (ALT), elevated
* Nucleated red cells
lymphocytes increased
* Bone marrow granulomas
atypical lymphocytes increased
* AFB smear positive  
heterophile antibody positive  
* Granulomas on biopsy
monocytes, increased
Epstein-Barr virus titre positive


=====Radiographic features=====
* Increased abdominal uptake on gallium scan
* Multiple hypodense liver lesions on abdominal CT
* Multiple non-calcified pulmonary nodules on chest radiography


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{{ddx|Infectious mononucleosis}}


Evidence of "THORACIC AORTIC ANEURYSM"  (RARE)   
=====Clinical manifestations=====
* Optic neuritis
The following clinical manifestations (if present) would support this disease:
* Epitrochlear lymph node enlargement
cocaine use
* Periorbital edema
Turner syndrome
* Pharyngeal petechia
Pemberton sign positive
* Spleen enlargement
marfan syndrome
* Spleen palpable
aortic valve regurgitation
* Tonsillitis
superior vena cava obstruction
* Left upper quadrant abdominal tenderness
aortic dilation, ascending
* Axillary lymph node enlargement
* Inguinal lymph node enlargement
The following lab data (if present) would be useful in establishing the presence of the disease:
* Pesenteric lymph node enlargement
chest xray mediastinal mass middle
* Pharyngeal exudate
chest xray mediastinal mass posterior
* Pharyngeal erythema
mediastinal widening
* Spleen tenderness
chest xray aorta prominent or enlarged
* Tonsillar exudate
chest xray mediastinal mass anterior
* Generalized diffuse lymph node enlargement
chest xray mediastinal mass, adenopathy, or widening
* Cervical lymph node enlargement
* Pharyngeal swelling
* Sore throat


=====Laboratory abnormalities=====
* Marked elevationSGPT (ALT)
* SGPT (ALT) elevated
* Lymphocytes increased
* Atypical lymphocytes increased
* Heterophile antibody positive
* Monocytes increased
* Epstein-Barr virus titre positive


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Evidence of "SUBSTERNAL GOITER"  (RARE)   
{{ddx|Thoracic aortic aneurysm}}
   
=====Clinical manifestations=====
* Cocaine use
* Turner syndrome
* Pemberton sign positive
* Marfan syndrome
* Aortic valve regurgitation
* Superior vena cava obstruction
* Ascending aortic dilation
   
   
The following clinical manifestations (if present) would support this disease:
=====Radiographic features=====
upper extremity edema  
* Anterior mediastinal mass on chest radiography
chest mass  
* Middle mediastinal mass on chest radiography
neck mass  
* Posterior mediastinal mass on chest radiography 
thyroid enlargement  
* Aorta prominent or enlarged on chest radiography
tracheal compression  
 
Pemberton sign positive  
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{{ddx|Substernal goiter}}
   
=====Clinical manifestations=====
* Upper extremity edema  
* Chest mass  
* Neck mass  
* Thyroid enlargement  
* Tracheal compression  
* Pemberton sign positive  
   
   
The following lab data (if present) would be useful in establishing the presence of the disease:
=====Laboratory abnormalities=====
TSH elevated  
* TSH elevated  
chest xray mediastinal mass, adenopathy, or widening
chest xray mediastinal mass anterior
 


=====Radiographic features=====
*  Mediastinal mass, adenopathy, or widening on chest radiograph
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{{ddx|Thymoma}}


=====Clinical manifestations=====
* Bulbar palsy
* Facial candida infection
* Facial cyanosis
* Jugular venous distention
* Mouth candida infection
* Superior vena cava obstruction
* Diplopia
* Pemberton sign positive


Evidence of "THYMOMA"  (RARE)   
=====Laboratory abnormalities=====
* Pancytopenia
The following clinical manifestations (if present) would support this disease:
* Antistriational antibodies  
bulbar palsy
facial candida infection
facial cyanosis
jugular venous distention
mouth candida infection
superior vena cava obstruction
diplopia
Pemberton sign positive
The following lab data (if present) would be useful in establishing the presence of the disease:
pancytopenia
antistriational antibodies  
chest xray mediastinal mass, adenopathy, or widening
chest xray mediastinal mass anterior


=====Radiographic features=====
* Mediastinal mass, adenopathy, or widening on chest radiograph
* Anterior mediastinal mass on chest radiograph 


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{{ddx|Actinomycosis}}


Evidence of "ACTINOMYCOSIS"  (RARE)
=====Clinical manifestations=====
The following clinical manifestations (if present) would support this disease:
* Tongue mass
* Trismus
* Pericardial constriction
* Pharyngeal swelling
* Pharyngeal tenderness
* Abdominal fistula
* Bronchial fistula
* Empyema
* Lung abscess
* Right lower quadrant abdominal mass
* Chest wall suppuration
* Gingival fistula
* Chest wall fistula
* Gingival swelling
* Gingival tenderness
* Jaw induration
* Mandibular swelling


tongue mass
=====Laboratory abnormalities=====
trismus
* Branching Gram-positive bacilli on Gram stain
pericardial constriction
* Sulfur granule
pharyngeal swelling
pharyngeal tenderness
abdominal fistula
bronchial fistula
empyema
lung abscess
abdominal mass, right lower quadrant
chest wall suppuration
gingival fistula
chest wall fistula
gingival swelling
gingival tenderness
jaw induration
mandibular swelling


The following lab data (if present) would be useful in establishing the presence of the disease:
=====Radiographic features=====
* Mediastinal mass, adenopathy, or widening on chest radiography 
* Intracardiac mass on echocardiogram
* Hepatic cyst(s)


echocardiogram: intracardiac mass
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hepatic cyst(s)
mediastinal lymph node enlargement
chest xray mediastinal mass, adenopathy, or widening
Gram stain: branching Gram-positive bacilli
sulfur granule


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{{ddx|Chronic lymphocytic leukemia}}
 
=====Clinical manifestations=====
* Skin infiltration
* Sternal tenderness
* Lymph node firmness


=====Laboratory abnormalities=====
* Hemolysis
* Prolonged bleeding time
* Monoclonal gammopathy
* Cryoglobulinemia
* Marked increase of leukocytes
* Clonal B-lymphocytes on flow cytometry
* Lymphocytes increased


Evidence of "CHRONIC LYMPHOCYTIC LEUKEMIA"  (RARE)   
=====Radiographic features=====
* Mediastinal mass, adenopathy, or widening on chest radiography
The following clinical manifestations (if present) would support this disease:
skin infiltration
sternal tenderness
lymph node firmness
The following lab data (if present) would be useful in establishing the presence of the disease:
hemolysis
mediastinal lymph node enlargement
prolonged bleeding time
chest xray mediastinal mass, adenopathy, or widening  
monoclonal gammopathy
cryoglobulinemia
leukocytes, marked increase
flow cytometry: clonal B-lymphocytes
lymphocytes increased
   
   
The following findings (if present) would make this disease less likely:
The following findings (if present) would make this disease less likely:
left shift  
* Left shift  
metamyelocytes increased  
* Metamyelocytes increased  
 


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Evidence of "SUPERIOR VENA CAVA SYNDROME"  (RARE - Urgent action required)
{{ddx|Superior vena cava syndrome}}
The following clinical manifestations (if present) would support this disease:


stridor
=====Clinical manifestations=====
facial erythema  
* Stridor
forehead vein distention  
* Facial erythema  
lymphoma
* Forehead vein distention  
tracheal displacement  
* Lymphoma
chest vein distention  
* Tracheal displacement  
facial cyanosis  
* Chest vein distention  
collateral circulation increase  
* Facial cyanosis  
conjunctival edema  
* Collateral circulation increase  
conjunctival vein distention  
* Conjunctival edema  
upper extremity edema  
* Conjunctival vein distention  
upper extremity erythema  
* Upper extremity edema  
head edema  
* Upper extremity erythema  
jugular venous distention with inspiration  
* Head edema  
lung tumor  
* Jugular venous distention with inspiration  
extremity cyanosis  
* Lung tumor  
upper extremity vein distention  
* Extremity cyanosis  
facial edema  
* Upper extremity vein distention  
neck edema  
* Facial edema  
jugular venous distention  
* Neck edema  
lung cancer  
* Jugular venous distention  
upper extremity cyanosis  
* Lung cancer  
facial vein distention  
* Upper extremity cyanosis  
superior vena cava obstruction  
* Facial vein distention  
* Superior vena cava obstruction  


The following lab data (if present) would be useful in establishing the presence of the disease:
=====Radiographic features=====
 
* Mediastinal lymph node enlargement  
mediastinal lymph node enlargement  
* Non-calcified pulmonary nodule (< 4 cm) on chest radiography
chest xray pulmonary nodule (< 4 cm), non-calcified
* Mediastinal mass, adenopathy, or widening on chest radiography
chest xray mediastinal mass, adenopathy, or widening  


The following findings (if present) would exclude this disease:
The following findings (if present) would exclude this disease:
 
* hepatojugular reflux
hepatojugular reflux


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Evidence of "UNICENTRIC CASTLEMAN DISEASE"  (RARE)   
{{ddx|Unicentric Castleman disease}}
   
The following lab data (if present) would be useful in establishing the presence of the disease:
=====Radiographic features=====
mediastinal lymph node enlargement
* Mediastinal mass, adenopathy, or widening on chest radiography
chest xray mediastinal mass, adenopathy, or widening  


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Evidence of "ADULT STILL DISEASE"  (RARE)   
{{ddx|Adult Still disease}}
   
The following clinical manifestations (if present) would support this disease:
=====Clinical manifestations=====
ankylosis
* Ankylosis
hepatosplenomegaly
* Hepatosplenomegaly
weight loss, severe
* Severe weight loss
fever, recurrent
* Recurrent fever  
night sweats  
* Night sweats  
wrist pain  
* Wrist pain  
generalized diffuse lymph node enlargement  
* Generalized diffuse lymph node enlargement  
fever unknown origin  
* Fever unknown origin  
fever, remittent
* Remittent fever
fever, high grade
* High grade fever  
polyarticular
* Polyarticular
rash, evanescent
* Evanescent rash  
 
The following lab data (if present) would be useful in establishing the presence of the disease:
=====Laboratory abnormalities=====
leukocytes, marked increase  
* Leukocytes, marked increase  
ESR markedly increased  
* ESR markedly increased  
serum ferritin greatly increased  
* Serum ferritin greatly increased  
   
   
The following findings (if present) would make this disease less likely:
The following findings (if present) would make this disease less likely:
monoarticular  
* monoarticular  
   
   
The following findings (if present) would exclude this disease:
The following findings (if present) would exclude this disease:
asymptomatic  
* asymptomatic  


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Evidence of "SMALL CELL LUNG CARCINOMA"  (COMMON)   
{{ddx|Small cell lung carcinoma}}
   
=====Clinical manifestations=====
* Acanthosis nigricans
* Axillary lymph node enlargement
* Axillary lymph node pain
* Dysphagia
* Esophageal obstruction
* Heart tamponade
* Pericardial effusion
* Lower rib tenderness
* Tracheal displacement
* Hoarseness
* Digital clubbing
* Airway compression or obstruction
* Pemberton sign positive
* Velvet palms
* Horner syndrome
* Superior vena cava obstruction
* Bone pain
* Spinal cord compression
* Supraclavicular lymph node enlargement
* Intracranial metastatic tumor
* Acute symmetrical peripheral neuropathy
* Hemoptysis
* Right supraclavicular lymph node enlargement
* Tobacco smoking
   
   
The following clinical manifestations (if present) would support this disease:
=====Laboratory abnormalities=====
acanthosis nigricans
* Bone destruction
axillary lymph node enlargement
* Unilateral diaphragm elevation on chest radiography
axillary lymph node pain
* Non-calcified pulmonary nodule (< 4 cm) on chest radiography 
dysphagia
* Mediastinal mass, adenopathy, or widening on chest radiography
esophageal obstruction
* Pleural effusion
heart tamponade
* Pleural effusion (bloody)
pericardial effusion
* Non-calcified pulmonary mass (>= 4 cm)on chest radiography
rib tenderness, lower
* Hyponatremia
tracheal displacement
* Bone marrow tumor cells
hoarseness
* Serum calcitonin increased
digital clubbing
* Hilar lymph node enlargement on chest radiography
airway compression or obstruction
Pemberton sign positive
palms, velvet
Horner syndrome
superior vena cava obstruction
bone pain
spinal cord compression
supraclavicular lymph node enlargement
intracranial metastatic tumor  
acute symmetrical peripheral neuropathy
hemoptysis
right supraclavicular lymph node enlargement  
tobacco smoking
   
   
The following lab data (if present) would be useful in establishing the presence of the disease:
=====Radiographic features=====
bone destruction
* Normal on chest radiography
chest xray unilateral diaphragm elevation
* Normal on chest CT (contrast enhanced)  
chest xray pulmonary nodule (< 4 cm), non-calcified
chest xray mediastinal mass, adenopathy, or widening
pleural effusion
pleural effusion, bloody
chest xray pulmonary mass (>= 4 cm), non-calcified
hyponatremia
bone marrow tumor cells
serum calcitonin, increased
chest xray hilar lymph node enlargement
The following findings (if present) would make this disease less likely:
chest xray normal
chest CT (contrast enhanced) normal


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Evidence of "MALIGNANT HISTIOCYTOSIS"  (RARE)    
{{ddx|Malignant histiocytosis}}
    
The following clinical manifestations (if present) would support this disease:
=====Clinical manifestations=====
tendon xanthoma  
* Tendon xanthoma  
xanthoma
* Xanthoma
tuberous xanthoma  
* Tuberous xanthoma  
planar xanthoma  
* Planar xanthoma  
palmar planar xanthoma  
* Palmar planar xanthoma  
hepatosplenomegaly
* Hepatosplenomegaly
spleen enlargement  
* Spleen enlargement  
panniculitis
* Panniculitis
generalized diffuse lymph node enlargement  
* Generalized diffuse lymph node enlargement  
 
The following lab data (if present) would be useful in establishing the presence of the disease:
=====Laboratory abnormalities=====
ESR markedly increased  
* ESR markedly increased  
serum ferritin greatly increased  
* Serum ferritin greatly increased  
ESR mildly or moderately increased  
* ESR mildly or moderately increased  
C-reactive protein elevated
* C-reactive protein elevated
 
==References==
{{reflist|2}}

Latest revision as of 21:28, 13 August 2015


Differential Diagnosis

The following conditions must be considered in the differential diagnosis of Hodgkin's lymphoma: DDx [1][2][3][4][5][6][7]
  • Sarcoidosis DDx
  • Lymphocytic lymphoma DDx
  • Miliary tuberculosis DDx
  • Infectious mononucleosis DDx
  • Thoracic aortic aneurysm DDx
  • Substernal goiter DDx
  • Thymoma DDx
  • Actinomycosis DDx
  • Chronic lymphocytic leukemia DDx
  • Superior vena cava syndrome DDx
  • Unicentric Castleman disease DDx
  • Adult Still disease DDx
  • Small cell lung carcinoma DDx
  • Malignant histiocytosis DDx


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Mahshid Mir, M.D. [2]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


Template:WikiDoc Sources

Clinical manifestations
  • Mental nerve neuropathy
  • Alcohol intolerance
  • Exfoliative dermatitis
  • Epitrochlear lymph node enlargement
  • Inguinal lymph node enlargement
  • Hepatomegaly
  • Liver mass
  • Superior vena cava obstruction
  • Inferior vena cava obstruction
  • Femoral lymph node enlargement
  • Popliteal lymph node enlargement
  • Pemberton sign positive
  • Pel-Ebstein fever
  • Chylous ascites
  • Axillary lymph node enlargement
  • Erythema multiforme
  • Erythema nodosum
  • Hepatosplenomegaly
  • Mesenteric lymph node enlargement
  • Paraplegia
  • Pruritus
  • Spinal cord compression
  • Spleen enlargement
  • Urinary tract obstruction
  • Generalized diffuse lymph node enlargement
  • Airway compression or obstruction
  • Cryptococcosis
  • Bone pain
  • Cervical lymph node enlargement
  • Recurrent fever
  • Recurrent infection
  • Fixed lymph node
  • Neck mass
  • Night sweats
  • Malaise
  • Supraclavicular lymph node enlargement
  • Sweating increase
  • Fever unknown origin
  • Remittent fever
  • Painless lymphadenopathy
  • Regional lymph node enlargement
Laboratory abnormalities
  • Nucleated red cells
  • Hypogammaglobulinemia
  • Pancytopenia
  • Lymphocytes decreased
  • Granulomas on biopsy
Radiographic features
  • Retroperitoneal lymph node enlargement
  • Biliary tract dilatation on abdominal ultrasound
  • Bone lesion
  • Mediastinal mass,adenopathy, or widening on chest xray
  • Middle mediastinal mass on chest xray
  • Mediastinal lymph node enlargement
  • Anterior mediastinal mass on chest radiograph
  • Increased uptake on abdomen gallium scan
  • Ivory vertebra
  • Increased uptake on mediastinum gallium scan


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3] Mahshid Mir, M.D. [4]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


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Clinical manifestations
  • Corneal deposit
  • Corneal opacity
  • Parotid gland swelling
  • Polyneuropathy
  • Cranial nerve paralysis
  • Airway compression or obstruction
  • Retinal granuloma
  • Erythema nodosum
  • Uveitis
  • Ankle pain
  • Facial paralysis
  • Salivary gland swelling
  • Massive splenomegaly
  • Cryptococcosis
  • Generalized rash, papules (elevated, <0.5cm)
  • Iridocyclitis
  • Iritis
  • Dry cough
  • Night sweats
  • Spleen enlargement
  • Bilateral uveitis
  • Generalized diffuse lymph node enlargement
  • Polyarthritis
Laboratory abnormalities
  • Hypercalcemia
  • Increased lymphocytes in pleural effusion
  • Decreased Lymphocytes
  • Hypercalciuria
  • Mild-moderate elevation of alkaline phosphatase
  • PFT's: restrictive defect
  • PFT's: diffusion capacity decreased
  • Elevated serum angiotensin-converting enzyme
  • Increased vitamin D, 1,25-dihydroxy
Radiographic features
  • Heart conduction abnormality on electrocardiographic
  • Atrioventricular block
  • Retroperitoneal lymph node enlargement
  • Lung cyst on chest radiography
  • Interstitial infiltrate ( incl. reticulonodular )on chest radiography
  • Increased mediastinal uptake on gallium scan
  • Increased lung uptake on gallium scan
  • Mediastinal lymph node enlargement
  • Bone marrow granulomas
  • Mediastinal mass, adenopathy, or widening on chest radiography
  • Granulomas on biopsy
  • Hilar lymph node enlargement on chest radiography


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [5] Mahshid Mir, M.D. [6]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


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Clinical manifestations
  • Mental nerve neuropathy
  • Exfoliative dermatitis
  • Lower extremity paralysis
  • Gout
  • Esophageal candidiasis
  • Abdominal mass
  • Biliary tract obstruction
  • Breast mass
  • Epitrochlear lymph node enlargement
  • Erythema multiforme
  • Erythema nodosum
  • Esophageal obstruction
  • Facial edema
  • Gastric obstruction
  • Thyroid nodule
  • Hepatosplenomegaly
  • Intestinal obstruction
  • Intussusception
  • Liver mass
  • Mesenteric lymph node enlargement
  • Mucous membrane bleeding
  • Night sweats
  • Paraplegia
  • Pruritus
  • Anergy
  • Spinal cord compression
  • Stool clay color
  • Stool color yellow
  • Superior vena cava obstruction
  • Supraclavicular lymph node enlargement
  • Testicular mass
  • Urinary tract obstruction
  • Inferior vena cava obstruction
  • Generalized diffuse lymph node enlargement
  • Massive splenomegaly
  • Femoral lymph node enlargement
  • Popliteal lymph node enlargement
  • Airway compression or obstruction
  • Cryptococcosis
  • Recurrent infection
  • Fixed lymph node
  • Neck mass
  • Spleen enlargement
  • Fever unknown origin
  • Regional lymph node enlargement
  • Painless lymphadenopathy
  • Cancer
  • Lymphoma
  • Non-Hodgkin lymphoma
Laboratory abnormalities
  • Extreme hypercalcemia (>14 mg/dl)
  • Prolonged bleeding time
  • Markedly increased ESR
  • Hypogammaglobulinemia
  • Pancytopenia
  • Lymphocytes decreased
  • Pleural effusion (Exudate)
  • Bone marrow plasma cells increased
  • Lymphocytes increased in pleural effusion
  • Pleural effusion (Chylous)
  • Malignant ascites
  • Cryoglobulinemia
  • Vitamin D, 1,25-dihydroxy increased
Radiographic features
  • Bladder mass or abnormal shape on IVP
  • Bone destruction
  • Kidney mass
  • Mediastinal lymph node enlargement
  • Bone lesion
  • Retroperitoneal lymph node enlargement
  • Mediastinal mass, adenopathy, or widening on chest radiography
  • Anterior mediastinal mass on chest radiography
  • Biliary tract dilatation on abdominal ultrasound
  • Increased mediastinal uptake on gallium scan
  • Increased abdominal uptake on gallium scan


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [7] Mahshid Mir, M.D. [8]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


Template:WikiDoc Sources

Clinical manifestations
  • Prison inmate
  • Retinal granuloma
  • Erythema nodosum
  • Travel history (Haiti)
  • Immunosuppressive therapy
  • Severe weight loss
  • Corticosteroid use
  • Pleuritic chest pain
  • Progressive dyspnea
  • Fever unknown origin
  • Retinitis
  • Tuberculosis exposure
Laboratory abnormalities
  • Pancytopenia
  • PPD positive
  • Nucleated red cells
  • Bone marrow granulomas
  • AFB smear positive
  • Granulomas on biopsy
Radiographic features
  • Increased abdominal uptake on gallium scan
  • Multiple hypodense liver lesions on abdominal CT
  • Multiple non-calcified pulmonary nodules on chest radiography


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [9] Mahshid Mir, M.D. [10]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


Template:WikiDoc Sources

Clinical manifestations
  • Optic neuritis
  • Epitrochlear lymph node enlargement
  • Periorbital edema
  • Pharyngeal petechia
  • Spleen enlargement
  • Spleen palpable
  • Tonsillitis
  • Left upper quadrant abdominal tenderness
  • Axillary lymph node enlargement
  • Inguinal lymph node enlargement
  • Pesenteric lymph node enlargement
  • Pharyngeal exudate
  • Pharyngeal erythema
  • Spleen tenderness
  • Tonsillar exudate
  • Generalized diffuse lymph node enlargement
  • Cervical lymph node enlargement
  • Pharyngeal swelling
  • Sore throat
Laboratory abnormalities
  • Marked elevationSGPT (ALT)
  • SGPT (ALT) elevated
  • Lymphocytes increased
  • Atypical lymphocytes increased
  • Heterophile antibody positive
  • Monocytes increased
  • Epstein-Barr virus titre positive


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [11] Mahshid Mir, M.D. [12]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


Template:WikiDoc Sources

Clinical manifestations
  • Cocaine use
  • Turner syndrome
  • Pemberton sign positive
  • Marfan syndrome
  • Aortic valve regurgitation
  • Superior vena cava obstruction
  • Ascending aortic dilation
Radiographic features
  • Anterior mediastinal mass on chest radiography
  • Middle mediastinal mass on chest radiography
  • Posterior mediastinal mass on chest radiography
  • Aorta prominent or enlarged on chest radiography


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [13] Mahshid Mir, M.D. [14]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


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Clinical manifestations
  • Upper extremity edema
  • Chest mass
  • Neck mass
  • Thyroid enlargement
  • Tracheal compression
  • Pemberton sign positive
Laboratory abnormalities
  • TSH elevated
Radiographic features
  • Mediastinal mass, adenopathy, or widening on chest radiograph


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [15] Mahshid Mir, M.D. [16]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


Template:WikiDoc Sources

Clinical manifestations
  • Bulbar palsy
  • Facial candida infection
  • Facial cyanosis
  • Jugular venous distention
  • Mouth candida infection
  • Superior vena cava obstruction
  • Diplopia
  • Pemberton sign positive
Laboratory abnormalities
  • Pancytopenia
  • Antistriational antibodies
Radiographic features
  • Mediastinal mass, adenopathy, or widening on chest radiograph
  • Anterior mediastinal mass on chest radiograph


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [17] Mahshid Mir, M.D. [18]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


Template:WikiDoc Sources

Clinical manifestations
  • Tongue mass
  • Trismus
  • Pericardial constriction
  • Pharyngeal swelling
  • Pharyngeal tenderness
  • Abdominal fistula
  • Bronchial fistula
  • Empyema
  • Lung abscess
  • Right lower quadrant abdominal mass
  • Chest wall suppuration
  • Gingival fistula
  • Chest wall fistula
  • Gingival swelling
  • Gingival tenderness
  • Jaw induration
  • Mandibular swelling
Laboratory abnormalities
  • Branching Gram-positive bacilli on Gram stain
  • Sulfur granule
Radiographic features
  • Mediastinal mass, adenopathy, or widening on chest radiography
  • Intracardiac mass on echocardiogram
  • Hepatic cyst(s)


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [19] Mahshid Mir, M.D. [20]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


Template:WikiDoc Sources

Clinical manifestations
  • Skin infiltration
  • Sternal tenderness
  • Lymph node firmness
Laboratory abnormalities
  • Hemolysis
  • Prolonged bleeding time
  • Monoclonal gammopathy
  • Cryoglobulinemia
  • Marked increase of leukocytes
  • Clonal B-lymphocytes on flow cytometry
  • Lymphocytes increased
Radiographic features
  • Mediastinal mass, adenopathy, or widening on chest radiography

The following findings (if present) would make this disease less likely:

  • Left shift
  • Metamyelocytes increased


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [21] Mahshid Mir, M.D. [22]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


Template:WikiDoc Sources

Clinical manifestations
  • Stridor
  • Facial erythema
  • Forehead vein distention
  • Lymphoma
  • Tracheal displacement
  • Chest vein distention
  • Facial cyanosis
  • Collateral circulation increase
  • Conjunctival edema
  • Conjunctival vein distention
  • Upper extremity edema
  • Upper extremity erythema
  • Head edema
  • Jugular venous distention with inspiration
  • Lung tumor
  • Extremity cyanosis
  • Upper extremity vein distention
  • Facial edema
  • Neck edema
  • Jugular venous distention
  • Lung cancer
  • Upper extremity cyanosis
  • Facial vein distention
  • Superior vena cava obstruction
Radiographic features
  • Mediastinal lymph node enlargement
  • Non-calcified pulmonary nodule (< 4 cm) on chest radiography
  • Mediastinal mass, adenopathy, or widening on chest radiography

The following findings (if present) would exclude this disease:

  • hepatojugular reflux


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [23] Mahshid Mir, M.D. [24]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


Template:WikiDoc Sources

Radiographic features
  • Mediastinal mass, adenopathy, or widening on chest radiography


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [25] Mahshid Mir, M.D. [26]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


Template:WikiDoc Sources

Clinical manifestations
  • Ankylosis
  • Hepatosplenomegaly
  • Severe weight loss
  • Recurrent fever
  • Night sweats
  • Wrist pain
  • Generalized diffuse lymph node enlargement
  • Fever unknown origin
  • Remittent fever
  • High grade fever
  • Polyarticular
  • Evanescent rash
Laboratory abnormalities
  • Leukocytes, marked increase
  • ESR markedly increased
  • Serum ferritin greatly increased

The following findings (if present) would make this disease less likely:

  • monoarticular

The following findings (if present) would exclude this disease:

  • asymptomatic


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [27] Mahshid Mir, M.D. [28]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


Template:WikiDoc Sources

Clinical manifestations
  • Acanthosis nigricans
  • Axillary lymph node enlargement
  • Axillary lymph node pain
  • Dysphagia
  • Esophageal obstruction
  • Heart tamponade
  • Pericardial effusion
  • Lower rib tenderness
  • Tracheal displacement
  • Hoarseness
  • Digital clubbing
  • Airway compression or obstruction
  • Pemberton sign positive
  • Velvet palms
  • Horner syndrome
  • Superior vena cava obstruction
  • Bone pain
  • Spinal cord compression
  • Supraclavicular lymph node enlargement
  • Intracranial metastatic tumor
  • Acute symmetrical peripheral neuropathy
  • Hemoptysis
  • Right supraclavicular lymph node enlargement
  • Tobacco smoking
Laboratory abnormalities
  • Bone destruction
  • Unilateral diaphragm elevation on chest radiography
  • Non-calcified pulmonary nodule (< 4 cm) on chest radiography
  • Mediastinal mass, adenopathy, or widening on chest radiography
  • Pleural effusion
  • Pleural effusion (bloody)
  • Non-calcified pulmonary mass (>= 4 cm)on chest radiography
  • Hyponatremia
  • Bone marrow tumor cells
  • Serum calcitonin increased
  • Hilar lymph node enlargement on chest radiography
Radiographic features
  • Normal on chest radiography
  • Normal on chest CT (contrast enhanced)


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [29] Mahshid Mir, M.D. [30]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


Template:WikiDoc Sources

Clinical manifestations
  • Tendon xanthoma
  • Xanthoma
  • Tuberous xanthoma
  • Planar xanthoma
  • Palmar planar xanthoma
  • Hepatosplenomegaly
  • Spleen enlargement
  • Panniculitis
  • Generalized diffuse lymph node enlargement
Laboratory abnormalities
  • ESR markedly increased
  • Serum ferritin greatly increased
  • ESR mildly or moderately increased
  • C-reactive protein elevated

References

  1. ↑ Ferri, Fred (2011). Ferri's differential diagnosis: a practical guide to the differential diagnosis of symptoms, signs, and clinical disorders. Philadelphia, PA: Elsevier/Mosby. ISBN 978-0323076999.
  2. ↑ Siegenthaler, Walter (2007). Differential diagnosis in internal medicine: from symptom to diagnosis. Stuttgart New York: Thieme. ISBN 978-1588905512.
  3. ↑ Mesko, Dusan (2002). Differential diagnosis by laboratory medicine: a quick reference for physicians. Berlin New York: Springer-Verlag. ISBN 978-3540430575.
  4. ↑ Reeder and Felson's gamuts in radiology: comprehensive lists of roentgen differential diagnosis. Place of publication not identified: Springer. 2014. ISBN 978-1475781229.
  5. ↑ Burgener, Francis (2008). Differential diagnosis in conventional radiology. Stuttgart New York: Thieme. ISBN 978-1588902757.
  6. ↑ Gattuso, Paolo (2015). Differential diagnosis in surgical pathology. Philadelphia, PA: Saunders/Elsevier. ISBN 978-1455770137.
  7. ↑ "DXplain".
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