Acute respiratory distress syndrome differential diagnosis: Difference between revisions

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{{Acute respiratory distress syndrome}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Acute_respiratory_distress_syndrome]]
{{CMG}}
{{CMG}}; {{AE}} {{BShaller}}


==Overview==
==Overview==
Prior to the development of the [[Acute respiratory distress syndrome#diagnostic criteria|Berlin Definition]] in 2012, a greater emphasis was placed on excluding other potential illnesses prior to making a diagnosis of ARDS. While it is important to recognize and treat and underlying cause of the patient's impaired ventilation and hypoxemia, this search for potential etiologies should not delay any efforts to improve oxygenation and ventilation.
ARDS must be differentiated from other diseases that cause [[hypoxemia]] and pulmonary infiltrates, such as [[pulmonary edema]], diffuse [[pneumonia]], [[pulmonary hemorrhage]], [[interstitial lung disease]], and [[Radiation-induced lung injury|radiation pneumonitis]].


==Differential diagnosis==
==Differentiating ARDS from Other Diseases==
Prior to the development of the [[Acute respiratory distress syndrome diagnostic criteria|Berlin definition]], a greater emphasis was placed on excluding other potential illnesses before establishing the diagnosis of ARDS. While it is important to recognize and treat and underlying cause, this search for potential etiologies should not delay any focused efforts to improve [[oxygenation]] and [[ventilation]].
 
ARDS must be differentiated from other diseases that cause [[hypoxemia]] and pulmonary infiltrates, such as:<ref>{{cite book | last = Kasper | first = Dennis | title = Harrison's principles of internal medicine | publisher = McGraw Hill Education | location = New York | year = 2015 | isbn = 978-0071802154 }}</ref>
*Infectious [[pneumonia]] (bacterial, fungal, viral, or parasitic)
*[[Aspiration pneumonia|Aspiration pneumonitis (''chemical pneumonia'')]]
*[[Eosinophilic pneumonia|Acute eosinophilic pneumonia]]
*[[Pulmonary contusion]]
*Cardiogenic [[pulmonary edema]]
*Neurogenic [[pulmonary edema]]
*[[Hypersensitivity pneumonitis]]
*[[Pulmonary hemorrhage]]
 
On chest x ray, the bilateral, non-cardiogenic pulmonary infiltrates of ARDS may appear similar to those of cardiogenic (''hydrostatic'') [[pulmonary edema]]. Therefore, it is necessary to formally assess [[cardiac function curve|cardiac function]] and [[volume status]] if ARDS is suspected but no clear precipitating insult (e.g., [[sepsis]], [[trauma]], toxic inhalation) can be identified. The preferred methods for making this assessment in the [[ICU]] are:
*[[Echocardiogram|Echocardiography]] to assess heart function
*[[Central venous catheter|Central venous catheterization]] to measure [[central venous pressure]]
*[[Swan-Ganz catheter|Pulmonary artery (Swan-Ganz) catheterization]] to measure right-sided heart pressures and [[pulmonary capillary wedge pressure]] (a surrogate of [[left atrial pressure|''left atrial pressure'']])


==References==
==References==
{{Reflist|2}}
{{reflist|2}}


[[Category:Pulmonology]]
[[Category:Pulmonology]]

Latest revision as of 22:42, 19 February 2019

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

Overview

ARDS must be differentiated from other diseases that cause hypoxemia and pulmonary infiltrates, such as pulmonary edema, diffuse pneumonia, pulmonary hemorrhage, interstitial lung disease, and radiation pneumonitis.

Differentiating ARDS from Other Diseases

Prior to the development of the Berlin definition, a greater emphasis was placed on excluding other potential illnesses before establishing the diagnosis of ARDS. While it is important to recognize and treat and underlying cause, this search for potential etiologies should not delay any focused efforts to improve oxygenation and ventilation.

ARDS must be differentiated from other diseases that cause hypoxemia and pulmonary infiltrates, such as:[1]

On chest x ray, the bilateral, non-cardiogenic pulmonary infiltrates of ARDS may appear similar to those of cardiogenic (hydrostatic) pulmonary edema. Therefore, it is necessary to formally assess cardiac function and volume status if ARDS is suspected but no clear precipitating insult (e.g., sepsis, trauma, toxic inhalation) can be identified. The preferred methods for making this assessment in the ICU are:

References

  1. Kasper, Dennis (2015). Harrison's principles of internal medicine. New York: McGraw Hill Education. ISBN 978-0071802154.