Chest pain and fever: Difference between revisions

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Latest revision as of 22:31, 31 July 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2]

Abbreviations: ABG (arterial blood gas); ACE (angiotensin converting enzyme); BMI (body mass index); CBC (complete blood count); CSF (cerebrospinal fluid); CXR (chest X-ray); ECG (electrocardiogram); FEF (forced expiratory flow rate); FEV1 (forced expiratory volume); FVC (forced vital capacity); JVD (jugular vein distention); MCV (mean corpuscular volume); Plt (platelet); RV (residual volume); SIADH (syndrome of inappropriate antidiuretic hormone); TSH (thyroid stimulating hormone); Vt (tidal volume); WBC (white blood cell); Coronary CT angiography (CCTA); multidetector row scanners (MDCT); Cardiovascular magnetic resonance — CMRI; Myocardial perfusion imaging (MPI); single-photon emission CT (SPECT); Positron emission tomography (PET) scanning; Magnetic resonance (MR) angiography, Computed tomographic (CT) angiography, and Transesophageal echocardiography (TEE), late gadolinium enhancement (LGE); right ventricular hypertrophy (RVH), right atrial enlargement (RAE), functional tricuspid regurgitation (TR), Pulmonary artery systolic pressure (PASP; adenosine deaminase (ADA); Serum amyloid A (SAA), soluble interleukin-2 receptor (sIL2R); High-resolution CT (HRCT) scanning

Differentials on the basis of Etiology	Disease	Clinical manifestations										Diagnosis
		Symptoms								Risk factors	Physical exam	Lab Findings	EKG	Imaging	Gold standard
		Onset	Duration	Quality of Pain	Cough	Fever	Dyspnea	Weight loss	Associated Features	Risk factors	Physical exam	Lab Findings	EKG	Imaging	Gold standard
Cardiac	Pericarditis^[1]^[2]^[3]	Acute or subacute	May last for hours to days	Sharp & localized retrosternal pain	+	+	+	-	Pericardial friction rub	HIV TB Immunosuppression Acute trauma	Pericardial friction rub heard with the diaphragm of stethoscope	Leukocytosis ↑Troponin level ↑Erythrocyte sedimentation rate ↑C-reactive protein level	EKG changes (typically widespread ST segment elevation or PR depressions)	Chest x-ray typically normal Echocardiogram: normal or pericardial effusion CT scan: Noncalcified pericardial thickening with pericardial effusion CMR: inflamed pericardium and myocarditis	Pericardiocentesis Pericardial biopsy
	Pericardial Tamponade^[4]^[5]	Acute or subacute	May last for hours to days	Sharp and stabbing retrosternal pain	+/-	+	+	-	Pulsus paradoxus Pericardial rub	HIV TB Immunosuppression Acute trauma	Kussmaul sign Beck triad Pulsus paradoxus	Creatine kinase and isoenzymes Abnormal LFTs Antinuclear antibody assay, erythrocyte sedimentation rate and rheumatoid factor HIV testing	EKG findings: Sinus tachycardia Low QRS voltage Electrical alternans	CXR: enlarged cardiac silhouette with clear lung fields Echocardiography: Chamber collapse, Respiratory variation in volumes and flows, IVC plethora Swan-Ganz Catheterization: Equilibration of average intracardiac diastolic pressures (usually between 10 and 30 mmHg)	Echocardiography
	Myocarditis^[6]^[7]^[8]	Acute or subacute	Variable	Sharp & localized retrosternal pain reflects associated pericarditis	+/-	+	+	-	Heart failure Sudden cardiac death Arrythmias	Ischemic heart disease Valvular heart disease	S3 and S4 gallop Cardiac murmurs Pericardial friction rub	Serum cardiac troponin levels ↑ BNP or NT-proBNP level	Nonspecific ST changes, single atrial or ventricular ectopic beats, complex ventricular arrhythmias	CXR: Normal to enlarged with or without pulmonary vascular congestion and pleural effusions Echo: Left ventricular dilation, changes in left ventricular geometry (eg, development of a more spheroid shape), and wall motion abnormalities CMR: T1 and T2 signal intensity consistent with edema, presence of LGE consistent with necrosis or scar Radionuclide ventriculography: ↓ EF Cardiac catheterization: Assessment of hemodynamic status	Endomyocardial biopsy
	Heart Failure^[9]^[10]^[11]	Subacute or chronic	Variable	Dull Left sided chest pain	+	+/-	+	+	Orthopnea Peripheral edema Hemoptysis	Dyslipidemia, hypertension, smoking, family history of premature disease, and diabetes	S3 Elevated JVP Peripheral edema	Hyponatremia Hypoalbuminemia ↑ Serum brain natriuretic peptide (BNP) or NT-proBNP level A mild elevation in serum bilirubin (total bilirubin <3 mg/dL)	EKG findings are specific according to each cause of heart failure Q waves, ST and T wave abnormalities in patients with prior MI New onset arrhythmias (atrial fibrillation and ventricular tachycardia)	CXR: Cardiomegaly Echocardiography: ↓ EF Right heart catheterization: Pulmonary capillary wedge pressure >20 mmHg, right atrial pressure ≥12 mmHg) and/or decreased cardiac index (≤2.2 L/min/m2	Echocardiography
Differentials on the basis of Etiology	Disease	Clinical manifestations										Diagnosis
		Symptoms								Risk factors	Physical exam	Lab Findings	EKG	Imaging	Gold standard
		Onset	Duration	Quality of Pain	Cough	Fever	Dyspnea	Weight loss	Associated Features	Risk factors	Physical exam	Lab Findings	EKG	Imaging	Gold standard
Pulmonary	Pulmonary Embolism^[12]^[13]	Acute	May last minutes to hours	Sharp or knifelike or pleuritic pain Localized to side of lesion	+	+/-	+	-	Hemoptysis History of venous thromboembolism or coagulation abnormalities.	Hormone replacement therapy Cancer Oral contraceptive pills Stroke Pregnancy Postpartum Prior history of VTE Thrombophilia	S3 or S4 gallop Low grade fever Tachycardia Tachypnea Hypoxia	↑D-dimer ≥500 ng/mL Arterial blood gases (Respiratory alkalosis) ↑Troponin levels Hypercoagulation workup	Tachycardia and nonspecific ST-segment and T-wave changes (70 percent) S1Q3T3 pattern New right bundle branch block Inferior Q-waves (leads II, III, and aVF)	Duplex Ultrasonography: DVT CXR: Westermark sign, Hampton hump, Palla's sign Echocardiography: RV dilation (ratio of apical 4-chamber RV diameter to left ventricle (LV) diameter > 0.9) RV systolic dysfunction Ventilation-Perfusion Scanning: High probability	CT pulmonary angiography
	Pneumonia^[14]^[15]^[16]	Acute or chronic	Variable	Dull Localized to side of lesion	+	+	+	+/-	Altered mental status Tachycardia Rust-colored sputum Green sputum Red currant-jelly sputum Central cyanosis	Long hospital stay Ill contact exposure Aspiration	Wheezing Rhonchi Rales Decreased breath sounds Pleural friction rub	Arterial blood gas : Hypoxia, hypoxemia ↑ Procalcitonin Leukocytosis Sputum evaluation Positive blood cultures	Sinus tachycardia Nonspecific ST-segment or T-wave changes	CXR: Interstitial infiltrates, lobar consolidation, cavitation	CXR
	Tracheitis/ Bronchitis^[17]^[18]^[19]^[20]	Acute	Variable	Dull Substernal	+	+	+	-	Tachypnea Respiratory distress Hoarseness Dyspnea Cyanosis Sore throat Odynophagia Dysphonia	Aspiration Pneumonia	Inspiratory stridor (with or without expiratory stridor) Nasal flaring Wheezing	Gram stain of exudates: Neutrophils	Peaked P-wave	Radiography of the neck: Steeple sign Laryngotracheobronchoscopy: a normal epiglottis with subglottic narrowing, thick and purulent secretions in the trachea, pseudomembranes	Endoscopy
	Pleuritis	Acute or subacute or chronic	May last minutes to hours	Sharp Localized pleuritic	+	+	+	-	Sharp chest pain with breathing Itching in sites on the back Dizziness	Autoimmune conditions Infections	Tachypnea Tachycardia Pleural Rubs Decreased breath sounds	Leukocytosis Arterial blood gas (ABG): Hypoxia Thoracocentesis	EKG done to rule out other causes in differential diagnoses	Chest X Ray: Pleural fluid on one or both sides Computerized tomography (CT) scan: Pleural effusions	CXR
	Pleural Effusion^[21]^[22]^[23]	Acute or subacute or chronic	Variable	Dull Pleuritic pain	+	+/-	+	+/-	Increasing lower extremity edema Orthopnea Paroxysmal nocturnal dyspnea Night sweats Hemoptysis	Pneumonia	Diminished or inaudible breath sounds Pleural friction rub Egophony (known as "E-to-A" changes)	Pleural fluid LDH levels above 1000 IU/L Nucleated cells - Lymphocytosis - Eosinophilia - Mesothelial cells Pleural fluid culture and cytology Pleural fluid antinuclear antibody and rheumatoid factor	Typically not indicated	Chest X Ray: Pleural fluid on one or both sides Computerized tomography (CT) scan: Detects small pleural effusions, ie, less than 10 mL and possibly as little as 2 mL of liquid in the pleural space, Thickening of the visceral and parietal pleura MRI: Characterize the content of pleural effusions	Computed tomography
	Asthma & COPD^[24]^[25]^[26]^[27]	Acute or subacute or chronic	Variable	Tightness	+	+/-	+	+/-	Cyanosis	Smoking HF HTN	Elevated jugular venous pulse (JVP) Hyperinflation (barrel chest) Peripheral edema Clubbing Wheezing Rhonchi Diffusely decreased breath sounds Coarse crackles beginning with inspiration	Leukocytosis Eosinophilia Respiratory alkalosis	Peaked P-wave Reduced amplitude of the QRS complexes Multifocal atrial tachycardia (MAT)	CXR: Hyperinflation Spirometry: ↓ FEV1, PEF, ↓ FEV1/FVC	Spirometry
	Pulmonary Malignancy^[28]^[29]^[30]^[31]	Chronic	Variable	Dull aching	+	+/-	+	+	Bone pain Fatigue Neurologic dysfunction Superior vena cava (SVC) obstruction Hoarseness Hemidiaphragm paralysis Dysphagia Paraneoplastic syndromes Hypercalcemia	Smoking Metastasis	Wheeze Crackles Depending upon complications caused by the spread of cancer	Hypercalcemia	EKG may be performed before cancer treatment to identify any pre-existing conditions, or during treatment to check for possible heart damage	CXR and CT scan: Mass lesion, hilar lymphadenopathy Spirometry: ↓Vt, ↑RV Bronchoscopy: Biopsy	Bronchoscopy
	Acute chest syndrome (Sickle cell anemia)^[32]^[33]^[34]	Acute	May last minutes to hours	Chest tightness	+	+/-	+	-	Sickle cell anemia Vaso-occlusive crisis Pain crises	↑ WBC ↑ Hb levels ↓ fetal hemoglobin levels Smoking Vaso-occlusive pain events	Systolic murmur may be heard over the entire precordium	↑Erythrocyte sedimentation rate Peripheral blood smears: Schistiocytes ↑ Reticulocyte count	EKG typically not indicated	Plain radiography of the extremities: Avascular necrosis	---
Differentials on the basis of Etiology	Disease	Clinical manifestations										Diagnosis
		Symptoms								Risk factors	Physical exam	Lab Findings	EKG	Imaging	Gold standard
		Onset	Duration	Quality of Pain	Cough	Fever	Dyspnea	Weight loss	Associated Features	Risk factors	Physical exam	Lab Findings	EKG	Imaging	Gold standard
Gastrointestinal	Esophagitis^[35]^[36]^[37]	Acute	Variable	Burning Epigastric	+	+	-	+/-	Heartburn Abdominal pain	HIV Immunosuppression	No auscultatory finding	Troponin or other cardiac markers Leukopenia ↓CD4 count Human immunodeficiency virus (HIV) test	ECG is done to rule out acute coronary syndrome	Double-contrast esophageal barium study (esophagography) Endoscopy: Biopsy	Endoscopy
	Esophageal Perforation^[38]	Acute	Minutes to hours	Burning Upper abdominal	-	+/-	+	-	Eating disorders such as bulimia Repeated episodes of retching and vomiting with either recent excessive dietary or alcohol intake Subcutaneous emphysema	Instrumentation/surgery Penetrating or blunt trauma Medications, other ingestions, foreign body Violent retching/vomiting Hernia/intestinal volvulus/obstruction Inflammatory bowel disease Appendicitis Peptic ulcer disease	Mild tachycardia or hypothermia Hamman crunch (crackling sound upon chest auscultation occurs due to pneumomediastinum)	↑Serum amylase ↑C-reactive protein levels	EKG may be indicated to assess for myocardial ischemia due to acute gastrointestinal bleeding, especially if there is coexisting:Cardiovascular disease, significant anemia and advanced age	Plain chest films or chest CT: Pneumomediastinum, Free air under the diaphragm, •Pleural effusion •Pneumothorax (Macklin effect). •Subcutaneous emphysema Plain abdominal films (or abdominal CT scout film):The appearance of pneumoperitoneum -Free air under the diaphragm -Cupola sign (inverted cup) -Rigler sign (double-wall sign) -Psoas sign -Urachus sign	Confirmed by water-soluble contrast esophagram
	Mediastinitis^[39]^[40]^[41]^[42]	Acute, Chronic	Variable	Retrosternal irritation	+/-	+	+	-	Nonspecific	Infection Esophageal perforation Post operative complication	Dysphagia Dysphonia Stridor Hamman sign	Positive organisms in sternal culture Leukocytosis Positive blood cultures	Diffuse ST elevation	CT: Localize the infection and extent of spread MRI: Assesses vascular involvement and complications	CT scan
	Cholelithiasis^[43]^[44]^[45]^[46]	Acute, subacute	Minutes to hours	Burning Colicky Right upper abdomen Substernal epigastric	-	+/-	-	-	Obesity Fertile females in 40's	The presence of a common bile duct stone on transabdominal ultrasound •Clinical acute cholangitis •A serum bilirubin greater than 4 mg/dL (68 micromol/L)	Murphy sign negative Jaundice	↑ALT ↑AST ↑Amylase levels ↑ALP	Typically not indicated	Transabdominal ultrasound (TAUS): shows gallstones EUS: Detects biliary sludge MRCP: Detects stones >6mm Endoscopic Retrograde Cholangiopancreatography (ERCP): Diagnostic and therapeutic removal of stones	Endoscopic ultrasound and MECP
	Pancreatitis^[47]^[48]^[49]^[50]^[51]	Acute, Chronic	Variable	Epigastric Upper left side of the abdomen Pressure like	-	+	+	+/-	Primary cirrhosis Primary sclerosing cholangitis Cystic fibrosis Autoimmune diseases	Alcohol abuse Smoking Genetic predisposition	Tachypnea Hypoxemia Hypotension Cullen's sign Grey Turner sign	↑Amylase levels ↑Lipase levels ↑ALT ↑ALP Leukocytosis	T-wave inversion ST-segment depression ST-segment elevation rarely Q-waves	CT: focal or diffuse enlargement of the pancreas MRI: Pancreatic enlargement	CT Scan
Musculoskeletal	Costosternal syndromes (costochondritis)^[52]^[53]^[54]^[55]	Acute, subacute	Days to weeks	Pressure like on anterior part of chest wall	-	+	-	-	History of repeated minor trauma or unaccustomed activity (eg, painting, moving furniture)	Trauma	Pain by palpation of tender areas Maneuvers, such as the "crowing rooster" and horizontal arm flexion maneuver	Non specific	EKG is done to rule out other cardiovascular causes	CXR: To rule out fracture	Pain by palpation of tender areas
Differentials on the basis of Etiology	Disease	Clinical manifestations										Diagnosis
		Symptoms								Risk factors	Physical exam	Lab workup	EKG	Imaging	Gold standard
		Onset	Duration	Quality of Pain	Cough	Fever	Dyspnea	Weight loss	Associated Features	Risk factors	Physical exam	Lab workup	EKG	Imaging	Gold standard
Rheumatic	Rheumatoid arthritis^[56]	Chronic	Years	Symmetrical joint pain in Wrist Fingers Knees Feet Ankles	-	+	-	+	Extra-articular involvement of other organ systems Carpal tunnel syndrome Tarsal tunnel syndrome	Old age Smoking Autoimmune conditions	Reduced grip strength Rheumatoid nodules	Positive Rheumatic Factor Anti-CCP body Synovial fluid analysis: WBC between 1500 and 25,000/cubicmm, low glucose, low C3 and C4 complement level. Thrombocytosis Anemia Mild leukocytosis	ECG is done rule out the heart failure as RA is one of the causes of heart failure	Plain film radiography: periarticular osteopenia, joint space narrowing, and bone erosions MRI: Bone erosions Ultrasonography: Degree of inflammation and the volume of inflamed tissue	---
	Sternocostoclavicular hyperostosis (SAPHO syndrome)^[57]^[58]^[59]^[60]^[61]	Chronic	Years	Recurrent and multifocal pain in Sternoclavicular joint	-	+	-	-	Palmoplantar pustulosis (PPP)	Positive family history of: Spondyloarthritis IBD Psoriasis Rheumatoid arthritis Other autoimmune/autoinflammatory disease	Hyperostosis Osteitis Synovitis Pustular eruptions Inflammatory nodules or plaques	Serologic testing to exclude other diseases Non specific	ECG is done to rule out conductions defects and aortic insufficiency	Plain radiography: Hyperostotic changes (thickening of periosteum, cortex, and endosteum), sclerotic lesions, osteolysis, periosteal reaction, and osteoproliferation Bone scan: "bull's head" change Magnetic resonance imaging: Osteitis and soft tissue involvement Fluorodeoxyglucose positron emission tomography (FDG-PET)/CT: Differentiates active versus inactive lesions	Bone scan
	Systemic lupus erythematosus^[62] ^[63]^[64]	Chronic	Years	Skin Joints (fingers, wrist, knees) Kidneys SLE can affect any organ of the body	-	+	+	+	HLA-genetic mutations Female gender Being younger than 50	Autoimmune conditions Genetic predisposition Positive family history	Malar rash Photosensitive rash Discoid rash Arthritis of the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints of the hands Pleuro-pericardial friction rubs Systolic murmurs	Elevation of autoantibodies (ANA, anti-dsDNA, anti-SM, antiphospholipid) Complement levels decreased Anemia	Sinus tachycardia, ST segment changes, and ventricular conduction disturbances	Related to specific organ involvent	Anti-dsDNA antibody test
	Relapsing polychondritis^[65]	Chronic	Years	Intermittent pain in: Tissues that cover the end of the joints Cartilage of costal rib	+	+	+	+	Hodkin's lymphoma Myelodysplastic syndromes Gastrointestinal disorders Type 1 Diabetes mellitus Auricular chondritis	Autoimmune diseases	Physical examinations findings are seen related to nasal chondritis, ocular inflammation, cardiovascular disease, skin disease, CNS and pulmonary system	Negative rheumatoid factor Anti-type II collagen antibodies Antineutrophil cytoplasmic antibodies	ECG is done to rule out the cardiovascular complications of this disease	Non specific Related to specific organ involvent	No gold standard test for this disease
Others	Substance abuse (Cocaine)^[66]^[67]^[68]	Acute (hours)	Minutes to hours	Pressure like pain in the center of chest	+	+	+	+	Anxiety Dyspnea Nausea Palpitations	Psychiatric disorders	Signs of injection drug use Signs of drug inhalation Poor personal hygiene	Serum biomarkers (Troponin I, Troponin T) Toxicologic tests or drug screens of bodily fluids (blood, urine, saliva) and hairs	QT prolongation Sinus Tachycardia Arrhythmias Cardiac conduction abnormalities	---	Gold standard test depends on the type of substance is abuse
Others	Herpes Zoster^[69]^[70]^[71]	Acute or Chronic	Variable	Burning pain on Chest Upper back Lower back	-	+	-	-	People who had chickenpox	Immunosuppression	Painful grouped herpetiform vesicles on an erythematous base distributed in a single dermatome	Viral culture Direct immunofluorescence testing, Polymerase chain reaction assay (PCR)	ECG is done to rule out other cardiovascular causes of chest pain	Magnetic resonance imaging (MRI): To rule out encephalitis	Viral tissue culture

References

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↑ Castro O, Brambilla DJ, Thorington B, Reindorf CA, Scott RB, Gillette P, Vera JC, Levy PS (July 1994). "The acute chest syndrome in sickle cell disease: incidence and risk factors. The Cooperative Study of Sickle Cell Disease". Blood. 84 (2): 643–9. PMID 7517723.
↑ Vichinsky EP, Neumayr LD, Earles AN, Williams R, Lennette ET, Dean D, Nickerson B, Orringer E, McKie V, Bellevue R, Daeschner C, Manci EA (June 2000). "Causes and outcomes of the acute chest syndrome in sickle cell disease. National Acute Chest Syndrome Study Group". N. Engl. J. Med. 342 (25): 1855–65. doi:10.1056/NEJM200006223422502. PMID 10861320.
↑ Bott S, Prakash C, McCallum RW (August 1987). "Medication-induced esophageal injury: survey of the literature". Am. J. Gastroenterol. 82 (8): 758–63. PMID 3605035.
↑ Parfitt JR, Jayakumar S, Driman DK (September 2008). "Mycophenolate mofetil-related gastrointestinal mucosal injury: variable injury patterns, including graft-versus-host disease-like changes". Am. J. Surg. Pathol. 32 (9): 1367–72. PMID 18763324.
↑ Jaspersen D (March 2000). "Drug-induced oesophageal disorders: pathogenesis, incidence, prevention and management". Drug Saf. 22 (3): 237–49. PMID 10738847.
↑ Pate JW, Walker WA, Cole FH, Owen EW, Johnson WH (May 1989). "Spontaneous rupture of the esophagus: a 30-year experience". Ann. Thorac. Surg. 47 (5): 689–92. PMID 2730190.
↑ Loyd JE, Tillman BF, Atkinson JB, Des Prez RM (September 1988). "Mediastinal fibrosis complicating histoplasmosis". Medicine (Baltimore). 67 (5): 295–310. PMID 3045478.
↑ Feigin DS, Eggleston JC, Siegelman SS (January 1979). "The multiple roentgen manifestations of sclerosing mediastinitis". Johns Hopkins Med J. 144 (1): 1–8. PMID 762913.
↑ Garrett HE, Roper CL (December 1986). "Surgical intervention in histoplasmosis". Ann. Thorac. Surg. 42 (6): 711–22. PMID 3539049.
↑ Sherrick AD, Brown LR, Harms GF, Myers JL (August 1994). "The radiographic findings of fibrosing mediastinitis". Chest. 106 (2): 484–9. PMID 7774324.
↑ Fitzgerald JE, White MJ, Lobo DN (April 2009). "Courvoisier's gallbladder: law or sign?". World J Surg. 33 (4): 886–91. doi:10.1007/s00268-008-9908-y. PMID 19190960.
↑ Yang MH, Chen TH, Wang SE, Tsai YF, Su CH, Wu CW, Lui WY, Shyr YM (July 2008). "Biochemical predictors for absence of common bile duct stones in patients undergoing laparoscopic cholecystectomy". Surg Endosc. 22 (7): 1620–4. doi:10.1007/s00464-007-9665-2. PMID 18000708.
↑ Prat F, Meduri B, Ducot B, Chiche R, Salimbeni-Bartolini R, Pelletier G (March 1999). "Prediction of common bile duct stones by noninvasive tests". Ann. Surg. 229 (3): 362–8. PMC 1191701. PMID 10077048.
↑ Tse F, Barkun JS, Barkun AN (September 2004). "The elective evaluation of patients with suspected choledocholithiasis undergoing laparoscopic cholecystectomy". Gastrointest. Endosc. 60 (3): 437–48. PMID 15332044.
↑ Dickson AP, Imrie CW (October 1984). "The incidence and prognosis of body wall ecchymosis in acute pancreatitis". Surg Gynecol Obstet. 159 (4): 343–7. PMID 6237447.
↑ Yadav D, Agarwal N, Pitchumoni CS (June 2002). "A critical evaluation of laboratory tests in acute pancreatitis". Am. J. Gastroenterol. 97 (6): 1309–18. doi:10.1111/j.1572-0241.2002.05766.x. PMID 12094843.
↑ Fortson MR, Freedman SN, Webster PD (December 1995). "Clinical assessment of hyperlipidemic pancreatitis". Am. J. Gastroenterol. 90 (12): 2134–9. PMID 8540502.
↑ Lecesne R, Taourel P, Bret PM, Atri M, Reinhold C (June 1999). "Acute pancreatitis: interobserver agreement and correlation of CT and MR cholangiopancreatography with outcome". Radiology. 211 (3): 727–35. doi:10.1148/radiology.211.3.r99jn08727. PMID 10352598.
↑ Stimac D, Miletić D, Radić M, Krznarić I, Mazur-Grbac M, Perković D, Milić S, Golubović V (May 2007). "The role of nonenhanced magnetic resonance imaging in the early assessment of acute pancreatitis". Am. J. Gastroenterol. 102 (5): 997–1004. doi:10.1111/j.1572-0241.2007.01164.x. PMID 17378903.
↑ Wolf E, Stern S (February 1976). "Costosternal syndrome: its frequency and importance in differential diagnosis of coronary heart disease". Arch. Intern. Med. 136 (2): 189–91. PMID 1247350.
↑ Fam AG, Smythe HA (September 1985). "Musculoskeletal chest wall pain". CMAJ. 133 (5): 379–89. PMC 1346531. PMID 4027804.
↑ Bösner S, Becker A, Hani MA, Keller H, Sönnichsen AC, Karatolios K, Schaefer JR, Haasenritter J, Baum E, Donner-Banzhoff N (August 2010). "Chest wall syndrome in primary care patients with chest pain: presentation, associated features and diagnosis". Fam Pract. 27 (4): 363–9. doi:10.1093/fampra/cmq024. PMID 20406787.
↑ Zaruba RA, Wilson E (June 2017). "IMPAIRMENT BASED EXAMINATION AND TREATMENT OF COSTOCHONDRITIS: A CASE SERIES". Int J Sports Phys Ther. 12 (3): 458–467. PMC 5455195. PMID 28593100.
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[pmid18000708-44] Yang MH, Chen TH, Wang SE, Tsai YF, Su CH, Wu CW, Lui WY, Shyr YM (July 2008). "Biochemical predictors for absence of common bile duct stones in patients undergoing laparoscopic cholecystectomy". Surg Endosc. 22 (7): 1620–4. doi:10.1007/s00464-007-9665-2. PMID 18000708.

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[pmid6237447-47] Dickson AP, Imrie CW (October 1984). "The incidence and prognosis of body wall ecchymosis in acute pancreatitis". Surg Gynecol Obstet. 159 (4): 343–7. PMID 6237447.

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[pmid8540502-49] Fortson MR, Freedman SN, Webster PD (December 1995). "Clinical assessment of hyperlipidemic pancreatitis". Am. J. Gastroenterol. 90 (12): 2134–9. PMID 8540502.

[pmid10352598-50] Lecesne R, Taourel P, Bret PM, Atri M, Reinhold C (June 1999). "Acute pancreatitis: interobserver agreement and correlation of CT and MR cholangiopancreatography with outcome". Radiology. 211 (3): 727–35. doi:10.1148/radiology.211.3.r99jn08727. PMID 10352598.

[pmid17378903-51] Stimac D, Miletić D, Radić M, Krznarić I, Mazur-Grbac M, Perković D, Milić S, Golubović V (May 2007). "The role of nonenhanced magnetic resonance imaging in the early assessment of acute pancreatitis". Am. J. Gastroenterol. 102 (5): 997–1004. doi:10.1111/j.1572-0241.2007.01164.x. PMID 17378903.

[pmid1247350-52] Wolf E, Stern S (February 1976). "Costosternal syndrome: its frequency and importance in differential diagnosis of coronary heart disease". Arch. Intern. Med. 136 (2): 189–91. PMID 1247350.

[pmid4027804-53] Fam AG, Smythe HA (September 1985). "Musculoskeletal chest wall pain". CMAJ. 133 (5): 379–89. PMC 1346531. PMID 4027804.

[pmid20406787-54] Bösner S, Becker A, Hani MA, Keller H, Sönnichsen AC, Karatolios K, Schaefer JR, Haasenritter J, Baum E, Donner-Banzhoff N (August 2010). "Chest wall syndrome in primary care patients with chest pain: presentation, associated features and diagnosis". Fam Pract. 27 (4): 363–9. doi:10.1093/fampra/cmq024. PMID 20406787.

[pmid28593100-55] Zaruba RA, Wilson E (June 2017). "IMPAIRMENT BASED EXAMINATION AND TREATMENT OF COSTOCHONDRITIS: A CASE SERIES". Int J Sports Phys Ther. 12 (3): 458–467. PMC 5455195. PMID 28593100.

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@@ Line 1: / Line 1: @@
+__NOTOC__
+{{Chest pain}}
+{{CMG}};{{AE}}{{IQ}}
+<small><small>
 '''''Abbreviations:''''' '''ABG ('''[[arterial blood gas]]'''); ACE ('''[[Angiotensin-converting enzyme|angiotensin converting enzyme]]'''); BMI ('''[[body mass index]]'''); CBC ('''[[Complete blood counts|complete blood count]]'''); CSF ('''[[cerebrospinal fluid]]'''); CXR ('''[[chest X-ray]]'''); ECG ('''[[electrocardiogram]]'''); FEF ('''[[Spirometry|forced expiratory flow rate]]'''); FEV1 ('''[[forced expiratory volume]]'''); FVC ('''[[forced vital capacity]]'''); JVD ('''[[jugular vein distention]]''');''' '''MCV ('''[[mean corpuscular volume]]'''); Plt ('''[[platelet]]'''); RV ('''[[residual volume]]'''); SIADH ('''[[syndrome of inappropriate antidiuretic hormone]]'''); TSH ('''[[thyroid stimulating hormone]]'''); Vt ('''[[tidal volume]]''');''' '''WBC ('''[[White blood cells|white blood cell]]'''); Coronary CT angiography (CCTA); multidetector row scanners (MDCT); Cardiovascular magnetic resonance — CMRI; Myocardial perfusion imaging (MPI); single-photon emission CT (SPECT); Positron emission tomography (PET) scanning; Magnetic resonance (MR) angiography, Computed tomographic (CT) angiography, and Transesophageal echocardiography (TEE), late gadolinium enhancement (LGE); right ventricular hypertrophy (RVH), right atrial enlargement (RAE), functional tricuspid regurgitation (TR), Pulmonary artery systolic pressure (PASP; adenosine deaminase (ADA); Serum amyloid A (SAA), soluble interleukin-2 receptor (sIL2R); High-resolution CT (HRCT) scanning'''
@@ Line 25: / Line 30: @@
 !Associated Features
 |- style="background: #DCDCDC; padding: 5px;" |
-|
+! rowspan="4" |Cardiac
-!'''[[Stable Angina]]'''<ref name="pmid23166211">{{cite journal |vauthors=Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, Douglas PS, Foody JM, Gerber TC, Hinderliter AL, King SB, Kligfield PD, Krumholz HM, Kwong RY, Lim MJ, Linderbaum JA, Mack MJ, Munger MA, Prager RL, Sabik JF, Shaw LJ, Sikkema JD, Smith CR, Smith SC, Spertus JA, Williams SV, Anderson JL |title=2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=Circulation |volume=126 |issue=25 |pages=e354–471 |date=December 2012 |pmid=23166211 |doi=10.1161/CIR.0b013e318277d6a0 |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |Sudden (acute)
-| style="background: #F5F5F5; padding: 5px;" |2-10 minutes
-| style="background: #F5F5F5; padding: 5px;" |
-*Heaviness/pressure/ tightness/squeezing/ burning ([[Levine's sign]])
-*[[Retrosternal]]  or left sided chest pain
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +/-
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Nausea and vomiting|Nausea]] and [[vomiting]]
-*[[Diaphoresis]]
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Dyslipidemia]], [[hypertension]], smoking,  family history of premature disease, and [[diabetes]]
-| style="background: #F5F5F5; padding: 5px;" |
-*Transient [[third heart sound]] [[S3|(S3]] - [[Ventricular|ventricular filling sound]]) and [[fourth heart sound]] ([[S4]] - [[atrial]] filling sound)
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Cardiac enzymes]] normal
-| style="background: #F5F5F5; padding: 5px;" |
-*Exercise EKG: ST-segment depression
-| style="background: #F5F5F5; padding: 5px;" |
-*Exercise Stress Testing: Decreased [[myocardial]] perfusion
-*[[Transthoracic echocardiography]]: [[Ejection fraction]] <50 percent
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Coronary angiography]]
-|- style="background: #DCDCDC; padding: 5px;" |
-|
-!'''[[Unstable Angina]]'''<ref name="pmid8998090">{{cite journal |vauthors=Tatum JL, Jesse RL, Kontos MC, Nicholson CS, Schmidt KL, Roberts CS, Ornato JP |title=Comprehensive strategy for the evaluation and triage of the chest pain patient |journal=Ann Emerg Med |volume=29 |issue=1 |pages=116–25 |date=January 1997 |pmid=8998090 |doi= |url=}}</ref><ref name="pmid10492848">{{cite journal |vauthors=Ornato JP |title=Chest pain emergency centers: improving acute myocardial infarction care |journal=Clin Cardiol |volume=22 |issue=8 Suppl |pages=IV3–9 |date=August 1999 |pmid=10492848 |doi= |url=}}</ref><ref name="pmid7611601">{{cite journal |vauthors=Gibler WB |title=Evaluation of chest pain in the emergency department |journal=Ann. Intern. Med. |volume=123 |issue=4 |pages=315; author reply 317–8 |date=August 1995 |pmid=7611601 |doi= |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |[[Acute]]
-| style="background: #F5F5F5; padding: 5px;" |10-20 minutes
-| style="background: #F5F5F5; padding: 5px;" |
-*Same as stable angina but often more severe
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Nausea and vomiting]]
-*[[Diaphoresis]]
-*[[Presyncope]]
-*[[Palpitation|Palpitations]]
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Dyslipidemia]], [[hypertension]], smoking,  family history of premature disease, and [[diabetes]]
-| style="background: #F5F5F5; padding: 5px;" |
-*Reverse [[Splitting of S2|splitting]] of the [[second heart sound]]
-*[[Rales/Crackles|Rales or crackles]]
-*[[Elevated jugular venous pressure]]
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Cardiac Biomarkers|Cardiac biomarkers [Cardiac troponin I, cardiac troponin T]] and [[CK MB|<nowiki>MB isoenzyme of creatine kinase (CK-MB)]</nowiki>]] normal
-| style="background: #F5F5F5; padding: 5px;" |
-*[[ST-depression]]
-*New [[T wave]] inversions
-*Transient [[ST-elevation]]
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Echocardiography]]: [[Ejection fraction]] <50 percent
-*Exercise Stress Testing: Decreased [[myocardial]] perfusion
-| style="background: #F5F5F5; padding: 5px;" |
-*Invasive [[coronary angiography]]
-|- style="background: #DCDCDC; padding: 5px;" |
-|
-!'''[[Myocardial Infarction]]'''<ref name="pmid8704488">{{cite journal |vauthors=Svavarsdóttir AE, Jónasson MR, Gudmundsson GH, Fjeldsted K |title=Chest pain in family practice. Diagnosis and long-term outcome in a community setting |journal=Can Fam Physician |volume=42 |issue= |pages=1122–8 |date=June 1996 |pmid=8704488 |pmc=2146490 |doi= |url=}}</ref><ref name="pmid8163958">{{cite journal |vauthors=Klinkman MS, Stevens D, Gorenflo DW |title=Episodes of care for chest pain: a preliminary report from MIRNET. Michigan Research Network |journal=J Fam Pract |volume=38 |issue=4 |pages=345–52 |date=April 1994 |pmid=8163958 |doi= |url=}}</ref><ref name="pmid19883149">{{cite journal |vauthors=Bösner S, Becker A, Haasenritter J, Abu Hani M, Keller H, Sönnichsen AC, Karatolios K, Schaefer JR, Seitz G, Baum E, Donner-Banzhoff N |title=Chest pain in primary care: epidemiology and pre-work-up probabilities |journal=Eur J Gen Pract |volume=15 |issue=3 |pages=141–6 |date= 2009 |pmid=19883149 |doi=10.3109/13814780903329528 |url=}}</ref><ref name="pmid21391528">{{cite journal |vauthors=Ebell MH |title=Evaluation of chest pain in primary care patients |journal=Am Fam Physician |volume=83 |issue=5 |pages=603–5 |date=March 2011 |pmid=21391528 |doi= |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |[[Acute]]
-| style="background: #F5F5F5; padding: 5px;" |Commonly > 20 minutes
-| style="background: #F5F5F5; padding: 5px;" |
-*Same as [[stable angina]] but often more severe
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Nausea and vomiting]]
-*[[Diaphoresis]]
-*[[Presyncope]]
-*[[Palpitation|Palpitations]]
-*[[Lateral]] [[displacement]] of the [[apical impulse]]
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Dyslipidemia]], [[hypertension]], smoking,  family history of premature disease, and [[diabetes]]
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Hypotension]]
-*[[Tachycardia]]
-*[[S4]] [[Gallop rhythm|gallop]]
-*[[Paradoxical splitting of S2]]
-*[[Mitral regurgitation]] [[Heart murmur|murmur]]
-| style="background: #F5F5F5; padding: 5px;" |
-*Elevated [[cardiac enzymes]]
-*↑[[Brain natriuretic peptide|B-Type Natriuretic Peptide]]
-| style="background: #F5F5F5; padding: 5px;" |
-*ST elevation MI (STEMI)
-*Non-ST elevation MI (NSTEMI) or Non [[Q wave]]
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Echocardiography]]: ↓ EF
-*CCTA: [[Coronory artery]] stenosis
-*CMRI: Coronory vessels [[stenosis]]
-*MPI on SPECT or PET scanning: Decreased [[myocardial]] perfusion.
-| style="background: #F5F5F5; padding: 5px;" |
-*CCTA combined with MPI
-|- style="background: #DCDCDC; padding: 5px;" |
-! rowspan="9" |Cardiac
-![[Vasospastic]]/ Prinzmetal/ Variant Angina<ref name="pmid14434946">{{cite journal |vauthors=PRINZMETAL M, KENNAMER R, MERLISS R, WADA T, BOR N |title=Angina pectoris. I. A variant form of angina pectoris; preliminary report |journal=Am. J. Med. |volume=27 |issue= |pages=375–88 |date=September 1959 |pmid=14434946 |doi= |url=}}</ref><ref name="pmid3779913">{{cite journal |vauthors=Kaski JC, Crea F, Meran D, Rodriguez L, Araujo L, Chierchia S, Davies G, Maseri A |title=Local coronary supersensitivity to diverse vasoconstrictive stimuli in patients with variant angina |journal=Circulation |volume=74 |issue=6 |pages=1255–65 |date=December 1986 |pmid=3779913 |doi= |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |Gradual in onset and offset
-| style="background: #F5F5F5; padding: 5px;" |Episodic, gradual in onset and offset
-| style="background: #F5F5F5; padding: 5px;" |
-*Chest discomfort described as squeezing, tightness, pressure, constriction, strangling, burning, heart burn, fullness in the chest, a band-like sensation, knot in the center of the chest, lump in the throat, ache, and heavy weight on chest
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-* [[Nausea]], [[diaphoresis]], [[dizziness]], [[dyspnea]], and [[palpitations]]
-* Associated with other vasospastic disorders, such as [[Raynaud's phenomenon]] and [[migraine]] [[headache]]
-| style="background: #F5F5F5; padding: 5px;" |
-* Multiple drugs (ephedrine-based products, [[cocaine]], [[marijuana]], alcohol, butane, sumatriptan, and amphetamines)
-* Food-born [[botulism]]
-* Guide wire or balloon dilatation while doing PCI
-* [[Magnesium]] deficiency
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Tachycardia]], [[hypertension]], [[diaphoresis]], and a gallop rhythm
-| style="background: #F5F5F5; padding: 5px;" |
-* Urine drug screen may be positive for [[cocaine]] or other drugs
-| style="background: #F5F5F5; padding: 5px;" |
-* Transient (less than 15 minutes) ischemic ST changes in multiple leads
-* A tall and broad [[R wave]],
-* Disappearance of the [[S wave]]
-* A taller T wave
-* Negative [[U waves]]
-| style="background: #F5F5F5; padding: 5px;" |
-* Stress testing: normal noninvasive stress test, exercise-induced spasm with ST-segment elevation,
-* [[Stress echocardiography]] with ergonovine provocation: [[Vasospasm]] of [[coronory vessels]]
-* Coronary arteriography: [[Epicardial]] spasm
-| style="background: #F5F5F5; padding: 5px;" |
-* [[Coronary arteriography]]
-|- style="background: #DCDCDC; padding: 5px;" |
-!'''[[Aortic Dissection]]'''<ref name="pmid28847596">{{cite journal |vauthors=Takagi H, Ando T, Umemoto T |title=Meta-Analysis of Circadian Variation in the Onset of Acute Aortic Dissection |journal=Am. J. Cardiol. |volume=120 |issue=9 |pages=1662–1666 |date=November 2017 |pmid=28847596 |doi=10.1016/j.amjcard.2017.07.067 |url=}}</ref><ref name="pmid11922269">{{cite journal |vauthors=Kojima S, Sumiyoshi M, Nakata Y, Daida H |title=Triggers and circadian distribution of the onset of acute aortic dissection |journal=Circ. J. |volume=66 |issue=3 |pages=232–5 |date=March 2002 |pmid=11922269 |doi= |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |Sudden severe progressive pain (common) or [[chronic]] (rare)
-| style="background: #F5F5F5; padding: 5px;" |Variable
-| style="background: #F5F5F5; padding: 5px;" |
-* Tearing, ripping sensation, knife like
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Focal neurologic deficit]]
-*[[Hypotension]]
-| style="background: #F5F5F5; padding: 5px;" |
-* [[Hypertension]]
-* Genetically mediated [[collagen disorders]]
-* Preexisting [[aortic aneurysm]]
-* [[Bicuspid aortic valve]]
-* [[Aortic coarctation]]
-* [[Turner syndrome]]
-* [[Vasculitis]] ([[giant cell arteritis]], [[Takayasu arteritis]], [[rheumatoid arthritis]], [[syphilitic aortitis]])
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Pulse]] deficit
-*New [[Diastolic murmurs|diastolic murmur]]
-*[[Diastolic]] decrescendo [[Heart murmur|murmur]]
-*[[Focal neurologic deficit]]
-*[[Hypotension]]
-| style="background: #F5F5F5; padding: 5px;" |
-* [[D-dimer]] <500 ng/mL rules out [[aortic dissection]]
-* ↑Soluble ST2 (sST2)
-* Measurements of soluble elastin fragments, smooth muscle [[myosin heavy chain]], high-sensitivity [[C-reactive protein (CRP)|C-reactive protein]], [[fibrinogen]], and [[Fibrillin|fibrillin fragments]]
-| style="background: #F5F5F5; padding: 5px;" |
-* Nonspecific ST and T wave changes
-| style="background: #F5F5F5; padding: 5px;" |
-*CXR: [[Mediastinal]] and/or [[aortic widening]]
-*CTA: A compressed [[true lumen]]
-*MRA: Detects differential flow between the true and false lumens, widening of the [[aorta]] with a thickened wall
-*TEE: [[Intimal]] [[dissection]] flaps, true and false lumens, [[thrombosis]] in the false lumen
-*[[Aortography]]: Distortion of the normal contrast column, Flow reversal or stasis into a false channel, Failure of major branches to fill, and [[Aortic]] [[valvular regurgitation]]
-| style="background: #F5F5F5; padding: 5px;" |
-*[[CT angiography]]
-*[[Digital subtraction aortography]] (if high suspicion)
-|- style="background: #DCDCDC; padding: 5px;" |
 !'''[[Pericarditis]]'''<ref name="pmid15028364">{{cite journal |vauthors=Imazio M, Demichelis B, Parrini I, Giuggia M, Cecchi E, Gaschino G, Demarie D, Ghisio A, Trinchero R |title=Day-hospital treatment of acute pericarditis: a management program for outpatient therapy |journal=J. Am. Coll. Cardiol. |volume=43 |issue=6 |pages=1042–6 |date=March 2004 |pmid=15028364 |doi=10.1016/j.jacc.2003.09.055 |url=}}</ref><ref name="pmid15001332">{{cite journal |vauthors=Troughton RW, Asher CR, Klein AL |title=Pericarditis |journal=Lancet |volume=363 |issue=9410 |pages=717–27 |date=February 2004 |pmid=15001332 |doi=10.1016/S0140-6736(04)15648-1 |url=}}</ref><ref name="pmid12622586">{{cite journal |vauthors=Spodick DH |title=Acute pericarditis: current concepts and practice |journal=JAMA |volume=289 |issue=9 |pages=1150–3 |date=March 2003 |pmid=12622586 |doi= |url=}}</ref>
 | style="background: #F5F5F5; padding: 5px;" |[[Acute]] or [[subacute]]
@@ Line 305: / Line 135: @@
 | style="background: #F5F5F5; padding: 5px;" |
 *[[Endomyocardial biopsy]]
-|- style="background: #DCDCDC; padding: 5px;" |
-![[Hypertrophic cardiomyopathy]]<ref name="pmid8809524">{{cite journal |vauthors=Elliott PM, Kaski JC, Prasad K, Seo H, Slade AK, Goldman JH, McKenna WJ |title=Chest pain during daily life in patients with hypertrophic cardiomyopathy: an ambulatory electrocardiographic study |journal=Eur. Heart J. |volume=17 |issue=7 |pages=1056–64 |date=July 1996 |pmid=8809524 |doi= |url=}}</ref><ref name="pmid7199403">{{cite journal |vauthors=Pasternac A, Noble J, Streulens Y, Elie R, Henschke C, Bourassa MG |title=Pathophysiology of chest pain in patients with cardiomyopathies and normal coronary arteries |journal=Circulation |volume=65 |issue=4 |pages=778–89 |date=April 1982 |pmid=7199403 |doi= |url=}}</ref><ref name="pmid2295747">{{cite journal |vauthors=Webb JG, Sasson Z, Rakowski H, Liu P, Wigle ED |title=Apical hypertrophic cardiomyopathy: clinical follow-up and diagnostic correlates |journal=J. Am. Coll. Cardiol. |volume=15 |issue=1 |pages=83–90 |date=January 1990 |pmid=2295747 |doi= |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |[[Acute]] or [[subacute]]
-| style="background: #F5F5F5; padding: 5px;" |Variable
-| style="background: #F5F5F5; padding: 5px;" |Typical or atypical chest pain
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*[[HF]]
-*[[Arrhythmias]]
-*[[Syncope]]
-*Acute hemodynamic collapse
-| style="background: #F5F5F5; padding: 5px;" |
-* Positive family history of sudden cardiac death
-* [[Genetic mutation]]
-| style="background: #F5F5F5; padding: 5px;" |
-* [[S4]]
-* [[Systolic murmurs]]
-* LV apical impulse
-* Brisk [[carotid pulse]]
-* ↑ [[JVP]]
-* A [[parasternal lift]]
-| style="background: #F5F5F5; padding: 5px;" |Non-specific
-| style="background: #F5F5F5; padding: 5px;" |
-* Prominent abnormal [[Q waves]]
-* [[P wave]] abnormalities
-* [[Left axis deviation]]
-* Deeply inverted [[T waves]]
-| style="background: #F5F5F5; padding: 5px;" |
-[[Echocardiography]]:
-* [[LV hypertrophy]]
-* Systolic anterior motion of the [[mitral valve]],
-* [[LVOT obstruction]]
-*[[Cardiac catheterization]]
-**Pressure gradient
-**Augmentation of the gradient
-**[[Aortic pressure]]
-**[[Left ventricular]] pressure
-**Left [[atrial]] or [[pulmonary]] [[capillary wedge pressure]]
-*[[Coronary angiography]]
-**Obstructive [[epicardial]] [[coronary artery disease]]
-**[[Genetic testing]] for [[HCM]]: [[Sarcomere]] [[mutation]] in an athlete with a maximal LV wall thickness in the "grey zone"
-| style="background: #F5F5F5; padding: 5px;" |[[Genetic testing]] for HCM
-|- style="background: #DCDCDC; padding: 5px;" |
-![[Stress cardiomyopathy|Stress (takotsubo)]]
-[[Stress cardiomyopathy|Cardiomyopathy]]<ref name="pmid15687136">{{cite journal |vauthors=Sharkey SW, Lesser JR, Zenovich AG, Maron MS, Lindberg J, Longe TF, Maron BJ |title=Acute and reversible cardiomyopathy provoked by stress in women from the United States |journal=Circulation |volume=111 |issue=4 |pages=472–9 |date=February 2005 |pmid=15687136 |doi=10.1161/01.CIR.0000153801.51470.EB |url=}}</ref><ref name="pmid26159108">{{cite journal |vauthors=Krishnamoorthy P, Garg J, Sharma A, Palaniswamy C, Shah N, Lanier G, Patel NC, Lavie CJ, Ahmad H |title=Gender Differences and Predictors of Mortality in Takotsubo Cardiomyopathy: Analysis from the National Inpatient Sample 2009-2010 Database |journal=Cardiology |volume=132 |issue=2 |pages=131–136 |date=July 2015 |pmid=26159108 |doi=10.1159/000430782 |url=}}</ref><ref name="pmid26332547">{{cite journal |vauthors=Templin C, Ghadri JR, Diekmann J, Napp LC, Bataiosu DR, Jaguszewski M, Cammann VL, Sarcon A, Geyer V, Neumann CA, Seifert B, Hellermann J, Schwyzer M, Eisenhardt K, Jenewein J, Franke J, Katus HA, Burgdorf C, Schunkert H, Moeller C, Thiele H, Bauersachs J, Tschöpe C, Schultheiss HP, Laney CA, Rajan L, Michels G, Pfister R, Ukena C, Böhm M, Erbel R, Cuneo A, Kuck KH, Jacobshagen C, Hasenfuss G, Karakas M, Koenig W, Rottbauer W, Said SM, Braun-Dullaeus RC, Cuculi F, Banning A, Fischer TA, Vasankari T, Airaksinen KE, Fijalkowski M, Rynkiewicz A, Pawlak M, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Crea F, Dichtl W, Franz WM, Empen K, Felix SB, Delmas C, Lairez O, Erne P, Bax JJ, Ford I, Ruschitzka F, Prasad A, Lüscher TF |title=Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy |journal=N. Engl. J. Med. |volume=373 |issue=10 |pages=929–38 |date=September 2015 |pmid=26332547 |doi=10.1056/NEJMoa1406761 |url=}}</ref><ref name="pmid15583228">{{cite journal |vauthors=Bybee KA, Kara T, Prasad A, Lerman A, Barsness GW, Wright RS, Rihal CS |title=Systematic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction |journal=Ann. Intern. Med. |volume=141 |issue=11 |pages=858–65 |date=December 2004 |pmid=15583228 |doi= |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |[[Acute]]
-| style="background: #F5F5F5; padding: 5px;" |Commonly > 20 minutes
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Substernal]] heaviness or tightness
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*Setting of physical or emotional stress or critical illness
-| style="background: #F5F5F5; padding: 5px;" |Stress
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Murmurs]] and [[rales]] may be present on [[auscultation]] in the setting of [[Pulmonary edema|acute pulmonary edema]]
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Catecholamines|Catecholamines transiently elevated]]
-*↑TnT level
-*↑[[Brain natriuretic peptide|BNP level]]
-| style="background: #F5F5F5; padding: 5px;" |
-*[[ST segment elevation]]
-*[[ST depression]]
-*[[QT interval prolongation]], [[T wave inversion]], abnormal [[Q waves]]
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Radionuclide]] [[myocardial perfusion]] imaging: Transient perfusion abnormalities in the left ventricular apex
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Ventriculography]] and [[invasive coronary angiography]]
-|- style="background: #DCDCDC; padding: 5px;" |
-!'''[[Aortic Stenosis]]'''<ref name="pmid3984868">{{cite journal |vauthors=Green SJ, Pizzarello RA, Padmanabhan VT, Ong LY, Hall MH, Tortolani AJ |title=Relation of angina pectoris to coronary artery disease in aortic valve stenosis |journal=Am. J. Cardiol. |volume=55 |issue=8 |pages=1063–5 |date=April 1985 |pmid=3984868 |doi= |url=}}</ref><ref name="pmid16352020">{{cite journal |vauthors=Silaruks S, Clark D, Thinkhamrop B, Sia B, Buxton B, Tonkin A |title=Angina pectoris and coronary artery disease in severe isolated valvular aortic stenosis |journal=Heart Lung Circ |volume=10 |issue=1 |pages=14–23 |date=2001 |pmid=16352020 |doi=10.1046/j.1444-2892.2001.00060.x |url=}}</ref><ref name="pmid9924164">{{cite journal |vauthors=Munt B, Legget ME, Kraft CD, Miyake-Hull CY, Fujioka M, Otto CM |title=Physical examination in valvular aortic stenosis: correlation with stenosis severity and prediction of clinical outcome |journal=Am. Heart J. |volume=137 |issue=2 |pages=298–306 |date=February 1999 |pmid=9924164 |doi=10.1053/hj.1999.v137.95496 |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |[[Acute]], recurrent episodes of [[angina]]
-| style="background: #F5F5F5; padding: 5px;" |2-10 minutes
-| style="background: #F5F5F5; padding: 5px;" |
-*Heaviness/pressure/ tightness/squeezing/ burning ([[Levine's sign]])
-*[[Retrosternal]]
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Dyspnea]] and decreased exercise tolerance
-*[[Dizziness]] and [[syncope]]
-*[[Angina pectoris]]
-| style="background: #F5F5F5; padding: 5px;" |
-*[[HTN]]
-* Old age
-| style="background: #F5F5F5; padding: 5px;" |
-*[[S2]] is soft, single and [[Paradoxical splitting of S2|paradoxically split]]
-*[[A2]] delayed and tends to occur simultaneously with [[P2]]
-*[[Aortic]] [[Ejection murmur|ejection]] click
-*[[Fourth heart sound|Fourth heart sound (S4)]] can also be heard
-*Crescendo–decrescendo [[Heart murmur|murmur]]
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Schistiocytes]] on [[peripheral blood smear]]
-| style="background: #F5F5F5; padding: 5px;" |
-*Non specific (the voltage of the [[QRS complex]] is increased showing the presence of [[left ventricular hypertrophy]])
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Echocardiography]]: [[aortic leaflets]] thickened and calcified, ↑ [[pulmonary artery pressure]])
-*CMR: [[Myocardial fibrosis]], evaluation of [[aortic]] anatomy and size
-*MDCT: Degree of [[aortic valve]] calcification
-*PET: Measures active [[mineralization]] which correlates with [[stenosis]] severity
-| style="background: #F5F5F5; padding: 5px;" |
-**[[Echocardiography]]
 |- style="background: #DCDCDC; padding: 5px;" |
 ![[Heart Failure]]<ref name="pmid12163209">{{cite journal |vauthors=Anker SD, Sharma R |title=The syndrome of cardiac cachexia |journal=Int. J. Cardiol. |volume=85 |issue=1 |pages=51–66 |date=September 2002 |pmid=12163209 |doi= |url=}}</ref><ref name="pmid18440336">{{cite journal |vauthors=Horwich TB, Kalantar-Zadeh K, MacLellan RW, Fonarow GC |title=Albumin levels predict survival in patients with systolic heart failure |journal=Am. Heart J. |volume=155 |issue=5 |pages=883–9 |date=May 2008 |pmid=18440336 |doi=10.1016/j.ahj.2007.11.043 |url=}}</ref><ref name="pmid27656000">{{cite journal |vauthors=Breathett K, Allen LA, Udelson J, Davis G, Bristow M |title=Changes in Left Ventricular Ejection Fraction Predict Survival and Hospitalization in Heart Failure With Reduced Ejection Fraction |journal=Circ Heart Fail |volume=9 |issue=10 |pages= |date=October 2016 |pmid=27656000 |pmc=5082710 |doi=10.1161/CIRCHEARTFAILURE.115.002962 |url=}}</ref>
@@ Line 423: / Line 143: @@
 *Left sided chest pain
 | style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | +/-
 | style="background: #F5F5F5; padding: 5px;" | +
 | style="background: #F5F5F5; padding: 5px;" | +
@@ Line 473: / Line 193: @@
 !Associated Features
 |- style="background: #DCDCDC; padding: 5px;" |
-! rowspan="12" |Pulmonary
+! rowspan="8" |Pulmonary
 !'''[[Pulmonary Embolism]]'''<ref name="pmid17904458">{{cite journal |vauthors=Stein PD, Beemath A, Matta F, Weg JG, Yusen RD, Hales CA, Hull RD, Leeper KV, Sostman HD, Tapson VF, Buckley JD, Gottschalk A, Goodman LR, Wakefied TW, Woodard PK |title=Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II |journal=Am. J. Med. |volume=120 |issue=10 |pages=871–9 |date=October 2007 |pmid=17904458 |pmc=2071924 |doi=10.1016/j.amjmed.2007.03.024 |url=}}</ref><ref name="pmid2332918">{{cite journal |vauthors= |title=Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED) |journal=JAMA |volume=263 |issue=20 |pages=2753–9 |date=1990 |pmid=2332918 |doi= |url=}}</ref>
 | style="background: #F5F5F5; padding: 5px;" |[[Acute]]
@@ Line 520: / Line 240: @@
 | style="background: #F5F5F5; padding: 5px;" |
 *[[CT pulmonary angiography]]
-|- style="background: #DCDCDC; padding: 5px;" |
-!'''[[Pneumothorax|Spontaneous Pneumothorax]]'''<ref name="pmid3678419">{{cite journal |vauthors=Bense L, Wiman LG, Hedenstierna G |title=Onset of symptoms in spontaneous pneumothorax: correlations to physical activity |journal=Eur J Respir Dis |volume=71 |issue=3 |pages=181–6 |date=September 1987 |pmid=3678419 |doi= |url=}}</ref><ref name="pmid8553937">{{cite journal |vauthors=Seow A, Kazerooni EA, Pernicano PG, Neary M |title=Comparison of upright inspiratory and expiratory chest radiographs for detecting pneumothoraces |journal=AJR Am J Roentgenol |volume=166 |issue=2 |pages=313–6 |date=February 1996 |pmid=8553937 |doi=10.2214/ajr.166.2.8553937 |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |[[Acute]]
-| style="background: #F5F5F5; padding: 5px;" |May last minutes to hours
-| style="background: #F5F5F5; padding: 5px;" |
-*Sharp
-*Localized [[pleuritic]]
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Respiratory distress]]
-*[[Tachypnea]]
-*Asymmetric lung expansion
-*Hyperresonance on [[percussion]]
-*Decreased [[tactile fremitus]]
-*[[Tachycardia]]
-*Cardiac [[apical displacement]]
-| style="background: #F5F5F5; padding: 5px;" |
-* Smoking
-* Positive family history
-* [[Marfan syndrome]]
-* [[Homocystinuria]]
-* [[Thoracic]] [[endometriosis]].
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Decreased breath sounds]] on involved side
-*[[Respiratory sounds|Lung sounds]] transmitted from the unaffected [[hemithorax]] are minimal with [[auscultation]] at the [[midaxillary]] line
-*Adventitious lung sounds ([[crackles]], [[wheeze]]; an ipsilateral finding)
-*[[Pulsus paradoxus]]
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Respiratory alkalosis]] on [[Arterial blood gases|ABGs]]
-| style="background: #F5F5F5; padding: 5px;" |
-*Rightward shift in the mean electrical axis
-*Loss of [[precordial]] R waves
-*Diminution of the QRS voltage
-*Precordial T wave inversions
-| style="background: #F5F5F5; padding: 5px;" |
-*[[CXR]]: White [[visceral]] pleural line on the chest radiograph
-*[[CT]]: small amounts of [[intrapleural]] gas, atypical collections of [[pleural]] gas, and loculated pneumothoraces
-| style="background: #F5F5F5; padding: 5px;" |
-*CT scan
-|-
-!style="background: #DCDCDC; padding: 5px;" |[[Tension Pneumothorax]]<ref name="pmid8820023">{{cite journal |vauthors=Stark P, Leung A |title=Effects of lobar atelectasis on the distribution of pleural effusion and pneumothorax |journal=J Thorac Imaging |volume=11 |issue=2 |pages=145–9 |date=1996 |pmid=8820023 |doi= |url=}}</ref><ref name="pmid23179505">{{cite journal |vauthors=Jalli R, Sefidbakht S, Jafari SH |title=Value of ultrasound in diagnosis of pneumothorax: a prospective study |journal=Emerg Radiol |volume=20 |issue=2 |pages=131–4 |date=April 2013 |pmid=23179505 |doi=10.1007/s10140-012-1091-7 |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |[[Acute]]
-| style="background: #F5F5F5; padding: 5px;" |May last minutes to hours
-| style="background: #F5F5F5; padding: 5px;" |
-*Sharp
-*[[Pleuritic]]
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Hypotension]]
-*[[Jugular venous distention]]
-*[[Respiratory distress]]
-| style="background: #F5F5F5; padding: 5px;" |
-*Trauma
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Decreased breath sounds]] on involved side
-*[[Respiratory sounds|Lung sounds]] transmitted from the unaffected [[hemithorax]] are minimal with [[auscultation]] at the [[midaxillary]] line
-*Adventitious [[Respiratory sounds|lung sounds]] ([[crackles]], [[wheeze]]; an [[ipsilateral]] finding)
-*[[Pulsus paradoxus]]
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Arterial blood gases|Respiratory alkalosis on ABGs]]
-| style="background: #F5F5F5; padding: 5px;" |
-*Significant elevation of the ST-T segment from leads V1 to V4
-| style="background: #F5F5F5; padding: 5px;" |
-*[[CXR]]: A distinct shift of the [[mediastinum]] to the [[contralateral]] side, collapse of the [[ipsilateral]] lung, and flattening or inversion of the [[ipsilateral]] [[hemidiaphragm]]
-| style="background: #F5F5F5; padding: 5px;" |
-*[[CT scan]]
 |- style="background: #DCDCDC; padding: 5px;" |
 ![[Pneumonia]]<ref name="pmid14683661">{{cite journal |vauthors=File TM |title=Community-acquired pneumonia |journal=Lancet |volume=362 |issue=9400 |pages=1991–2001 |date=December 2003 |pmid=14683661 |doi=10.1016/S0140-6736(03)15021-0 |url=}}</ref><ref name="pmid17278083">{{cite journal |vauthors=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG |title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults |journal=Clin. Infect. Dis. |volume=44 Suppl 2 |issue= |pages=S27–72 |date=March 2007 |pmid=17278083 |doi=10.1086/511159 |url=}}</ref><ref name="pmid25337751">{{cite journal |vauthors=Musher DM, Thorner AR |title=Community-acquired pneumonia |journal=N. Engl. J. Med. |volume=371 |issue=17 |pages=1619–28 |date=October 2014 |pmid=25337751 |doi=10.1056/NEJMra1312885 |url=}}</ref>
@@ Line 703: / Line 351: @@
 | style="background: #F5F5F5; padding: 5px;" |
 *[[CXR]]
-|- style="background: #DCDCDC; padding: 5px;" |
-!'''[[Pulmonary Hypertension]]'''<ref name="pmid15006585">{{cite journal |vauthors=Mesquita SM, Castro CR, Ikari NM, Oliveira SA, Lopes AA |title=Likelihood of left main coronary artery compression based on pulmonary trunk diameter in patients with pulmonary hypertension |journal=Am. J. Med. |volume=116 |issue=6 |pages=369–74 |date=March 2004 |pmid=15006585 |doi=10.1016/j.amjmed.2003.11.015 |url=}}</ref><ref name="pmid11591592">{{cite journal |vauthors=Rich S, McLaughlin VV, O'Neill W |title=Stenting to reverse left ventricular ischemia due to left main coronary artery compression in primary pulmonary hypertension |journal=Chest |volume=120 |issue=4 |pages=1412–5 |date=October 2001 |pmid=11591592 |doi= |url=}}</ref><ref name="pmid10190427">{{cite journal |vauthors=Kawut SM, Silvestry FE, Ferrari VA, DeNofrio D, Axel L, Loh E, Palevsky HI |title=Extrinsic compression of the left main coronary artery by the pulmonary artery in patients with long-standing pulmonary hypertension |journal=Am. J. Cardiol. |volume=83 |issue=6 |pages=984–6, A10 |date=March 1999 |pmid=10190427 |doi= |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |[[Acute]] or [[subacute]] or [[chronic]]
-| style="background: #F5F5F5; padding: 5px;" |Variable
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Substernal]] pressure like
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Dyspnea]]
-*Symptoms of [[right heart failure]] ([[edema]])
-*Past history of [[heart murmur]]
-*[[Deep venous thrombosis|Deep venous thrombosis (DVT)]]
-*[[Arthritis]] or [[Arthralgia|arthralgias]]
-*[[Rash]]
-| style="background: #F5F5F5; padding: 5px;" |
-* Smoking
-* [[HF]]
-* Heavy [[snoring]]
-* [[Morbid obesity]]
-| style="background: #F5F5F5; padding: 5px;" |
-*The intensity of the [[P2|pulmonic component of the second heart sound (P2]]) may be increased and the [[P2]] may demonstrate fixed or paradoxical [[splitting]].
-*[[Systolic ejection murmur]]
-*A [[S4|right-sided fourth heart sound (S4)]] with a left [[parasternal heave]]
-| style="background: #F5F5F5; padding: 5px;" |
-*Abnormal [[Arterial blood gases|Arterial blood gas]]
-*[[Antinuclear antibody|Antinuclear antibody (ANA) levels]]
-*[[Anti-neutrophil cytoplasmic antibody|Antineutrophil cytoplasmic antibody (ANCA)]]
-*[[Brain natriuretic peptide|Brain natriuretic peptide (BNP of NT-proBNP)]]
-*[[HIV testing]]
-*[[Iron deficiency]]
-*[[PFTs|Pulmonary Function Testing]]
-*[[Polysomnography]]
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Right axis deviation]]
-*An R wave/S wave ratio greater than one in lead V1
-*Incomplete or complete [[right bundle branch block]]
-*Increased P wave amplitude in lead II (P pulmonale) due to right [[atrial enlargement]]
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Chest Radiography]]: [[Oligemic]] lung fields
-*[[Echocardiography]]:  [[PASP]] is >50 and the TRV is >3.4
-*[[Ventilation-Perfusion (V/Q) Lung Scanning]]: Abnormal
-*Right-sided [[cardiac catheterization]]: Mean [[PCWP]] >15 mmHg,
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Cardiac catheterization]]
 |- style="background: #DCDCDC; padding: 5px;" |
 ![[Pleural Effusion]]<ref name="pmid3757561">{{cite journal |vauthors=Feinsilver SH, Barrows AA, Braman SS |title=Fiberoptic bronchoscopy and pleural effusion of unknown origin |journal=Chest |volume=90 |issue=4 |pages=516–9 |date=October 1986 |pmid=3757561 |doi= |url=}}</ref><ref name="pmid3581930">{{cite journal |vauthors=Collins TR, Sahn SA |title=Thoracocentesis. Clinical value, complications, technical problems, and patient experience |journal=Chest |volume=91 |issue=6 |pages=817–22 |date=June 1987 |pmid=3581930 |doi= |url=}}</ref><ref name="pmid15753638">{{cite journal |vauthors=Venekamp LN, Velkeniers B, Noppen M |title=Does 'idiopathic pleuritis' exist? Natural history of non-specific pleuritis diagnosed after thoracoscopy |journal=Respiration |volume=72 |issue=1 |pages=74–8 |date=2005 |pmid=15753638 |doi=10.1159/000083404 |url=}}</ref>
@@ Line 863: / Line 464: @@
 | style="background: #F5F5F5; padding: 5px;" |
 *[[Bronchoscopy]]
-|- style="background: #DCDCDC; padding: 5px;" |
-![[Sarcoidosis]]<ref name="pmid26727158">{{cite journal |vauthors=Ungprasert P, Carmona EM, Utz JP, Ryu JH, Crowson CS, Matteson EL |title=Epidemiology of Sarcoidosis 1946-2013: A Population-Based Study |journal=Mayo Clin. Proc. |volume=91 |issue=2 |pages=183–8 |date=February 2016 |pmid=26727158 |pmc=4744129 |doi=10.1016/j.mayocp.2015.10.024 |url=}}</ref><ref name="pmid11734441">{{cite journal |vauthors=Baughman RP, Teirstein AS, Judson MA, Rossman MD, Yeager H, Bresnitz EA, DePalo L, Hunninghake G, Iannuzzi MC, Johns CJ, McLennan G, Moller DR, Newman LS, Rabin DL, Rose C, Rybicki B, Weinberger SE, Terrin ML, Knatterud GL, Cherniak R |title=Clinical characteristics of patients in a case control study of sarcoidosis |journal=Am. J. Respir. Crit. Care Med. |volume=164 |issue=10 Pt 1 |pages=1885–9 |date=November 2001 |pmid=11734441 |doi=10.1164/ajrccm.164.10.2104046 |url=}}</ref><ref name="pmid15753626">{{cite journal |vauthors=Rizzato G, Tinelli C |title=Unusual presentation of sarcoidosis |journal=Respiration |volume=72 |issue=1 |pages=3–6 |date=2005 |pmid=15753626 |doi=10.1159/000083392 |url=}}</ref><ref name="pmid15281433">{{cite journal |vauthors=Rizzato G, Palmieri G, Agrati AM, Zanussi C |title=The organ-specific extrapulmonary presentation of sarcoidosis: a frequent occurrence but a challenge to an early diagnosis. A 3-year-long prospective observational study |journal=Sarcoidosis Vasc Diffuse Lung Dis |volume=21 |issue=2 |pages=119–26 |date=June 2004 |pmid=15281433 |doi= |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |Chronic
-| style="background: #F5F5F5; padding: 5px;" |Days to week
-| style="background: #F5F5F5; padding: 5px;" |
-*Chest fullness
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Löfgren syndrome]] ([[fever]], bilateral hilar [[lymphadenopathy]] (BHL), and [[Polyarthralgia|polyarthralgias]])
-*[[Uveitis]]
-*[[Heart block]]
-*[[Lymphocytic]] [[meningitis]]
-*[[Diabetes insipidus]]
-*[[Fatigue]]
-*[[Hypercalciuria]]
-| style="background: #F5F5F5; padding: 5px;" |
-* Black population
-* [[Autoimmune]] diseases
-| style="background: #F5F5F5; padding: 5px;" |
-*Diminished respiratory sounds
-| style="background: #F5F5F5; padding: 5px;" |
-*↑ [[ACE level]], [[adenosine deaminase]], SAA, sIL2R
-*[[Hypercalciuria]]
-*Elevated [[1,25-dihydroxyvitamin D]] levels
-| style="background: #F5F5F5; padding: 5px;" |
-*[[AV block]]
-*Prolongation of the [[PR interval]] (first-degree AV block)
-*[[Ventricular arrhythmias]] (sustained or nonsustained [[ventricular tachycardia]] and ventricular premature beats [VPBs])
-*[[Supraventricular arrhythmias]]
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Chest radiograph]]: [[Bilateral hilar adenopathy]]
-*High-resolution CT (HRCT) scanning of the chest: [[Ground glass]] opacification, Hilar and [[mediastinal lymphadenopathy]],    [[Bronchial]] wall thickening
-| style="background: #F5F5F5; padding: 5px;" |
-*Lung [[Biopsy]]
 |- style="background: #DCDCDC; padding: 5px;" |
 ![[Acute chest syndrome]] ([[Sickle cell anemia|Sickle cell anemia)]]<ref name="pmid9057664">{{cite journal |vauthors=Vichinsky EP, Styles LA, Colangelo LH, Wright EC, Castro O, Nickerson B |title=Acute chest syndrome in sickle cell disease: clinical presentation and course. Cooperative Study of Sickle Cell Disease |journal=Blood |volume=89 |issue=5 |pages=1787–92 |date=March 1997 |pmid=9057664 |doi= |url=}}</ref><ref name="pmid7517723">{{cite journal |vauthors=Castro O, Brambilla DJ, Thorington B, Reindorf CA, Scott RB, Gillette P, Vera JC, Levy PS |title=The acute chest syndrome in sickle cell disease: incidence and risk factors. The Cooperative Study of Sickle Cell Disease |journal=Blood |volume=84 |issue=2 |pages=643–9 |date=July 1994 |pmid=7517723 |doi= |url=}}</ref><ref name="pmid10861320">{{cite journal |vauthors=Vichinsky EP, Neumayr LD, Earles AN, Williams R, Lennette ET, Dean D, Nickerson B, Orringer E, McKie V, Bellevue R, Daeschner C, Manci EA |title=Causes and outcomes of the acute chest syndrome in sickle cell disease. National Acute Chest Syndrome Study Group |journal=N. Engl. J. Med. |volume=342 |issue=25 |pages=1855–65 |date=June 2000 |pmid=10861320 |doi=10.1056/NEJM200006223422502 |url=}}</ref>
@@ Line 954: / Line 518: @@
 !Associated Features
 |- style="background: #DCDCDC; padding: 5px;" |
-| rowspan="9" |Gastrointestinal
+| rowspan="5" |Gastrointestinal
-!'''[[GERD]], [[Peptic Ulcer]]'''<ref name="pmid16928254">{{cite journal |vauthors=Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R |title=The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus |journal=Am. J. Gastroenterol. |volume=101 |issue=8 |pages=1900–20; quiz 1943 |date=August 2006 |pmid=16928254 |doi=10.1111/j.1572-0241.2006.00630.x |url=}}</ref><ref name="pmid15290658">{{cite journal |vauthors=Vakil NB, Traxler B, Levine D |title=Dysphagia in patients with erosive esophagitis: prevalence, severity, and response to proton pump inhibitor treatment |journal=Clin. Gastroenterol. Hepatol. |volume=2 |issue=8 |pages=665–8 |date=August 2004 |pmid=15290658 |doi= |url=}}</ref><ref name="pmid18289194">{{cite journal |vauthors=Giannini EG, Zentilin P, Dulbecco P, Vigneri S, Scarlata P, Savarino V |title=Management strategy for patients with gastroesophageal reflux disease: a comparison between empirical treatment with esomeprazole and endoscopy-oriented treatment |journal=Am. J. Gastroenterol. |volume=103 |issue=2 |pages=267–75 |date=February 2008 |pmid=18289194 |doi=10.1111/j.1572-0241.2007.01659.x |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |[[Acute (medicine)|Acute]]
-| style="background: #F5F5F5; padding: 5px;" |
-*Minutes to hours ([[Gastroesophageal reflux disease|gastroesophageal reflux]])
-*Prolonged ([[peptic ulcer]])
-*5 to 60 minutes
-| style="background: #F5F5F5; padding: 5px;" |
-*Burning
-*[[Substernal]]
-*[[Epigastric]]
-| style="background: #F5F5F5; padding: 5px;" | +/-
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +/-
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Visceral]], [[substernal]], worse with recumbency, no radiation, relief with food, antacids
-*[[Hematemesis]] or [[melena]] resulting from [[gastrointestinal bleeding]]
-*[[Dyspepsia]]
-| style="background: #F5F5F5; padding: 5px;" |
-* Prolonged [[NSAIDs]] intake
-* Smoking
-* Alcohol abuse
-* Spicy foods
-* [[H-pylori infection]]
-| style="background: #F5F5F5; padding: 5px;" |
-*Not any auscultatory findings associated with this disease
-*[[Enamel]] [[Erosion (dental)|erosion]] or other dental manifestations
-| style="background: #F5F5F5; padding: 5px;" |
-*↑Serum [[Gastrin]] Level
-*[[Secretin Stimulation Test]]
-*[[H-Pylori testing]]
-| style="background: #F5F5F5; padding: 5px;" |
-* [[EKG]] usually normal but may show [[T wave inversions]] in leads V2 through V4 consistent with [[myocardial ischemia]] in patients with [[peptic ulcer]] perforation
-| style="background: #F5F5F5; padding: 5px;" |
-*Upper [[Gastrointestinal]] [[Endoscopy]]: [[Biopsy]]
-*[[Esophageal Manometry]]: To exclude an esophageal motility disorder
-*Esophageal impedance pH testing: Monitors esophageal [[pH]]
-| style="background: #F5F5F5; padding: 5px;" |
-*Upper [[Gastrointestinal]] [[Endoscopy]]
-|- style="background: #DCDCDC; padding: 5px;" |
-!'''[[Diffuse Esophageal Spasm]]'''<ref name="pmid3826958">{{cite journal |vauthors=Katz PO, Dalton CB, Richter JE, Wu WC, Castell DO |title=Esophageal testing of patients with noncardiac chest pain or dysphagia. Results of three years' experience with 1161 patients |journal=Ann. Intern. Med. |volume=106 |issue=4 |pages=593–7 |date=April 1987 |pmid=3826958 |doi= |url=}}</ref><ref name="pmid20179690">{{cite journal |vauthors=Kahrilas PJ |title=Esophageal motor disorders in terms of high-resolution esophageal pressure topography: what has changed? |journal=Am. J. Gastroenterol. |volume=105 |issue=5 |pages=981–7 |date=May 2010 |pmid=20179690 |pmc=2888528 |doi=10.1038/ajg.2010.43 |url=}}</ref><ref name="pmid17900331">{{cite journal |vauthors=Pandolfino JE, Ghosh SK, Rice J, Clarke JO, Kwiatek MA, Kahrilas PJ |title=Classifying esophageal motility by pressure topography characteristics: a study of 400 patients and 75 controls |journal=Am. J. Gastroenterol. |volume=103 |issue=1 |pages=27–37 |date=January 2008 |pmid=17900331 |doi=10.1111/j.1572-0241.2007.01532.x |url=}}</ref><ref name="pmid18364587">{{cite journal |vauthors=Kahrilas PJ, Ghosh SK, Pandolfino JE |title=Esophageal motility disorders in terms of pressure topography: the Chicago Classification |journal=J. Clin. Gastroenterol. |volume=42 |issue=5 |pages=627–35 |date=2008 |pmid=18364587 |pmc=2895002 |doi=10.1097/MCG.0b013e31815ea291 |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |[[Acute (medicine)|Acute]]
-| style="background: #F5F5F5; padding: 5px;" |
-*Minutes to hours
-*5 to 60 minutes
-| style="background: #F5F5F5; padding: 5px;" |
-*Burning
-*Pressure
-*[[Visceral]], spontaneous, [[substernal]]
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +/-
-| style="background: #F5F5F5; padding: 5px;" | +/-
-| style="background: #F5F5F5; padding: 5px;" |
-*Associated with cold liquids
-*Relief with [[nitroglycerin]]
-| style="background: #F5F5F5; padding: 5px;" | ---
-| style="background: #F5F5F5; padding: 5px;" | ---
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Barium swallow]]: Multiple areas of [[spasm]]  throughout the length of the esophagus
-*Impedance testing: Higher amplitudes and better transit of swallowed boluses
-| style="background: #F5F5F5; padding: 5px;" |
-*No ECG findings associated with DES, but ECG is done to exclude [[variant angina]] due to higher concurrent association of variant angina with DES
-| style="background: #F5F5F5; padding: 5px;" |
-*Esophageal [[Esophageal motility study|manometry]] : ≥20 percent premature contractions (distal latency <4.5 seconds)
-| style="background: #F5F5F5; padding: 5px;" |
-* [[Esophageal manometry]]
-|- style="background: #DCDCDC; padding: 5px;" |
 ![[Esophagitis]]<ref name="pmid3605035">{{cite journal |vauthors=Bott S, Prakash C, McCallum RW |title=Medication-induced esophageal injury: survey of the literature |journal=Am. J. Gastroenterol. |volume=82 |issue=8 |pages=758–63 |date=August 1987 |pmid=3605035 |doi= |url=}}</ref><ref name="pmid18763324">{{cite journal |vauthors=Parfitt JR, Jayakumar S, Driman DK |title=Mycophenolate mofetil-related gastrointestinal mucosal injury: variable injury patterns, including graft-versus-host disease-like changes |journal=Am. J. Surg. Pathol. |volume=32 |issue=9 |pages=1367–72 |date=September 2008 |pmid=18763324 |doi= |url=}}</ref><ref name="pmid10738847">{{cite journal |vauthors=Jaspersen D |title=Drug-induced oesophageal disorders: pathogenesis, incidence, prevention and management |journal=Drug Saf |volume=22 |issue=3 |pages=237–49 |date=March 2000 |pmid=10738847 |doi= |url=}}</ref>
 | style="background: #F5F5F5; padding: 5px;" |[[Acute (medicine)|Acute]]
@@ Line 1,053: / Line 549: @@
 | style="background: #F5F5F5; padding: 5px;" |
 *[[Endoscopy]]
-|- style="background: #DCDCDC; padding: 5px;" |
-![[Eosinophilic esophagitis|Eosinophilic Esophagitis]]<ref name="pmid18471509">{{cite journal |vauthors=Kapel RC, Miller JK, Torres C, Aksoy S, Lash R, Katzka DA |title=Eosinophilic esophagitis: a prevalent disease in the United States that affects all age groups |journal=Gastroenterology |volume=134 |issue=5 |pages=1316–21 |date=May 2008 |pmid=18471509 |doi=10.1053/j.gastro.2008.02.016 |url=}}</ref><ref name="pmid12612531">{{cite journal |vauthors=Straumann A, Rossi L, Simon HU, Heer P, Spichtin HP, Beglinger C |title=Fragility of the esophageal mucosa: a pathognomonic endoscopic sign of primary eosinophilic esophagitis? |journal=Gastrointest. Endosc. |volume=57 |issue=3 |pages=407–12 |date=March 2003 |pmid=12612531 |doi=10.1067/mge.2003.123 |url=}}</ref><ref name="pmid18407800">{{cite journal |vauthors=Straumann A, Bussmann C, Zuber M, Vannini S, Simon HU, Schoepfer A |title=Eosinophilic esophagitis: analysis of food impaction and perforation in 251 adolescent and adult patients |journal=Clin. Gastroenterol. Hepatol. |volume=6 |issue=5 |pages=598–600 |date=May 2008 |pmid=18407800 |doi=10.1016/j.cgh.2008.02.003 |url=}}</ref><ref name="pmid19577011">{{cite journal |vauthors=Prasad GA, Alexander JA, Schleck CD, Zinsmeister AR, Smyrk TC, Elias RM, Locke GR, Talley NJ |title=Epidemiology of eosinophilic esophagitis over three decades in Olmsted County, Minnesota |journal=Clin. Gastroenterol. Hepatol. |volume=7 |issue=10 |pages=1055–61 |date=October 2009 |pmid=19577011 |pmc=3026355 |doi=10.1016/j.cgh.2009.06.023 |url=}}</ref><ref name="pmid17764492">{{cite journal |vauthors=Prasad GA, Talley NJ, Romero Y, Arora AS, Kryzer LA, Smyrk TC, Alexander JA |title=Prevalence and predictive factors of eosinophilic esophagitis in patients presenting with dysphagia: a prospective study |journal=Am. J. Gastroenterol. |volume=102 |issue=12 |pages=2627–32 |date=December 2007 |pmid=17764492 |doi=10.1111/j.1572-0241.2007.01512.x |url=}}</ref><ref name="pmid15933677">{{cite journal |vauthors=Desai TK, Stecevic V, Chang CH, Goldstein NS, Badizadegan K, Furuta GT |title=Association of eosinophilic inflammation with esophageal food impaction in adults |journal=Gastrointest. Endosc. |volume=61 |issue=7 |pages=795–801 |date=June 2005 |pmid=15933677 |doi= |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |[[Chronic (medical)|Chronic]]
-| style="background: #F5F5F5; padding: 5px;" |Variable
-| style="background: #F5F5F5; padding: 5px;" |
-*Burning
-*[[Retrosternal]]
-*Abdominal
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-* [[Dysphagia]]
-* Food impaction
-* [[GERD]]
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Allergy|Allergic]] [[Disease|diseases]]
-*[[Asthma]]
-*[[Rinitis]]
-*[[Eczema]]
-| style="background: #F5F5F5; padding: 5px;" |
-*No auscultatory finding in the this [[disease]]
-| style="background: #F5F5F5; padding: 5px;" |
-*Elevated [[IgE]] (>114,000 units/L)
-*Elevated peripheral [[eosinophils]]
-| style="background: #F5F5F5; padding: 5px;" |
-*Typically no finding on EKG
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Barium studies]]: [[Strictures]] and a ringed esophagus
-*[[Endoscopy]]: Stacked circular rings ("feline" esophagus)  ●[[Strictures]]   ●Linear furrows   ●Whitish papules
-*[[Esophageal biopsy]]: More than 15 [[Eosinophil granulocyte|eosinophils]] per high-power field
-| style="background: #F5F5F5; padding: 5px;" |
-*Esophageal [[biopsy]]
 |- style="background: #DCDCDC; padding: 5px;" |
 ![[Esophageal perforation|Esophageal Perforation]]<ref name="pmid2730190">{{cite journal |vauthors=Pate JW, Walker WA, Cole FH, Owen EW, Johnson WH |title=Spontaneous rupture of the esophagus: a 30-year experience |journal=Ann. Thorac. Surg. |volume=47 |issue=5 |pages=689–92 |date=May 1989 |pmid=2730190 |doi= |url=}}</ref>
@@ Line 1,236: / Line 698: @@
 *CT Scan
 |- style="background: #DCDCDC; padding: 5px;" |
-![[Hiatal Hernia|Sliding Hiatal Hernia]]<ref name="pmid8899401">{{cite journal |vauthors=Weston AP |title=Hiatal hernia with cameron ulcers and erosions |journal=Gastrointest. Endosc. Clin. N. Am. |volume=6 |issue=4 |pages=671–9 |date=October 1996 |pmid=8899401 |doi= |url=}}</ref><ref name="pmid16472589">{{cite journal |vauthors=Bredenoord AJ, Weusten BL, Timmer R, Smout AJ |title=Intermittent spatial separation of diaphragm and lower esophageal sphincter favors acidic and weakly acidic reflux |journal=Gastroenterology |volume=130 |issue=2 |pages=334–40 |date=February 2006 |pmid=16472589 |doi=10.1053/j.gastro.2005.10.053 |url=}}</ref><ref name="pmid18656819">{{cite journal |vauthors=Kahrilas PJ, Kim HC, Pandolfino JE |title=Approaches to the diagnosis and grading of hiatal hernia |journal=Best Pract Res Clin Gastroenterol |volume=22 |issue=4 |pages=601–16 |date=2008 |pmid=18656819 |pmc=2548324 |doi=10.1016/j.bpg.2007.12.007 |url=}}</ref>
+|Musculoskeletal
-| style="background: #F5F5F5; padding: 5px;" |[[Acute (medicine)|Acute]]
-| style="background: #F5F5F5; padding: 5px;" |Variable
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Epigastric]]
-*Burning
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Obstruction]]
-*Cameron [[Ulcer|ulcers]]
-*GERD
-*Dysphagia
-| style="background: #F5F5F5; padding: 5px;" |
-* Trauma
-* Iatrogenic
-* Congenital malformation
-| style="background: #F5F5F5; padding: 5px;" |
-*Bowel sounds may be heard in the chest
-| style="background: #F5F5F5; padding: 5px;" |
-*Non specific
-| style="background: #F5F5F5; padding: 5px;" |
-*T wave inversion in anterior lead.
-| style="background: #F5F5F5; padding: 5px;" |
-*Barium swallow: At least three rugal folds traversing the diaphragm
-*Upper endoscopy: A greater than 2-cm separation between the squamocolumnar junction and the diaphragmatic impression
-*High resolution manometry: The separation of the crural diaphragm from the lower esophageal sphincter (LES) by a pressure trough
-| style="background: #F5F5F5; padding: 5px;" |
-*Upper endoscopy
-*High resolution manometry (for smaller hernias)
-|- style="background: #DCDCDC; padding: 5px;" |
-| rowspan="6" |Musculoskeletal
 ![[Costochondritis|Costosternal syndromes (costochondritis)]]<ref name="pmid1247350">{{cite journal |vauthors=Wolf E, Stern S |title=Costosternal syndrome: its frequency and importance in differential diagnosis of coronary heart disease |journal=Arch. Intern. Med. |volume=136 |issue=2 |pages=189–91 |date=February 1976 |pmid=1247350 |doi= |url=}}</ref><ref name="pmid4027804">{{cite journal |vauthors=Fam AG, Smythe HA |title=Musculoskeletal chest wall pain |journal=CMAJ |volume=133 |issue=5 |pages=379–89 |date=September 1985 |pmid=4027804 |pmc=1346531 |doi= |url=}}</ref><ref name="pmid20406787">{{cite journal |vauthors=Bösner S, Becker A, Hani MA, Keller H, Sönnichsen AC, Karatolios K, Schaefer JR, Haasenritter J, Baum E, Donner-Banzhoff N |title=Chest wall syndrome in primary care patients with chest pain: presentation, associated features and diagnosis |journal=Fam Pract |volume=27 |issue=4 |pages=363–9 |date=August 2010 |pmid=20406787 |doi=10.1093/fampra/cmq024 |url=}}</ref><ref name="pmid28593100">{{cite journal |vauthors=Zaruba RA, Wilson E |title=IMPAIRMENT BASED EXAMINATION AND TREATMENT OF COSTOCHONDRITIS: A CASE SERIES |journal=Int J Sports Phys Ther |volume=12 |issue=3 |pages=458–467 |date=June 2017 |pmid=28593100 |pmc=5455195 |doi= |url=}}</ref>
 | style="background: #F5F5F5; padding: 5px;" |Acute, subacute
@@ Line 1,293: / Line 722: @@
 *CXR: To rule out fracture
 |Pain by palpation of tender areas
-|- style="background: #DCDCDC; padding: 5px;" |
-!Lower rib pain syndromes<ref name="pmid8344569">{{cite journal |vauthors=Scott EM, Scott BB |title=Painful rib syndrome--a review of 76 cases |journal=Gut |volume=34 |issue=7 |pages=1006–8 |date=July 1993 |pmid=8344569 |pmc=1374244 |doi= |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |Chronic
-| style="background: #F5F5F5; padding: 5px;" |Variable
-| style="background: #F5F5F5; padding: 5px;" |
-*Aching
-*Lower chest
-*Upper abdomen
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*Common in women with a mean age in the mid-40s
-| style="background: #F5F5F5; padding: 5px;" | ---
-| style="background: #F5F5F5; padding: 5px;" |
-*Hooking maneuver
-*Reproduces pain by pressing a tender spot on the costal margin
-| style="background: #F5F5F5; padding: 5px;" |
-*Non specific
-*The workup is done for excluding cardiac disorders and other causes of chest pain
-| style="background: #F5F5F5; padding: 5px;" |
-*EKG is done to rule out other cardiovascular causes
-| style="background: #F5F5F5; padding: 5px;" |
-*CXR: To rule out fracture
-| style="background: #F5F5F5; padding: 5px;" | ---
-|- style="background: #DCDCDC; padding: 5px;" |
-!Sternalis syndrome
-| style="background: #F5F5F5; padding: 5px;" |Chronic
-| style="background: #F5F5F5; padding: 5px;" |Variable
-| style="background: #F5F5F5; padding: 5px;" |Pressure like pain
-*Over the body of sternum
-*Sternalis muscle
-*Left or middle side of the chest wall
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Heart|Cardiac]] diseases
-| style="background: #F5F5F5; padding: 5px;" |
-* Daily activities
-* Emotional [[distress]]
-* [[Anxiety]]
-| style="background: #F5F5F5; padding: 5px;" |
-*Localized [[tenderness]] is found directly over the body of the sternum or overlying sternalis muscle
-| style="background: #F5F5F5; padding: 5px;" |
-*No specific diagnostic test for this disease
-*The workup is done for excluding cardiac disorders and other causes of chest pain
-| style="background: #F5F5F5; padding: 5px;" |
-*EKG is done to rule out other cardiovascular causes
-| style="background: #F5F5F5; padding: 5px;" |
-*[[X-rays|X-ray]] : To rule out fracture
-| style="background: #F5F5F5; padding: 5px;" |
-*Physical exam
-|- style="background: #DCDCDC; padding: 5px;" |
-![[Tietze's syndrome]]<ref name="pmid1697801">{{cite journal |vauthors=Aeschlimann A, Kahn MF |title=Tietze's syndrome: a critical review |journal=Clin. Exp. Rheumatol. |volume=8 |issue=4 |pages=407–12 |date=1990 |pmid=1697801 |doi= |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |Acute
-| style="background: #F5F5F5; padding: 5px;" |Weeks
-| style="background: #F5F5F5; padding: 5px;" |Pressure like pain over
-*Costosternal joint
-*[[Sternoclavicular articulation|Sternoclavicular]] joint
-*[[Costochondral joint|Costochondral]] joint
-*Second and third ribs
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*Most often involve the areas of 2nd and 3rd ribs
-*More common in young adults
-*Sternocostoclavicular hyperostosis
-*Ankylosing spondylitis
-| style="background: #F5F5F5; padding: 5px;" |
-* Upper respiratory infections
-* Excessive coughing
-| style="background: #F5F5F5; padding: 5px;" |
-*Painful and localized swelling of the costosternal, [[Sternoclavicular articulation|sternoclavicular]], or [[Costochondral joint|costochondral joints]] most often involving 2nd and 3rd [[ribs]]
-| style="background: #F5F5F5; padding: 5px;" |
-*No specific diagnostic test for this disease
-*The workup is done for excluding cardiac disorders and other causes of chest pain
-| style="background: #F5F5F5; padding: 5px;" |
-*EKG is done to rule out other cardiovascular causes
-| style="background: #F5F5F5; padding: 5px;" |
-*[[X-rays|X-ray]]: To rule out fracture
-| style="background: #F5F5F5; padding: 5px;" |
-*Tests are done to rule out other diseases
-|- style="background: #DCDCDC; padding: 5px;" |
-![[Xiphoidalgia]]<ref name="pmid13266001">{{cite journal |vauthors=LIPKIN M, FULTON LA, WOLFSON EA |title=The syndrome of the hypersensitive xiphoid |journal=N. Engl. J. Med. |volume=253 |issue=14 |pages=591–7 |date=October 1955 |pmid=13266001 |doi=10.1056/NEJM195510062531403 |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |Acute
-| style="background: #F5F5F5; padding: 5px;" |Variable
-| style="background: #F5F5F5; padding: 5px;" |Pressure like pain over
-*Over the xiphoid process
-*Sternum
-*Xiphisternal joint
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*Symptoms are aggravated by twisting and bending movements
-| style="background: #F5F5F5; padding: 5px;" |
-* Cough
-* Heavy work
-| style="background: #F5F5F5; padding: 5px;" |
-*Provocative test
-| style="background: #F5F5F5; padding: 5px;" |
-*No specific diagnostic test for this disease
-*The workup is done for excluding cardiac disorders and other causes of chest pain
-| style="background: #F5F5F5; padding: 5px;" |
-*EKG is done to rule out other cardiovascular causes
-| style="background: #F5F5F5; padding: 5px;" |
-*X-ray: To rule out fracture
-| style="background: #F5F5F5; padding: 5px;" |
-*Tests are done to rule out other diseases
-|- style="background: #DCDCDC; padding: 5px;" |
-!Spontaneous [[sternoclavicular]] [[subluxation]]<ref name="pmid1458785">{{cite journal |vauthors=van Holsbeeck M, van Melkebeke J, Dequeker J, Pennes DR |title=Radiographic findings of spontaneous subluxation of the sternoclavicular joint |journal=Clin. Rheumatol. |volume=11 |issue=3 |pages=376–81 |date=September 1992 |pmid=1458785 |doi= |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |Acute, Chronic
-| style="background: #F5F5F5; padding: 5px;" |Variable
-| style="background: #F5F5F5; padding: 5px;" |Aching pain over [[Sternoclavicular articulation|Sternoclavicular joint]]
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*More common in middle age [[women]]
-*Occurs in dominant hands with repetitive tasks of heavy or moderate quality
-| style="background: #F5F5F5; padding: 5px;" |
-* Trauma
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Palpation]] of tender areas
-| style="background: #F5F5F5; padding: 5px;" |
-*No specific diagnostic test for this disease
-*The workup is done for excluding cardiac disorders and other causes of chest pain
-| style="background: #F5F5F5; padding: 5px;" |
-*EKG is done to rule out other cardiovascular causes
-| style="background: #F5F5F5; padding: 5px;" |
-*[[X-rays|X-ray]]: Sclerosis of the medial clavicle
-| style="background: #F5F5F5; padding: 5px;" |
-*X-ray
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
 ! rowspan="3" |Differentials on the basis of Etiology
@@ Line 1,456: / Line 745: @@
 !Associated Features
 |- style="background: #DCDCDC; padding: 5px;" |
-| rowspan="7" |Rheumatic
+| rowspan="4" |Rheumatic
-![[Fibromyalgia]]<ref name="pmid20380956">{{cite journal |vauthors=Almansa C, Wang B, Achem SR |title=Noncardiac chest pain and fibromyalgia |journal=Med. Clin. North Am. |volume=94 |issue=2 |pages=275–89 |date=March 2010 |pmid=20380956 |doi=10.1016/j.mcna.2010.01.002 |url=}}</ref><ref name="pmid7979843">{{cite journal |vauthors=Disla E, Rhim HR, Reddy A, Karten I, Taranta A |title=Costochondritis. A prospective analysis in an emergency department setting |journal=Arch. Intern. Med. |volume=154 |issue=21 |pages=2466–9 |date=November 1994 |pmid=7979843 |doi= |url=}}</ref><ref name="pmid1543409">{{cite journal |vauthors=Wise CM, Semble EL, Dalton CB |title=Musculoskeletal chest wall syndromes in patients with noncardiac chest pain: a study of 100 patients |journal=Arch Phys Med Rehabil |volume=73 |issue=2 |pages=147–9 |date=February 1992 |pmid=1543409 |doi= |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |[[Chronic (medical)|Chronic]]
-| style="background: #F5F5F5; padding: 5px;" |Variable
-| style="background: #F5F5F5; padding: 5px;" |
-*Raynaud phenomenon (RP)
-*Deep [[Pain|ache]] and burning pain on
-**[[Shoulder|Shoulders]]
-**Back of the [[Neck]]
-**[[Chest]]
-**Lower [[Human back|Back]]
-**[[Elbow|Elbows]]
-**[[Hip (anatomy)|Hips]]
-**Shin
-**[[Knee|Knees]]
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Somatization]]
-*[[Depression]]
-*IBS
-| style="background: #F5F5F5; padding: 5px;" | ---
-| style="background: #F5F5F5; padding: 5px;" |
-*Presence of [[tenderness]] in soft-tissue anatomic locations
-| style="background: #F5F5F5; padding: 5px;" |
-*Non specific
-*Normal [[Blood, Sweat & Tea|Blood]] and [[Urine|urine test]] (mandatory to rule out other diseases)
-| style="background: #F5F5F5; padding: 5px;" |
-*P-wave dispersions (Pd)
-| style="background: #F5F5F5; padding: 5px;" | ---
-| style="background: #F5F5F5; padding: 5px;" | ---
-|- style="background: #DCDCDC; padding: 5px;" |
 ![[Rheumatoid arthritis]]<ref name="pmid23335586">{{cite journal |vauthors=Rodríguez-Henríquez P, Solano C, Peña A, León-Hernández S, Hernández-Díaz C, Gutiérrez M, Pineda C |title=Sternoclavicular joint involvement in rheumatoid arthritis: clinical and ultrasound findings of a neglected joint |journal=Arthritis Care Res (Hoboken) |volume=65 |issue=7 |pages=1177–82 |date=July 2013 |pmid=23335586 |doi=10.1002/acr.21958 |url=}}</ref>
 | style="background: #F5F5F5; padding: 5px;" |[[Chronic (medical)|Chronic]]
@@ Line 1,528: / Line 784: @@
 *Ultrasonography: Degree of inflammation and the volume of inflamed tissue
 | style="background: #F5F5F5; padding: 5px;" | ---
-|- style="background: #DCDCDC; padding: 5px;" |
-![[Ankylosing spondylitis]]<ref name="pmid22798267">{{cite journal |vauthors=Ramonda R, Lorenzin M, Lo Nigro A, Vio S, Zucchetta P, Frallonardo P, Campana C, Oliviero F, Modesti V, Punzi L |title=Anterior chest wall involvement in early stages of spondyloarthritis: advanced diagnostic tools |journal=J. Rheumatol. |volume=39 |issue=9 |pages=1844–9 |date=September 2012 |pmid=22798267 |doi=10.3899/jrheum.120107 |url=}}</ref><ref name="pmid23678156">{{cite journal |vauthors=Wendling D, Prati C, Demattei C, Loeuille D, Richette P, Dougados M |title=Anterior chest wall pain in recent inflammatory back pain suggestive of spondyloarthritis. data from the DESIR cohort |journal=J. Rheumatol. |volume=40 |issue=7 |pages=1148–52 |date=July 2013 |pmid=23678156 |doi=10.3899/jrheum.121460 |url=}}</ref><ref name="pmid1488919">{{cite journal |vauthors=Jurik AG |title=Seronegative anterior chest wall syndromes. A study of the findings and course at radiography |journal=Acta Radiol Suppl |volume=381 |issue= |pages=1–42 |date=1992 |pmid=1488919 |doi= |url=}}</ref><ref name="pmid19604431">{{cite journal |vauthors=Guglielmi G, Cascavilla A, Scalzo G, Salaffi F, Grassi W |title=Imaging of sternocostoclavicular joint in spondyloarthropaties and other rheumatic conditions |journal=Clin. Exp. Rheumatol. |volume=27 |issue=3 |pages=402–8 |date=2009 |pmid=19604431 |doi= |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |[[Chronic (medical)|Chronic]]
-| style="background: #F5F5F5; padding: 5px;" |Years
-| style="background: #F5F5F5; padding: 5px;" |Intermittent pain in
-*[[Vertebral column|Spine]] joint
-*[[Sacroiliac joint|Sacroiliac]] joint
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*Patients with [[Human leukocyte antigen|HLA]]-27 variant
-*Extra-articular joint involvements
-*[[Restrictive lung disease|Restrictive pulmonary disease]]
-*Acute coronary syndromes (ACS), strokes, venous thromboembolism, conduction abnormalities
-| style="background: #F5F5F5; padding: 5px;" |
-* Genetics (Monozygotic twins)
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Tenderness]] of the SI
-*Limited spinal [[Range of motion|ROM]]
-*[[Schober's test|Schober test]]
-| style="background: #F5F5F5; padding: 5px;" |
-*↑ESR
-*↑CRP
-*↑ALP
-*↑IgA
-*[[Antigen]] HLA-27 positive
-*Negative Rheumatic Factor
-| style="background: #F5F5F5; padding: 5px;" |
-*ECG is done to rule out conductions defects and aortic insufficiency
-| style="background: #F5F5F5; padding: 5px;" |
-*Plain radiography: Erosions, ankylosis, changes in joint width, or sclerosis.
-*Magnetic resonance imaging (MRI): Osteitis" or "bone marrow edema" (BME)
-| style="background: #F5F5F5; padding: 5px;" |
-*Plain films of the sacroiliac joints
-|- style="background: #DCDCDC; padding: 5px;" |
-![[Psoriatic arthritis]]<ref name="pmid1488919">{{cite journal |vauthors=Jurik AG |title=Seronegative anterior chest wall syndromes. A study of the findings and course at radiography |journal=Acta Radiol Suppl |volume=381 |issue= |pages=1–42 |date=1992 |pmid=1488919 |doi= |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |[[Chronic (medical)|Chronic]]
-| style="background: #F5F5F5; padding: 5px;" |Years
-| style="background: #F5F5F5; padding: 5px;" |Asymmetrical intermittent pain in
-*[[Interphalangeal articulations of hand|Interphalangeal joints]]
-*Nails
-*Wrist
-*[[Knee|Knees]]
-*Ankles
-*Lower [[Human back|Back]]
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Psoriasis]]
-*[[Enthesitis]]
-*[[Tenosynovitis]]
-*[[Dactylitis]]
-| style="background: #F5F5F5; padding: 5px;" |
-* Psoriasis
-* HLA-B*27 positive
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Dactylitis]] with sausage [[digits]]
-*Onycholysis
-*Pitting edema
-*Ocular involvement
-| style="background: #F5F5F5; padding: 5px;" |Non specific
-| style="background: #F5F5F5; padding: 5px;" |
-*Longer PR interval
-| style="background: #F5F5F5; padding: 5px;" |
-*X-ray: "pencil-in-cup" deformity, erosive changes and new bone formation, lysis of the terminal phalanges; fluffy periostitis
-*MRI: Detects articular, periarticular, and soft-tissue inflammation, enthesitis
-| style="background: #F5F5F5; padding: 5px;" |
-*X-ray
 |- style="background: #DCDCDC; padding: 5px;" |
 !Sternocostoclavicular [[hyperostosis]] (SAPHO syndrome)<ref name="pmid1488919">{{cite journal |vauthors=Jurik AG |title=Seronegative anterior chest wall syndromes. A study of the findings and course at radiography |journal=Acta Radiol Suppl |volume=381 |issue= |pages=1–42 |date=1992 |pmid=1488919 |doi= |url=}}</ref><ref name="pmid8484129">{{cite journal |vauthors=Saghafi M, Henderson MJ, Buchanan WW |title=Sternocostoclavicular hyperostosis |journal=Semin. Arthritis Rheum. |volume=22 |issue=4 |pages=215–23 |date=February 1993 |pmid=8484129 |doi= |url=}}</ref><ref name="pmid19772827">{{cite journal |vauthors=Magrey M, Khan MA |title=New insights into synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome |journal=Curr Rheumatol Rep |volume=11 |issue=5 |pages=329–33 |date=October 2009 |pmid=19772827 |doi= |url=}}</ref><ref name="pmid19479702">{{cite journal |vauthors=Colina M, Govoni M, Orzincolo C, Trotta F |title=Clinical and radiologic evolution of synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome: a single center study of a cohort of 71 subjects |journal=Arthritis Rheum. |volume=61 |issue=6 |pages=813–21 |date=June 2009 |pmid=19479702 |doi=10.1002/art.24540 |url=}}</ref><ref name="pmid23597971">{{cite journal |vauthors=Carneiro S, Sampaio-Barros PD |title=SAPHO syndrome |journal=Rheum. Dis. Clin. North Am. |volume=39 |issue=2 |pages=401–18 |date=May 2013 |pmid=23597971 |doi=10.1016/j.rdc.2013.02.009 |url=}}</ref>
@@ Line 1,707: / Line 891: @@
 | style="background: #F5F5F5; padding: 5px;" |
 *No gold standard test for this disease
-|- style="background: #DCDCDC; padding: 5px;" |
-|Psychiatric
-![[Panic attack]]/ Disorder<ref name="pmid10906353">{{cite journal |vauthors=Fleet RP, Martel JP, Lavoie KL, Dupuis G, Beitman BD |title=Non-fearful panic disorder: a variant of panic in medical patients? |journal=Psychosomatics |volume=41 |issue=4 |pages=311–20 |date=2000 |pmid=10906353 |doi=10.1176/appi.psy.41.4.311 |url=}}</ref><ref name="pmid7954018">{{cite journal |vauthors=Fleet RP, Dupuis G, Marchand A, Burelle D, Beitman BD |title=Panic disorder, chest pain and coronary artery disease: literature review |journal=Can J Cardiol |volume=10 |issue=8 |pages=827–34 |date=October 1994 |pmid=7954018 |doi= |url=}}</ref><ref name="pmid8068393">{{cite journal |vauthors=Simpson RJ, Kazmierczak T, Power KG, Sharp DM |title=Controlled comparison of the characteristics of patients with panic disorder |journal=Br J Gen Pract |volume=44 |issue=385 |pages=352–6 |date=August 1994 |pmid=8068393 |pmc=1238951 |doi= |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |Acute or subacute or chronic
-| style="background: #F5F5F5; padding: 5px;" |Variable
-| style="background: #F5F5F5; padding: 5px;" |Variable
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*History of [[Depression]]
-*[[Panic attack|Panic attacks]]
-*[[Agoraphobia]]
-| style="background: #F5F5F5; padding: 5px;" |
-*Psychiatric disorders
-| style="background: #F5F5F5; padding: 5px;" |
-*Anxious
-*Tachypneic
-| style="background: #F5F5F5; padding: 5px;" |
-*Thyroid function tests
-*Complete blood count
-*Chemistry panel
-| style="background: #F5F5F5; padding: 5px;" |
-*Sinus Tachycardia
-| style="background: #F5F5F5; padding: 5px;" |
-*No any specific radiographic test is done
-| style="background: #F5F5F5; padding: 5px;" | ---
 |- style="background: #DCDCDC; padding: 5px;" |
 | rowspan="2" |
@@ Line 1,798: / Line 954: @@
 *Viral tissue culture
 |}
+</small></small>
 == References ==
 {{Reflist|2}}

Chest pain and fever: Difference between revisions

Latest revision as of 22:31, 31 July 2018

References

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