Sarcoidosis differential diagnosis: Difference between revisions

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Latest revision as of 21:58, 27 October 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]Roshan Dinparasti Saleh M.D.

Overview

Sarcoidosis has many differentials, which can be classified depending on the organ involved, pathologic findings and laboratory findings.

Differential Diagnosis

Sarcoidosis has been defined as a multisystem granulomatous disorder of unknown cause^[1], but granulomatous inflammation alone is not sufficient for the diagnosis of sarcoidosis because alternative etiologies of granulomatous inflammation need to be excluded.

Causes of granulomatous reaction beside sarcoidosis

Mycobacterium tuberculosis
Mycoplasma
Pneumocystis jiroveci
Brucellosis
Cat-scratch fever
Atypical mycobacteria
Toxoplasmosis
Berylliosis
Hard metal
Zirconium
Tattoo
Hypersensitivity pneumonitis
Medications (e.g., methotrexate)
ANCA-associated vasculitis
Necrotizing sarcoid granuloma
Lymphoma
Cancer
Granulomatous lesions of unknown significance
Crohn’s disease
Lymphocytic interstitial pneumonia
Behçet’s disease
Rheumatoid nodules^[1]

Data supporting the likelihood of sarcoidosis

Demographics
1. U.S. African American
2. Northern European
Medical history
1. Non-smoker
2. No symptoms (in patient with bilateral hilar adenopathy on CXR)
3. Family history of sarcoidosis
4. Symptoms involving more than two organs commonly involved by sarcoidosis
Laboratory data
1. Elevated ACE level (especially if > 2× ULN)
2. Elevated calcium level
3. Elevated alkaline phosphatase level
4. Elevated soluble IL-2 receptor
5. Leukopenia
Radiographic findings
1. CXR:
  1. bilateral hilar adenopathy especially if without symptoms
  2. Upper lobe disease
2. HRCT:
  1. Disease along bronchovascular bundle
  2. Subpleural reticulonodular infiltrates
  3. Mediastinal adenopathy
  4. Peribronchial thickening
  5. Traction bronchiectasis of upper lobe
Skin lesions
1. Lupus pernio
2. Erythema nodosum
3. Maculopapular lesions
Ocular disease
1. Uveitis
2. Optic neuritis
Neurological disease
1. Seventh cranial nerve palsy
Renal disease
1. Nephrocalcinosis
2. Interstitial nephritis^[2]

Data weakening the likelihood of sarcoidosis

Demographics
1. Age< 18 years

Medical history
1. Exposure to tuberculosis
2. Exposure to organic bioaerosol
3. Exposure to beryllium
4. Intravenous drug abuse

Laboratory data
1. Positive anti-neutrophil cytoplasm antibody (ANCA)

Radiographic findings
1. CXR:
  1. Pleural effusion
2. HRCT:
  1. Subpleural honeycombing

Ocular disease
1. Episcleritis

Renal disease
1. Glomerulonephritis ^[2]

Spirometry

Low FEV1/FVC ratio

Normal to high FEV1/FVC ratio

Obstructive Lung Disease

Restrictive Lung Disease

Bronchodilator therapy

DLCO

Increased FEV1

No change in FEV1

Normal DLCO

Decreased DLCO

Asthma

COPD

Chest wall disorders

Interstitial Lung Disease

Spirometry Findings in Various Lung Conditions

Spirometry showing Obstructive and Restrictive Lung Disease ([Source:By CNX OpenStax [CC BY 4.0 (http://creativecommons.org/licenses/by/4.0)], via Wikimedia Commons])

Disease		Clinical manifestations											Diagnosis
		Symptoms				Physical exam							Lab findings	Imaging			Gold standard
		Cough	Dyspnea	Hemoptysis	Fever	History/Exposure	Cyanosis	Clubbing	JVD	Peripheral edema	Auscultation	Other prominent findings	Lab findings	CXR	CT	DLCco
Hypersensitivity Pneumonitis		+	+	-	+	History of allergen exposure	-	+	-	-	Diffuse fine bibasilar crackles	Constitutional symptoms Weight loss Anorexia Muscle weakness	Neutrophilia Elevated ESR Elevated CRP Elevated immunoglobulin No peripheral blood eosinophilia	Poorly defined micronodular or diffuse interstitial pattern In chronic form Fibrosis Loss of lung volume Coarse linear opacities	Ground-glass opacities or Diffusely increased radiodensities Diffuse micronodules Focal air trapping Mosaic perfusion Occasionaly thin-walled cysts Mild fibrotic changes	↓	Clinical diagnosis
Acute Respiratory Distress Syndrome (ARDS)		-	+	-	-	Trauma Sepsis Drug overdose Massive transfusion Acute pancreatitis Aspiration	+	-	-	-	Coarse breath sounds Rhonchi crackles Decreased breath sounds	Initially respiratory alkalosis transforming to respiratory acidosis	BNP level of less than 100 pg/mL PaO₂ / FiO₂ <300 Leukopenia Leukocytosis Thrombocytopenia	Bilateral pulmonary infiltrates Initially patchy peripheral Later diffuse bilateral Ground glass Frank alveolar infiltrate	Bronchial dilatation within areas of ground-glass opacification	↓	PaO₂ / FiO₂ <300
Bronchitis	Acute	+	-	+/-	+	-	-	-	-	-	Diffuse wheezes High-pitched continuous sounds The use of accessory muscles Prolonged expiration Rhonchi Rales	Hoarseness	N/A	Normal	N/A	-	Clinical diagnosis
Bronchitis	Chronic	+	+	-	-	A positive history of chronic productive cough Shortness of breath	+	-	+	+	Prolonged expiration; wheezing Diffusely decreased breath sound Coarse crackles with inspiration Coarse rhonchi	N/A	Chronic hypoxemia may lead to polycythemia Increase in Neutrophils count Chronic respiratory acidosis.	Radiolucency Diaphragmatic flattening due to hyperinflation Increased retrosternal airspace on the lateral radiograph	N/A	↓	N/A
Pneumoconiosis^[3]	SIlicosis^[4]^[5]	+	+	+/-	-	Occupational history Sandblasting Bystanders Quartzite miller Tunnel workers Silica flour workers Workers in the scouring powder industry	+	+	+	-	Hyperresonant Fine crackles Rhonchi Bronchial breath sounds Expiratory wheezing Increased tactile fremitus. Loud P2	Increased susceptiblity to tuberculosis.	Respiratory acidosis Abnormal sputum Anemia Neutrophilia Elevated ESR Elevated CRP Elevated immunoglobulin	Small round opacities Symmetrically distributed Upper-zone predominance Diffuse interstitial pattern of fibrosis without the typical nodular opacities in chronic case	Nodular changes in lung parenchyma Progressive massive fibrosis Bullae, emphysema Pleural, mediastinal, and hilar changes	↓	Lung biopsy
	Asbestosis					Shipyard workers Pipe fitting Insulators						Lung cancer Mesothelioma		Predilection to lower lobes Fine and coarse linear, peripheral, reticular opacities	Subpleural linear opacities seen parallel to the pleura Basilar lung fibrosis Peribronchiolar, intralobular, and interlobular septal fibrosis; Honeycombing Pleural plaques.
	Berylliosis					Electronic manufactures						-		Hilar adenopathy Increased interstitial markings.	Ground glass opacification Parenchymal nodules Septal lines
	Byssinosis					Cotton wool workers						Increased susceptibility to Actinomyces and Aspergillus infection.		Diffuse air-space consolidation	Pulmonary fibrosis with honeycombing Peri bronchovascular distribution of nodules Ground-glass attenuations
Sarcoidosis		+	+	+	+	African Americans Autoimmune	-	-	-	-	Usually normal Occasional crackles	Dermatologic manifestations Ocular involvement Osseous involvement Heart failure from cardiomyopathy Lymphocytic meningitis Cranial nerve palsies	Hypercalcemia or hypercalciuria Elevated 1, 25-dihydroxyvitamin D levels Elevated angiotensin-converting enzyme (ACE)	Bilateral hilar lymphadenopathy	High-resolution CT (HRCT) scanning of the chest may identify Active alveolitis Fibrosis	↓	Biopsy
Pleural Effusion		+	+	+/-	+/-	Transudate CHF Cirrhosis Exudate Parapneumonic causes Malignancy	+/-	+/-	+/-	+/-	Decreased tactile fremitus Diminished or inaudible breath sounds Pleural friction rub	Peripheral edema, distended neck veins, and S₃ gallop suggest congestive heart failure. Edema may also be a manifestation of nephrotic syndrome, pericardial disease, or, when combined with yellow nailbeds, the yellow nail syndrome. Cutaneous changes and ascites suggest liver disease. Lymphadenopathy or a palpable mass suggests malignancy.	Thoracentesis Exudate Transudate LDH, glucose, cytology Other specific labs of underlying etiology	Supine Blunting of the costophrenic angle Homogenous increase in density spread over the lower lung fields Lateral decubitus Free flowing effusion as layers	Thickened pleura Mild effusions can aslo be detected	↓	Thoracocentesis
Interstitial (Nonidiopathic) Pulmonary Fibrosis		+	++	+	-	Connective-tissue disorder Pneumoconiosis	+	+	+	+	Wheezing S3 P2 End-inspiratory rales	Increased A-a gradient	Elevated ESR Serologic testing for ANA, RF, ANCA & ASCA may be positive	Reticular and/or nodular opacities Honeycomb appearance (late finding)	Bilateral reticular and nodular interstitial infiltrates	↓	Video-assisted thoracoscopic lung biopsy
Lymphocytic Interstitial Pneumonia^[6]		+	+	+	+	Autoimmune Lymphoproliferative disorders	-	+	-	-	Wheezing Rales	Increased A-a gradient	Polyclonal hypergammaglobulinemia Increased LDH	Bibasilar interstitial or micronodular infiltrates	Determines the degree of fibrosis Cysts (characterstic)	N	Open lung biopsy
Obesity^[7]^[8]		+	+	-	-	Overweight Diabetes mellitus Asthma	-	-	-	+	Wheezing	-	Increased hematocrit	X ray findings are often limited due to body habitus	CT findings are variable and depends upon severity of obesity	N	Clinical
Pulmonary Eosinophilia^[9]		+	+	+	+	Infections Parasitic Fungal Mycobacterial	+	-	+	+	Wheezing Rales	Increased A-a gradient	Leukocytosis with eosinophilia (> 250/µL)	Interstitial or diffuse nodular densities	Determines extent and distribution of the disease Interstitial infiltrates Cysts and nodules	↓	Biopsy of lesion (skin or lung)
Neuromuscular disease	Scoliosis	-	+	-	-	Postural abnormality	-	-	-	-	Decreased breath sounds	In severe scoliosis, the rib cage may press against the lungs making it more difficult to breathe.	R/0 genetic conditions Marfan's syndrome Edward's syndrome Total lymphocyte count (should be >1500/μL) Nutritional status must be assessed	Accurate depiction of the true magnitude of the spinal deformity can be assessed by supine anteroposterior (AP) and lateral spinal radiographs	N/A	N	Clinical Radiographs
	Muscular dystrophy	-	+	-	-	Proximal muscle weakness	-	-	-	-	Decreased breath sounds	Rash	Elevated CPK and aldolase +ANA +Anti-Jo abs Elevated ESR, CRP and RF	N/A	N/A	N	Muscle biopsy
	ALS	-	+	-	-	Muscle weakness Neurological deficit	-	-	-	-	Decreased breath sounds	Symptoms begin with limb involvement diue to muscle weakness and atrophy. Cognitive or behavioral dysfunction Sensory nerves and the autonomic nervous system are generally unaffected	N/A	Not significant/diagnostic	Not significant/diagnostic	-	Clinical diagnosis Nerve conduction studies and needle electromyography (EMG)
	Myasthenia gravis	-	+	-	+	H/O of difficulty getting up from chair Combing Difficulty in swallowing	-	-	-	-	Decreased breath sounds	Extraocular, bulbar, or proximal limb muscles. Breathing as rapid and shallow Respiratory muscle weakness can lead to acute respiratory failure may require immediate intubation.	Anti–acetylcholine receptor (AChR) antibody (Ab) test +	Thymoma as an anterior mediastinal mass.	Thymoma as an anterior mediastinal mass.	N	Electromyography

References

↑ ^1.0 ^1.1 Statement on sarcoidosis: Joint Statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee, February 1999. Am J Respir Crit Care Med 160:736–755, 1999.
↑ ^2.0 ^2.1 Judson MA: The diagnosis of sarcoidosis. Clin Chest Med 29(3):415–427, 2008.
↑ Gay SE, Kazerooni EA, Toews GB, Lynch JP, Gross BH, Cascade PN, Spizarny DL, Flint A, Schork MA, Whyte RI, Popovich J, Hyzy R, Martinez FJ (1998). "Idiopathic pulmonary fibrosis: predicting response to therapy and survival". Am. J. Respir. Crit. Care Med. 157 (4 Pt 1): 1063–72. doi:10.1164/ajrccm.157.4.9703022. PMID 9563720.
↑ du Bois RM (2006). "Evolving concepts in the early and accurate diagnosis of idiopathic pulmonary fibrosis". Clin. Chest Med. 27 (1 Suppl 1): S17–25, v–vi. doi:10.1016/j.ccm.2005.08.001. PMID 16545629.
↑ Neghab M, Mohraz MH, Hassanzadeh J (2011). "Symptoms of respiratory disease and lung functional impairment associated with occupational inhalation exposure to carbon black dust". J Occup Health. 53 (6): 432–8. PMID 21996929.
↑ Honda O, Johkoh T, Ichikado K, Tomiyama N, Maeda M, Mihara N, Higashi M, Hamada S, Naito H, Yamamoto S, Nakamura H (1999). "Differential diagnosis of lymphocytic interstitial pneumonia and malignant lymphoma on high-resolution CT". AJR Am J Roentgenol. 173 (1): 71–4. doi:10.2214/ajr.173.1.10397102. PMID 10397102.
↑ Zammit C, Liddicoat H, Moonsie I, Makker H (2010). "Obesity and respiratory diseases". Int J Gen Med. 3: 335–43. doi:10.2147/IJGM.S11926. PMC 2990395. PMID 21116339.
↑ O’Neill, Donal (2015). "Measuring obesity in the absence of a gold standard". Economics & Human Biology. 17: 116–128. doi:10.1016/j.ehb.2015.02.002. ISSN 1570-677X.
↑ de Górgolas M, Casado V, Renedo G, Alen JF, Fernández Guerrero ML (2009). "Nodular lung schistosomiais lesions after chemotherapy for dysgerminoma". Am. J. Trop. Med. Hyg. 81 (3): 424–7. PMID 19706907.

[wasog-1] 1.0 ^1.1 Statement on sarcoidosis: Joint Statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee, February 1999. Am J Respir Crit Care Med 160:736–755, 1999.

[judson-2] 2.0 ^2.1 Judson MA: The diagnosis of sarcoidosis. Clin Chest Med 29(3):415–427, 2008.

[pmid9563720-3] Gay SE, Kazerooni EA, Toews GB, Lynch JP, Gross BH, Cascade PN, Spizarny DL, Flint A, Schork MA, Whyte RI, Popovich J, Hyzy R, Martinez FJ (1998). "Idiopathic pulmonary fibrosis: predicting response to therapy and survival". Am. J. Respir. Crit. Care Med. 157 (4 Pt 1): 1063–72. doi:10.1164/ajrccm.157.4.9703022. PMID 9563720.

[pmid16545629-4] u Bois RM (2006). "Evolving concepts in the early and accurate diagnosis of idiopathic pulmonary fibrosis". Clin. Chest Med. 27 (1 Suppl 1): S17–25, v–vi. doi:10.1016/j.ccm.2005.08.001. PMID 16545629.

[pmid21996929-5] Neghab M, Mohraz MH, Hassanzadeh J (2011). "Symptoms of respiratory disease and lung functional impairment associated with occupational inhalation exposure to carbon black dust". J Occup Health. 53 (6): 432–8. PMID 21996929.

[pmid10397102-6] Honda O, Johkoh T, Ichikado K, Tomiyama N, Maeda M, Mihara N, Higashi M, Hamada S, Naito H, Yamamoto S, Nakamura H (1999). "Differential diagnosis of lymphocytic interstitial pneumonia and malignant lymphoma on high-resolution CT". AJR Am J Roentgenol. 173 (1): 71–4. doi:10.2214/ajr.173.1.10397102. PMID 10397102.

[pmid21116339-7] Zammit C, Liddicoat H, Moonsie I, Makker H (2010). "Obesity and respiratory diseases". Int J Gen Med. 3: 335–43. doi:10.2147/IJGM.S11926. PMC 2990395. PMID 21116339.

[O’Neill2015-8] O’Neill, Donal (2015). "Measuring obesity in the absence of a gold standard". Economics & Human Biology. 17: 116–128. doi:10.1016/j.ehb.2015.02.002. ISSN 1570-677X.

[pmid19706907-9] Górgolas M, Casado V, Renedo G, Alen JF, Fernández Guerrero ML (2009). "Nodular lung schistosomiais lesions after chemotherapy for dysgerminoma". Am. J. Trop. Med. Hyg. 81 (3): 424–7. PMID 19706907.

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@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Sarcoidosis}}
-{{CMG}} {{AE}}
+{{CMG}} {{AE}}{{HK}}Roshan Dinparasti Saleh M.D.
 ==Overview==
-Please help WikiDoc by adding content here.  It's easy!  Click  [[Help:How_to_Edit_a_Page|here]]  to learn about editing.
+[[Sarcoidosis]] has many differentials, which can be classified depending on the organ involved, pathologic findings and laboratory findings.
 ==Differential Diagnosis==
-Sarcoidosis has many differentials, which can be classified depending on the organ involved.<ref>Samter's immunologic diseases.—6th ed./[edited by] K. Frank Austen … [et al.]</ref>
+[[Sarcoidosis]] has been defined as a multisystem granulomatous disorder of unknown cause<ref name="wasog">Statement on sarcoidosis: Joint Statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee, February 1999. Am J Respir Crit Care Med 160:736–755, 1999.</ref>, but [[granulomatous inflammation]] alone is not sufficient for the diagnosis of [[sarcoidosis]] because alternative etiologies of [[granulomatous inflammation]] need to be excluded.
-'''Lung'''<ref name="pmid1871095">{{cite journal| author=Khomenko AG| title=[Diagnosis of granulomatous lung diseases]. | journal=Probl Tuberk | year= 1991 | volume=  | issue= 3 | pages= 5-9 | pmid=1871095 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1871095  }} </ref>
+===Causes of [[granulomatous reaction]] beside [[sarcoidosis]]===
+* [[Mycobacterium tuberculosis]]
-.Tuberculosis   2.Atypical Mycobacteriosis   3.Cryptococcosis   4.Aspergillosis   5.Aspiration of foriegn materials
+* [[Mycoplasma]]
-.Blastomycosis  7.Pneumocystitis carinii     8.Pneumoconiosis   9.Drug reactions  10.Hypersensitivity pneumonitis
+* [[Pneumocystis jiroveci]]
-.Drug reactions12..Histoplasmosis           13.Chronic interstitial pneumonia
+* [[Brucellosis]]
-.Necrotizing sarcoid granulomatosis         15.Wegner's granulomatosis
+* [[Cat-scratch fever]]
+* [[Atypical mycobacteria]]
+* [[Toxoplasmosis]]
+* [[Berylliosis]]
+* [[Hard metal]]
+* [[Zirconium]]
+* [[Tattoo]]
+* [[Hypersensitivity pneumonitis]]
+* Medications (e.g., [[methotrexate]])
+* [[ANCA-associated vasculitis]]
+* [[Necrotizing sarcoid granuloma]]
+* [[Lymphoma]]
+* [[Cancer]]
+* Granulomatous lesions of unknown significance
+* [[Crohn’s disease]]
+* [[Lymphocytic interstitial pneumonia]]
+* [[Behçet’s disease]]
+* [[Rheumatoid nodules]]<ref name="wasog">Statement on sarcoidosis: Joint Statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee, February 1999. Am J Respir Crit Care Med 160:736–755, 1999.</ref>
-'''Lymph Node'''
+===Data supporting the likelihood of [[sarcoidosis]]===
+# '''Demographics'''
-.Tuberculosis   2.Atypical Mycobacteriosis   3.Brucellosis   4.GLUS syndrome   5.Cat scratch disease
+## U.S. [[African American]]
-.Toxoplasmosis  7.Hodgkin disease            8.Non Hodgkin lymphoma            9.Sarcoid reaction in lymph nodes to carcinoma
+## [[Northern European]]
-.Kikuchi disease(granulomatous histiocytic necrotizing lymphadenitis)
+# '''Medical history'''
+## [[Non-smoker]]
+## No symptoms (in patient with [[bilateral hilar adenopathy]] on [[CXR]])
+## Family history of [[sarcoidosis]]
+## Symptoms involving more than two organs commonly involved by [[sarcoidosis]]
+# '''Laboratory data'''
+## Elevated [[ACE]] level (especially if > 2× ULN)
+## Elevated [[calcium]] level
+## Elevated [[alkaline phosphatase]] level
+## Elevated [[soluble IL-2 receptor]]
+## [[Leukopenia]]
+#  '''Radiographic findings'''
+## [[CXR]]:
+###[[bilateral hilar adenopathy]] especially if '''without''' symptoms
+### Upper lobe disease
+## [[HRCT]]:
+### Disease along bronchovascular bundle
+### Subpleural reticulonodular infiltrates
+### [[Mediastinal adenopathy]]
+### [[Peribronchial thickening]]
+### [[Traction bronchiectasis]] of upper lobe
+# '''Skin lesions'''
+## [[Lupus pernio]]
+## [[Erythema nodosum]]
+## Maculopapular lesions
+# '''Ocular disease'''
+## [[Uveitis]]
+## [[Optic neuritis]]
+# '''Neurological disease'''
+## [[Seventh cranial nerve palsy]]
+# '''Renal disease'''
+## [[Nephrocalcinosis]]
+## [[Interstitial nephritis]]<ref name="judson">Judson MA: The diagnosis of sarcoidosis. Clin Chest Med 29(3):415–427, 2008.</ref>
-'''Skin'''
+===Data weakening the likelihood of [[sarcoidosis]]===
+# '''Demographics'''
+## Age< 18 years
-.Tuberculosis   2.Atypical mycobacteriosis   3.Fungal infection   4.Rheumatoid nodules   6.Reaction to foreign bodies
+# '''Medical history'''
+## Exposure to [[tuberculosis]]
+## Exposure to [[organic bioaerosol]]
+## Exposure to [[beryllium]]
+## [[Intravenous drug abuse]]
-'''Liver'''
+# '''Laboratory data'''
+## Positive [[anti-neutrophil cytoplasm antibody]] ([[ANCA]])
-.Tuberculosis   2.Brucellosis   3.Schitosomiasis   4.Crohn's disease   5.Hodgkin's disease  6. Non hodgkin's lymphoma
+#  '''Radiographic findings'''
-.GLUS syndrome  8.Primary biliary cirrhosis
+## [[CXR]]:
+### [[Pleural effusion]]
+## [[HRCT]]:
+### Subpleural [[honeycombing]]
-'''Bone Marrow'''
+# '''Ocular disease'''
+## [[Episcleritis]]
-.Tuberculosis   2.Histoplasmosis   3.Cytomegalovirus   4.Drugs   5.Infectious Mononucleosis   6.GLUS syndrome
+# '''Renal disease'''
-.Hodgkin's disease   8.Non Hodgkin's lymphoma
+## [[Glomerulonephritis]] <ref name="judson">Judson MA: The diagnosis of sarcoidosis. Clin Chest Med 29(3):415–427, 2008.</ref>
-'''Other biopsy sites'''
+{{familytree/start}}
+{{familytree | | | | | | | | | | | | | | A01 | | | | | | | | | |A01=Spirometry}}
+{{familytree | | | | | | | | | | | | | | |!| | | | | | | | | | | }}
+{{familytree | | | | | | |,|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|.| | | |}}
+{{familytree | | | | | | B01 | | | | | | | | | | | | | | B02 | | | |B01=Low FEV1/FVC ratio|B02=Normal to high FEV1/FVC ratio|}}
+{{familytree | | | | | | |!| | | | | | | | | | | | | | | |!| | | | | }}
+{{familytree | | | | | | C01 | | | | | | | | | | | | | | C02 | | | |C01=Obstructive Lung Disease|C02=Restrictive Lung Disease|}}
+{{familytree | | | | | | |!| | | | | | | | | | | | | | | |!| | | | | }}
+{{familytree | | | | | | D01 | | | | | | | | | | | | | | D02 | | | | |D01=Bronchodilator therapy|D02=DLCO}}
+{{familytree | | | | | | |!| | | | | | | | | | | | | | | |!| | | | | }}
+{{familytree | |,|-|-|-|-|^|-|-|-|-|.| | | | | |,|-|-|-|-|^|-|-|-|-|.| }}
+{{familytree | E01 | | | | | | | | E02 | | | | E03 | | | | | | | | E04 | | |E01=Increased FEV1|E02=No change in FEV1|E03=Normal DLCO|E04=Decreased DLCO|}}
+{{familytree | |!| | | | | | | | | |!| | | | | |!| | | | | | | | | |!| | | }}
+{{familytree | F01 | | | | | | | | F02 | | | | F03 | | | | | | | | F04 | | |F01=Asthma|F02=COPD|F03=Chest wall disorders|F04=Interstitial Lung Disease|}}
+{{familytree/end}}
-.Tuberculosis   2.Brucellosis   3.Crohn's disease   4.GLUS Syndrome   5.Other infections   6.Giant cell myocarditis
-==Differential diagnosis==
+====Spirometry Findings in Various Lung Conditions====
+[[image:Figure 39 03 05f.jpg|thumb|center|Spirometry showing Obstructive and Restrictive Lung Disease ([Source:By CNX OpenStax [CC BY 4.0 (http://creativecommons.org/licenses/by/4.0)], via Wikimedia Commons])]]
+{|
+|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
+! colspan="2" rowspan="3" |Disease
+! colspan="11" |Clinical manifestations
+! colspan="5" |Diagnosis
+|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
+! colspan="4" |Symptoms
+! colspan="7" |Physical exam
+! rowspan="2" |Lab findings
+! colspan="3" |Imaging
+!Gold standard
+|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
+!Cough
+!Dyspnea
+!Hemoptysis
+!Fever
+!History/Exposure
+!Cyanosis
+!Clubbing
+!JVD
+!Peripheral edema
+!Auscultation
+!Other prominent findings
+!CXR
+!CT
+!DLCco
+!
+|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+| colspan="2" |Hypersensitivity Pneumonitis
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* History of [[allergen]] exposure
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Diffuse fine bibasilar [[crackles]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Constitutional symptoms
+** [[Weight loss]]
+** Anorexia
+** Muscle weakness
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Neutrophilia
+* Elevated [[ESR]]
+* Elevated [[CRP]]
+* Elevated [[immunoglobulin]]
+* No peripheral blood [[eosinophilia]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Poorly defined micronodular or diffuse interstitial pattern
+* In chronic form
+** Fibrosis
+** Loss of lung volume
+** Coarse linear opacities
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Ground-glass opacities '''or'''
+* Diffusely increased radiodensities
+* Diffuse micronodules
+* Focal air trapping
+* Mosaic perfusion
+* Occasionaly thin-walled cysts
+* Mild fibrotic changes
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |''↓''
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
+*Clinical diagnosis
+|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+| colspan="2" |[[Acute respiratory distress syndrome|Acute Respiratory Distress Syndrome]] ([[Acute respiratory distress syndrome|ARDS]])
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Trauma]]
+* [[Sepsis]]
+* [[Drug overdose]]
+* [[Blood transfusion|Massive transfusion]]
+* [[Acute pancreatitis]] [[Aspiration]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Coarse [[breath sounds]]
+* Rhonchi [[crackles]]
+* Decreased [[breath sounds]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Initially [[respiratory alkalosis]] transforming to respiratory acidosis
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[BNP]] level of less than 100 pg/mL
+* PaO<sub>2</sub> '''/''' FiO<sub>2</sub> <300
+* [[Leukopenia]]
+* [[Leukocytosis]]
+* [[Thrombocytopenia]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Bilateral pulmonary infiltrates
+** Initially patchy peripheral
+** Later diffuse bilateral
+* Ground glass
+* Frank alveolar infiltrate
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Bronchial dilatation within areas of ground-glass opacification
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |''↓''
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* PaO<sub>2</sub> '''/''' FiO<sub>2</sub> <300
+|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+| rowspan="2" |[[Bronchitis]]
+|Acute
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+/-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Diffuse [[Wheeze|wheezes]]
+* High-pitched continuous sounds
+* The use of accessory muscles
+* Prolonged expiration
+* [[Rhonchi]]
+* [[Rales]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Hoarseness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* N/A
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Normal
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* N/A
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Clinical diagnosis
+|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|Chronic
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* A positive history of chronic productive [[cough]]
+* Shortness of breath
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Prolonged expiration; [[wheezing]]
+* Diffusely decreased breath sound
+* Coarse [[crackles]] with inspiration
+* Coarse [[rhonchi]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* N/A
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Chronic [[hypoxemia]] may lead to [[polycythemia]]
+* Increase in [[Neutrophil|Neutrophils]] count
+* Chronic [[respiratory acidosis]].
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Radiolucency
+* Diaphragmatic flattening due to hyperinflation
+* Increased retrosternal airspace on the lateral radiograph
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* N/A
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |''↓''
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*N/A
+|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+| rowspan="4" |[[Occupational lung disease|Pneumoconiosis]]<ref name="pmid9563720">{{cite journal |vauthors=Gay SE, Kazerooni EA, Toews GB, Lynch JP, Gross BH, Cascade PN, Spizarny DL, Flint A, Schork MA, Whyte RI, Popovich J, Hyzy R, Martinez FJ |title=Idiopathic pulmonary fibrosis: predicting response to therapy and survival |journal=Am. J. Respir. Crit. Care Med. |volume=157 |issue=4 Pt 1 |pages=1063–72 |year=1998 |pmid=9563720 |doi=10.1164/ajrccm.157.4.9703022 |url=}}</ref>
+|[[Occupational lung disease|SIlicosis]]<ref name="pmid16545629">{{cite journal |vauthors=du Bois RM |title=Evolving concepts in the early and accurate diagnosis of idiopathic pulmonary fibrosis |journal=Clin. Chest Med. |volume=27 |issue=1 Suppl 1 |pages=S17–25, v–vi |year=2006 |pmid=16545629 |doi=10.1016/j.ccm.2005.08.001 |url=}}</ref><ref name="pmid21996929">{{cite journal |vauthors=Neghab M, Mohraz MH, Hassanzadeh J |title=Symptoms of respiratory disease and lung functional impairment associated with occupational inhalation exposure to carbon black dust |journal=J Occup Health |volume=53 |issue=6 |pages=432–8 |year=2011 |pmid=21996929 |doi= |url=}}</ref>
+| rowspan="4" style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| rowspan="4" style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| rowspan="4" style="padding: 5px 5px; background: #F5F5F5;" align="center" | +/-
+| rowspan="4" style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Occupational history
+** Sandblasting
+** Bystanders
+** Quartzite miller
+** Tunnel workers
+** Silica flour workers
+** Workers in the scouring powder industry
+| rowspan="4" style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| rowspan="4" style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| rowspan="4" style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| rowspan="4" style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
+| rowspan="4" style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+**Hyperresonant
+**Fine [[crackles]]
+**Rhonchi
+**Bronchial breath sounds
+**Expiratory wheezing
+**Increased [[tactile fremitus]].
+**Loud P2
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Increased susceptiblity to [[tuberculosis]].
+| rowspan="4" style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Respiratory acidosis]]
+*[[Abnormal sputum]]
+*[[Anemia]]
+*[[Neutrophilia]]
+*Elevated [[ESR]]
+*Elevated [[CRP]]
+*Elevated [[immunoglobulin]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Small round opacities
+** Symmetrically distributed
+** Upper-zone predominance
+* Diffuse interstitial pattern of fibrosis without the typical nodular opacities in chronic case
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Nodular changes in lung parenchyma
+* Progressive massive fibrosis
+* Bullae, emphysema
+* Pleural, mediastinal, and hilar changes
+| rowspan="4" style="padding: 5px 5px; background: #F5F5F5;" align="center" |''↓''
+| rowspan="4" style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Biopsy|Lung biopsy]]
+|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|[[Asbestosis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Shipyard workers
+* Pipe fitting
+* Insulators
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Lung cancer]]
+* [[Mesothelioma]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Predilection to lower lobes
+* Fine and coarse linear, peripheral, reticular opacities
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Subpleural linear opacities seen parallel to the pleura
+* Basilar lung fibrosis
+* Peribronchiolar, intralobular, and interlobular septal fibrosis;
+* Honeycombing
+* Pleural plaques.
+|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|[[Berylliosis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Electronic manufactures
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Hilar adenopathy
+* Increased interstitial markings.
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Ground glass opacification
+* Parenchymal nodules
+* Septal lines
+|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+|[[Byssinosis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Cotton wool workers
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Increased susceptibility to ''[[Actinomyces]]'' and ''[[Aspergillus]]'' infection.
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Diffuse air-space consolidation
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Pulmonary fibrosis with honeycombing
+* Peri bronchovascular distribution of nodules
+* Ground-glass attenuations
+|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+| colspan="2" |[[Sarcoidosis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* African Americans
+* [[Autoimmune]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Usually normal
+* Occasional crackles
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Dermatological lesions|Dermatologic manifestations]]
+* Ocular involvement
+* Osseous involvement
+* Heart failure from [[cardiomyopathy]]
+* Lymphocytic [[meningitis]]
+* [[Cranial nerve palsies]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Hypercalcemia]] or [[hypercalciuria]]
+* Elevated [[Vitamin D|1, 25-dihydroxyvitamin D levels]]
+* Elevated [[angiotensin-converting enzyme]] (ACE)
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Bilateral hilar lymphadenopathy
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* High-resolution CT (HRCT) scanning of the chest may identify
+** Active alveolitis
+** Fibrosis
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |''↓''
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Biopsy]]
+|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+| colspan="2" |[[Pleural effusion|Pleural Effusion]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+/-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+/-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |'''Transudate'''
+* [[Congestive heart failure|CHF]]
+* [[Cirrhosis]]
+'''Exudate'''
+* [[Parapneumonic effusion|Parapneumonic causes]]
+* [[Malignancy]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+/-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+/-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+/-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+/-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Decreased [[tactile fremitus]]
+* Diminished or inaudible [[breath sounds]]
+* Pleural [[friction rub]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Peripheral edema, distended neck veins, and S<sub>3</sub> gallop suggest [[congestive heart failure]].
+* Edema may also be a manifestation of nephrotic syndrome, pericardial disease, or, when combined with yellow nailbeds, the yellow nail syndrome.
+* Cutaneous changes and ascites suggest liver disease.
+* Lymphadenopathy or a palpable mass suggests malignancy.
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Thoracentesis
+** [[Exudate]]
+** [[Transudate]]
+** [[LDH]], [[glucose]], [[cytology]]
+* Other specific labs of underlying etiology
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Supine
+* Blunting of the costophrenic angle
+* Homogenous increase in density spread over the lower lung fields
+Lateral decubitus
+* Free flowing effusion as layers
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Thickened pleura
+* Mild effusions can aslo be detected
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |''↓''
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Thoracocentesis]]
+|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+| colspan="2" |Interstitial (Nonidiopathic) [[Idiopathic pulmonary fibrosis|Pulmonary Fibrosis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ++
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Connective tissue disorder|Connective-tissue disorder]]
+* [[Pneumoconiosis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Wheezing]]
+* [[S3]]
+* [[P2]]
+* End-inspiratory rales
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Increased A-a gradient
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Elevated [[ESR]]
+* Serologic testing for [[ANA]], [[RF]], [[Anti-neutrophil cytoplasmic antibody|ANCA]] & ASCA may be positive
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Reticular and/or nodular opacities
+* Honeycomb appearance (late finding)
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Bilateral reticular and nodular interstitial infiltrates
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |''↓''
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Video-assisted thoracoscopic lung biopsy
+|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+| colspan="2" |[[Interstitial Pneumonia|Lymphocytic Interstitial Pneumonia]]<ref name="pmid10397102">{{cite journal |vauthors=Honda O, Johkoh T, Ichikado K, Tomiyama N, Maeda M, Mihara N, Higashi M, Hamada S, Naito H, Yamamoto S, Nakamura H |title=Differential diagnosis of lymphocytic interstitial pneumonia and malignant lymphoma on high-resolution CT |journal=AJR Am J Roentgenol |volume=173 |issue=1 |pages=71–4 |year=1999 |pmid=10397102 |doi=10.2214/ajr.173.1.10397102 |url=}}</ref>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Autoimmune]]
+* [[Lymphoproliferative disorders]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Wheezing]]
+* [[Rales]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Increased A-a gradient
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Polyclonal hypergammaglobulinemia
+* Increased [[LDH]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Bibasilar interstitial or micronodular infiltrates
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Determines the degree of fibrosis
+* Cysts (characterstic)
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Open lung biopsy
+|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+| colspan="2" |[[Obesity]]<ref name="pmid21116339">{{cite journal |vauthors=Zammit C, Liddicoat H, Moonsie I, Makker H |title=Obesity and respiratory diseases |journal=Int J Gen Med |volume=3 |issue= |pages=335–43 |year=2010 |pmid=21116339 |pmc=2990395 |doi=10.2147/IJGM.S11926 |url=}}</ref><ref name="O’Neill2015">{{cite journal|last1=O’Neill|first1=Donal|title=Measuring obesity in the absence of a gold standard|journal=Economics & Human Biology|volume=17|year=2015|pages=116–128|issn=1570677X|doi=10.1016/j.ehb.2015.02.002}}</ref>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Overweight
+* [[Diabetes mellitus]]
+* [[Asthma]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Wheezing]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Polycythemia|Increased hematocrit]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* X ray findings are often limited due to body habitus
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* CT findings are variable and depends upon severity of obesity
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Clinical
+|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
+| colspan="2" |[[Eosinophilia|Pulmonary Eosinophilia]]<ref name="pmid19706907">{{cite journal |vauthors=de Górgolas M, Casado V, Renedo G, Alen JF, Fernández Guerrero ML |title=Nodular lung schistosomiais lesions after chemotherapy for dysgerminoma |journal=Am. J. Trop. Med. Hyg. |volume=81 |issue=3 |pages=424–7 |year=2009 |pmid=19706907 |doi= |url=}}</ref>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Infections
+* [[Parasitic]]
+* [[Fungal]]
+* [[Mycobacterial]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Wheezing]]
+* [[Rales]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Increased A-a gradient
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Leukocytosis]] with [[eosinophilia]] (> 250/µL)
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
+* Interstitial or diffuse nodular densities
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Determines extent and distribution of the disease
-{| class="wikitable"
+* Interstitial infiltrates
-!Causes of
+* Cysts and nodules
-lung cavities
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |''↓''
-!Differentiating Features
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Biopsy of lesion (skin or lung)
-!Differentiating radiological findings
+|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
-!Diagnosis
+| rowspan="4" |Neuromuscular disease
-confirmation
+|Scoliosis
-|-
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-*[[Malignancy]] ([[Lung cancer|Primary lung cance<nowiki/>r]])<ref name="pmid4353362">{{cite journal |vauthors=Chaudhuri MR |title=Primary pulmonary cavitating carcinomas |journal=Thorax |volume=28 |issue=3 |pages=354–66 |year=1973 |pmid=4353362 |pmc=470041 |doi= |url=}}</ref>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
-*Elderly male or female <ref name="pmid4353362">{{cite journal |vauthors=Chaudhuri MR |title=Primary pulmonary cavitating carcinomas |journal=Thorax |volume=28 |issue=3 |pages=354–66 |year=1973 |pmid=4353362 |pmc=470041 |doi= |url=}}</ref>
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*Chronic smokers
+* Postural abnormality
-*Presents with a [[low-grade fever]], absence of [[leukocytosis]], systemic complaints [[weight loss]], [[fatigue]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
-*Absence of factors that predispose to [[gastric content aspiration]], no response to [[antibiotics]] within 10 days
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
-*[[Hemoptysis]] is commonly associated with [[bronchogenic carcinoma]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
-*A coin-shaped lesion with thick wall(>15mm) is seen on CXR with less ground glass opacities <ref name="pmid8572761">{{cite journal |vauthors=Mouroux J, Padovani B, Elkaïm D, Richelme H |title=Should cavitated bronchopulmonary cancers be considered a separate entity? |journal=Ann. Thorac. Surg. |volume=61 |issue=2 |pages=530–2 |year=1996 |pmid=8572761 |doi=10.1016/0003-4975(95)00973-6 |url=}}</ref> <ref name="pmid16183941">{{cite journal |vauthors=Onn A, Choe DH, Herbst RS, Correa AM, Munden RF, Truong MT, Vaporciyan AA, Isobe T, Gilcrease MZ, Marom EM |title=Tumor cavitation in stage I non-small cell lung cancer: epidermal growth factor receptor expression and prediction of poor outcome |journal=Radiology |volume=237 |issue=1 |pages=342–7 |year=2005 |pmid=16183941 |doi=10.1148/radiol.2371041650 |url=}}</ref>
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*[[Bronchoalveolar lavage]] [[cytology]] shows malignant cells
+* Decreased [[breath sounds]]
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*[[Biopsy]] of lung
+* In severe scoliosis, the rib cage may press against the lungs making it more difficult to breathe.
-|-
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-|
+* R/0 genetic conditions
-*Pulmonary [[Tuberculosis, pulmonary|Tuberculosis]]
+** [[Marfan's syndrome]]
-|
+** [[Edwards syndrome|Edward's syndrome]]
-*Mostly in endemic areas
+* Total [[Lymphocyte|lymphocyte count]] (should be >1500/μL)
-*Symptoms include [[productive cough]],[[night sweats]], [[fever]] and [[weight loss]]
+* Nutritional status must be assessed
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*CXR and CT demonstrates [[Internal|cavities]] in the upper lobe of the lung
+* Accurate depiction of the true magnitude of the spinal deformity can be assessed by supine anteroposterior (AP) and lateral spinal radiographs
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*[[Sputum]] smear positive for [[acid-fast bacilli]] and nucleic acid amplification tests (NAAT) is used on sputum or any sterile fluid for rapid diagnosis and is positive for mycobacteria.
+* N/A
-|-
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*[[Necrotizing Pulmonary Infections|Necrotizing]] [[Pneumonia]]
+* Clinical
-|
+* Radiographs
-*Any age group
+|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
-*Acute, [[fulminant]] life threating complication of prior infection
+|[[Muscular dystrophy]]
-*>100.4F fever, with [[Hemodynamically unstable|hemodynamic]] instability
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
-*Worsening [[pneumonia]]-like symptoms
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
-*CXR demonstrates multiple cavitary lesions
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*[[Pleural effusion]] and [[empyema]] are common findings
+* Proximal muscle weakness
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
-*[[Complete blood count|CBC]] is positive for causative organism
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
-|-
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
-*Loculated [[empyema]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-|
+* Decreased [[breath sounds]]
-* Children and elderly are at risk
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Rash]]
-*Pleuritic [[chest pain]], [[dry cough]], [[fever]] with chills
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*Dullness to [[Percussion of the lungs|percussion]] decreased [[breath sounds]], and reduced vocal resonance on examination
+* Elevated [[CPK]] and [[aldolase]]
-|
+* [[Antinuclear antibodies|+ANA]]
-*[[Empyema]] appears lenticular in shape and has a thin wall with smooth luminal margins
+* +Anti-Jo abs
-|
+* Elevated [[ESR]], [[C-reactive protein|CRP]] and [[RF]]
-*[[Thoracocentesis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-|-
+* N/A
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*[[Granulomatosis with polyangiitis]] ([[Wegener's granulomatosis|Wegener's]])<ref name="pmid10377211">{{cite journal |vauthors=Langford CA, Hoffman GS |title=Rare diseases.3: Wegener's granulomatosis |journal=Thorax |volume=54 |issue=7 |pages=629–37 |year=1999 |pmid=10377211 |pmc=1745525 |doi= |url=}}</ref>
+* N/A
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
-*Women are more commonly effected than man.<ref name="pmid12541109">{{cite journal |vauthors=Lee KS, Kim TS, Fujimoto K, Moriya H, Watanabe H, Tateishi U, Ashizawa K, Johkoh T, Kim EA, Kwon OJ |title=Thoracic manifestation of Wegener's granulomatosis: CT findings in 30 patients |journal=Eur Radiol |volume=13 |issue=1 |pages=43–51 |year=2003 |pmid=12541109 |doi=10.1007/s00330-002-1422-2 |url=}}</ref>
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*Kidneys are also involved
+* [[Muscle biopsy]]
-*Upper respiratory tract symptoms , perforation of [[nasal septum]], [[chronic sinusitis]], [[otitis media]], [[mastoiditis]].
+|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
-*Lower respiratory tract symptoms, [[hemoptysis]],  [[cough]], [[dyspnea]].
+|[[ALS]]
-*Renal symptoms, [[hematuria]], red cell [[casts]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
-*Pulmonary nodules with cavities and infiltrates are a frequent manifestation on CXR
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*Positive for [[P-ANCA]]
+* Muscle weakness
-*Biopsy of the tissue involved shows necrotizing [[granulomas]] <ref name="pmid10377211">{{cite journal |vauthors=Langford CA, Hoffman GS |title=Rare diseases.3: Wegener's granulomatosis |journal=Thorax |volume=54 |issue=7 |pages=629–37 |year=1999 |pmid=10377211 |pmc=1745525 |doi= |url=}}</ref>
+* Neurological deficit
-|-
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
-*[[Rheumatoid nodule]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
-*Elderly females of 40-50 age group
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*Manifestation of [[rheumatoid arthritis]]
+* Decreased [[breath sounds]]
-*Presents with other systemic symptoms including symmetric [[arthritis]] of the small joints of the hands and feet with morning stiffness are common manifestations.
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-|
+* Symptoms begin with limb involvement diue to muscle weakness and atrophy.
-*Pulmonary nodules with cavitation are located in the upper lobe ([[Caplan syndrome]]) on Xray.
+* Cognitive or behavioral dysfunction
-|
+* Sensory nerves and the autonomic nervous system are generally unaffected
-*Positive for both [[rheumatoid factor]] and anticyclic citrullinated peptide [[Antibody|antibody.]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N/A
-|-
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Not significant/diagnostic
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Not significant/diagnostic
-*[[Sarcoidosis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*More common in African-American females
+* Clinical diagnosis
-*Often [[asymptomatic]] except for [[Lymphadenopathy|enlarged lymph nodes]]<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 |year=2001 |pmid=11734441 |doi=10.1164/ajrccm.164.10.2104046 |url=}}</ref>
+* Nerve conduction studies and needle [[electromyography]] (EMG)
-*Associated with [[restrictive lung disease]]
+|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
-*[[Erythema nodosum]]
+|[[Myasthenia gravis]]
-*[[Lupus pernio]] (skin lesions on face resembling lupus)
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
-*[[Bell's palsy|Bell palsy]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-*[[Epithelioid]] [[granuloma]]<nowiki/>s containing microscopic [[Schaumann bodies|Schaumann]] and asteroid bodies
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
-*On CXR bilateral [[Lymphadenopathy|adenopathy]] and coarse reticular opacities are seen.
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |H/O of difficulty getting up from chair
-*CT of the chest demonstrates extensive [[Hilar lymphadenopathy|hilar]] and mediastinal adenopathy
+* Combing
-*Additional findings on CT include [[fibrosis]] (honeycomb, linear, or associated with bronchial distortion), pleural thickening, and ground-glass opacities.<ref name="pmid2748828">{{cite journal |vauthors=Brauner MW, Grenier P, Mompoint D, Lenoir S, de Crémoux H |title=Pulmonary sarcoidosis: evaluation with high-resolution CT |journal=Radiology |volume=172 |issue=2 |pages=467–71 |year=1989 |pmid=2748828 |doi=10.1148/radiology.172.2.2748828 |url=}}</ref>
+* [[Dysphagia|Difficulty in swallowing]]
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
-*Biopsy of lung shows non-[[caseating]] [[granuloma]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
-|-
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
-*[[Bronchiolitis obliterans]] ([[Cryptogenic organizing pneumonia]])<ref name="pmid9724431">{{cite journal |vauthors=Murphy J, Schnyder P, Herold C, Flower C |title=Bronchiolitis obliterans organising pneumonia simulating bronchial carcinoma |journal=Eur Radiol |volume=8 |issue=7 |pages=1165–9 |year=1998 |pmid=9724431 |doi=10.1007/s003300050527 |url=}}</ref><ref name="pmid19561910">{{cite journal |vauthors=Al-Ghanem S, Al-Jahdali H, Bamefleh H, Khan AN |title=Bronchiolitis obliterans organizing pneumonia: pathogenesis, clinical features, imaging and therapy review |journal=Ann Thorac Med |volume=3 |issue=2 |pages=67–75 |year=2008 |pmid=19561910 |pmc=2700454 |doi=10.4103/1817-1737.39641 |url=}}</ref>
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-|
+* Decreased [[breath sounds]]
-*Rare condition and mimics [[asthma]], [[pneumonia]] and [[emphysema]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*It is caused by [[drug]] or [[toxin]] exposure, [[autoimmune diseases]], [[viral infections]], or [[radiation injury]]
+* Extraocular, bulbar, or proximal limb muscles.
-*People working in industries are at high risk
+* Breathing as rapid and shallow
-*Presents with [[Fever|feve]]<nowiki/>r, [[cough]], [[wheezing]] and [[shortness of breath]] over weeks to months,<ref name="pmid2805873">{{cite journal |vauthors=Cordier JF, Loire R, Brune J |title=Idiopathic bronchiolitis obliterans organizing pneumonia. Definition of characteristic clinical profiles in a series of 16 patients |journal=Chest |volume=96 |issue=5 |pages=999–1004 |year=1989 |pmid=2805873 |doi= |url=}}</ref>
+* Respiratory muscle weakness can lead to acute respiratory failure may require immediate intubation.
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*Common appearance on CT is patchy [[Consolidation (medicine)|consolidation,]]<nowiki/>often accompanied by ground-glass opacities and nodules.<ref name="pmid8109493">{{cite journal |vauthors=Lee KS, Kullnig P, Hartman TE, Müller NL |title=Cryptogenic organizing pneumonia: CT findings in 43 patients |journal=AJR Am J Roentgenol |volume=162 |issue=3 |pages=543–6 |year=1994 |pmid=8109493 |doi=10.2214/ajr.162.3.8109493 |url=}}</ref>
+* Anti–acetylcholine receptor (AChR) antibody (Ab) test +
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*Biopsy of the lung <ref name="pmid19561910">{{cite journal |vauthors=Al-Ghanem S, Al-Jahdali H, Bamefleh H, Khan AN |title=Bronchiolitis obliterans organizing pneumonia: pathogenesis, clinical features, imaging and therapy review |journal=Ann Thorac Med |volume=3 |issue=2 |pages=67–75 |year=2008 |pmid=19561910 |pmc=2700454 |doi=10.4103/1817-1737.39641 |url=}}</ref>
+* [[Thymoma]] as an anterior mediastinal mass.
-*[[Pulmonary function tests]] demonstrate low fev1/fvc
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-|-
+* [[Thymoma]] as an anterior mediastinal mass.
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
-*[[Langerhans cell histiocytosis|Langerhans]] cell [[Langerhans cell histiocytosis|Histiocytosis]]<ref name="pmid22429393">{{cite journal |vauthors=Suri HS, Yi ES, Nowakowski GS, Vassallo R |title=Pulmonary langerhans cell histiocytosis |journal=Orphanet J Rare Dis |volume=7 |issue= |pages=16 |year=2012 |pmid=22429393 |pmc=3342091 |doi=10.1186/1750-1172-7-16 |url=}}</ref>
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-|
+* [[Electromyography]]
-*Exclusively afflicts smokers, with a peak age of onset of between 20 and 40 years.
-*Clinical presentation varies, but symptoms generally include months of dry [[cough]], [[fever]], [[night sweats]] and [[weight loss]].
-*Skin is involved in 80% of the cases, scaly [[erythematous rash]] is typical.
-|
-*Thin-walled cystic cavities are the usual radiographic manifestation, observed in over 50% of patients by either CXR or CT scans.<ref name="pmid2787035">{{cite journal |vauthors=Moore AD, Godwin JD, Müller NL, Naidich DP, Hammar SP, Buschman DL, Takasugi JE, de Carvalho CR |title=Pulmonary histiocytosis X: comparison of radiographic and CT findings |journal=Radiology |volume=172 |issue=1 |pages=249–54 |year=1989 |pmid=2787035 |doi=10.1148/radiology.172.1.2787035 |url=}}</ref>
-|
-*Biopsy of the lung
 |}
-Sarcoidosis must be differentiated from other diseases that cause [[bone pain]], [[edema]], and [[erythema]].
-{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
-|+
-! style="background: #4479BA; width: 180px;" | {{fontcolor|#ffffff|Disease}}
-! style="background: #4479BA; width: 650px;" | {{fontcolor|#ffffff|Findings}}
-|-
-| style="padding: 7px 7px; background: #DCDCDC;" | '''Soft tissue infection'''<br> (Commonly [[cellulitis]])
-| style="padding: 7px 7px; background: #F5F5F5;" | History of skin warmness, swelling and erythema. Bone probing is the definite way to differentiate them.<ref name="pmid8532002">{{cite journal |vauthors=Bisno AL, Stevens DL |title=Streptococcal infections of skin and soft tissues |journal=N. Engl. J. Med. |volume=334 |issue=4 |pages=240–5 |year=1996 |pmid=8532002 |doi=10.1056/NEJM199601253340407 |url=}}</ref><ref name="pmid24947530">{{cite journal |vauthors=Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL, Hirschmann JV, Kaplan SL, Montoya JG, Wade JC |title=Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America |journal=Clin. Infect. Dis. |volume=59 |issue=2 |pages=147–59 |year=2014 |pmid=24947530 |doi=10.1093/cid/ciu296 |url=}}</ref>
-|-
-| style="padding: 7px 7px; background: #DCDCDC;" |'''[[Osteonecrosis]]'''<br>(Avascular necrosis of bone)
-| style="padding: 7px 7px; background: #F5F5F5;" |Previous history of trauma, radiation, use of steroids or biphosphonates are suggestive to differentiate osteonecrosis from ostemyelitis.<ref name="pmid21865285">{{cite journal |vauthors=Shigemura T, Nakamura J, Kishida S, Harada Y, Ohtori S, Kamikawa K, Ochiai N, Takahashi K |title=Incidence of osteonecrosis associated with corticosteroid therapy among different underlying diseases: prospective MRI study |journal=Rheumatology (Oxford) |volume=50 |issue=11 |pages=2023–8 |year=2011 |pmid=21865285 |doi=10.1093/rheumatology/ker277 |url=}}</ref><ref name="pmid25480307">{{cite journal |vauthors=Slobogean GP, Sprague SA, Scott T, Bhandari M |title=Complications following young femoral neck fractures |journal=Injury |volume=46 |issue=3 |pages=484–91 |year=2015 |pmid=25480307 |doi=10.1016/j.injury.2014.10.010 |url=}}</ref><br> MRI is diagnostic.<ref name="pmid22022684">{{cite journal |vauthors=Amanatullah DF, Strauss EJ, Di Cesare PE |title=Current management options for osteonecrosis of the femoral head: part 1, diagnosis and nonoperative management |journal=Am J. Orthop. |volume=40 |issue=9 |pages=E186–92 |year=2011 |pmid=22022684 |doi= |url=}}</ref><ref name="pmid15116601">{{cite journal |vauthors=Etienne G, Mont MA, Ragland PS |title=The diagnosis and treatment of nontraumatic osteonecrosis of the femoral head |journal=Instr Course Lect |volume=53 |issue= |pages=67–85 |year=2004 |pmid=15116601 |doi= |url=}}</ref>
-|-
-| style="padding: 7px 7px; background: #DCDCDC;" |'''[[Charcot arthropathy|Charcot joint]]'''
-| style="padding: 7px 7px; background: #F5F5F5;" |Patients with [[Charcot arthropathy|Charcot joint]] commonly develop skin ulcerations that can in turn lead to secondary osteomyelitis.<br>Contrast-enhanced MRI may be diagnostically useful if it shows a sinus tract, replacement of soft tissue fat, a fluid collection, or extensive marrow abnormalities. Bone biopsy is the definitive diagnostic modality.<ref name="pmid16436821">{{cite journal |vauthors=Ahmadi ME, Morrison WB, Carrino JA, Schweitzer ME, Raikin SM, Ledermann HP |title=Neuropathic arthropathy of the foot with and without superimposed osteomyelitis: MR imaging characteristics |journal=Radiology |volume=238 |issue=2 |pages=622–31 |year=2006 |pmid=16436821 |doi=10.1148/radiol.2382041393 |url=}}</ref>
-|-
-| style="padding: 7px 7px; background: #DCDCDC;" |'''[[Bone tumors]]'''
-| style="padding: 7px 7px; background: #F5F5F5;" |May present with local pain and radiographic changes consistent with osteomyelitis. <br>Tumors most likely to mimic osteomyelitis are ''osteoid osteomas'' and ''chondroblastomas'' that produce small, round, radiolucent lesions on radiographs.<ref>{{cite book | last = Lovell | first = Wood | title = Lovell and Winter's pediatric orthopaedics | publisher = Wolters Kluwer Health/Lippincott Williams & Wilkins | location = Philadelphia | year = 2014 | isbn = 978-1605478142 }}</ref>
-|-
-| style="padding: 7px 7px; background: #DCDCDC;" |'''[[Gout]]'''
-| style="padding: 7px 7px; background: #F5F5F5;" |Gout presents with [[joint pain]] and [[swelling]]. Joint aspiration and crystals in synovial fluid is diagnostic for gout.<ref name="pmid20662061">{{cite journal |vauthors=Joosten LA, Netea MG, Mylona E, Koenders MI, Malireddi RK, Oosting M, Stienstra R, van de Veerdonk FL, Stalenhoef AF, Giamarellos-Bourboulis EJ, Kanneganti TD, van der Meer JW |title=Engagement of fatty acids with Toll-like receptor 2 drives interleukin-1β production via the ASC/caspase 1 pathway in monosodium urate monohydrate crystal-induced gouty arthritis |journal=Arthritis Rheum. |volume=62 |issue=11 |pages=3237–48 |year=2010 |pmid=20662061 |pmc=2970687 |doi=10.1002/art.27667 |url=}}</ref>
-|-
-| style="padding: 7px 7px; background: #DCDCDC;" |'''[[SAPHO syndrome]]'''<br>(Synovitis, acne, pustulosis, hyperostosis, and osteitis)
-| style="padding: 7px 7px; background: #F5F5F5;" |[[SAPHO syndrome]] consists of a wide spectrum of neutrophilic [[dermatosis]] associated with aseptic osteoarticular lesions. <br>It can mimic osteomyelitis in patients who lack the characteristic findings of pustulosis and [[synovitis]]. <br>The diagnosis is established via clinical manifestations; bone culture is sterile in the setting of [[osteitis]].
-|-
-| style="padding: 7px 7px; background: #DCDCDC;" |'''[[Sarcoidosis]]'''
-| style="padding: 7px 7px; background: #F5F5F5;" |It involves most frequently the pulmonary [[parenchyma]] and mediastinal lymph nodes, but any organ system can be affected. <br>Bone involvement is often bilateral and bones commonly affected include the middle and distal phalanges (producing “sausage finger”), wrist, skull, vertebral column, and long bones.
-|-
-| style="padding: 7px 7px; background: #DCDCDC;" |'''[[Langerhans' cell histiocytosis]]'''
-| style="padding: 7px 7px; background: #F5F5F5;" |The disease usually manifests in the skeleton and solitary bone lesions are encountered twice as often as multiple bone lesions.<br>The tumours can develop in any bone, but most commonly originate in the skull and jaw, followed by vertebral bodies, ribs, pelvis, and long bones.<ref name="pmid26461144">{{cite journal |vauthors=Picarsic J, Jaffe R |title=Nosology and Pathology of Langerhans Cell Histiocytosis |journal=Hematol. Oncol. Clin. North Am. |volume=29 |issue=5 |pages=799–823 |year=2015 |pmid=26461144 |doi=10.1016/j.hoc.2015.06.001 |url=}}</ref>
-|-
-|}
-must be differentiated from other causes of hypercalcaemia
-{|
-! colspan="9" style="background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Differential diagnosis of hyperparathyroidism on the basis of hypercalcemia}}
-|-
-! colspan="2" rowspan="2" style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Disorder}}
-! rowspan="2" style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Mechanism of hypercalcemia}}
-! rowspan="2" style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Clinical features}}
-! colspan="4" style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Laboratory findings}}
-! rowspan="2" style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Imaging & diagnostic modalities}}
-|-
-! style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|PTH}}
-! style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Calcium}}
-! style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Phosphate}}
-! style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Other findings}}
-|-
-! rowspan="3" style="background: #DCDCDC; text-align: center;" |'''Hyperparathyroidism'''
-! style="background: #DCDCDC; text-align: center;" |Primary hyperparathyroidism
-| style="background: #F5F5F5;" |Increase in [[secretion]] of [[parathyroid hormone]] ([[PTH]]) from a primary process in [[parathyroid gland]]. [[Parathyroid hormone]] causes increase in [[serum]] [[calcium]].
-| style="background: #F5F5F5;" |
-* Usually asymptomatic
-* [[Hypercalcemia]] detected on routine biochemical  panel
-| style="background: #F5F5F5; text-align: center;" |↑
-| style="background: #F5F5F5; text-align: center;" |↑
-| style="background: #F5F5F5; text-align: center;" |↓/Normal
-| style="background: #F5F5F5; text-align: center;" |Normal/↑ calcitriol
-| rowspan="3" style="background: #F5F5F5;" |Findings of bone resorption:
-* [[X-ray]]
-* [[Dual energy X-ray absorptiometry]] ([[DXA]])
-Preoperative localization of hyperfunctioning [[parathyroid gland]]:
-* Non-Invasive
-** [[Tc-99m sestamibi scintigraphy]]
-** Neck [[ultrasound]]
-** 4D-CT
-** [[SPECT]](P-SPECT)
-** [[Positron emission tomography|PET]]
-** [[MRI]]
-* Invasive:
-** Super sensitive [[venous]] sampling
-** Selective [[arteriography]]
-** [[Angiogram|Angiography]]
-Predicting post-operative success:
-* [[Intraoperative parathyroid hormone]] monitoring
-|-
-! style="background: #DCDCDC; text-align: center;" |Secondary hyperparathyroidism
-| style="background: #F5F5F5;" |Increase in [[secretion]] of [[parathyroid hormone]] ([[PTH]]) from a secondary process. [[Parathyroid hormone]] causes increase in [[serum]] [[calcium]] after long periods.
-| style="background: #F5F5F5;" |
-* May present with history of:
-** [[Chronic renal failure]]
-** [[Vitamin D deficiency]]
-| style="background: #F5F5F5; text-align: center;" |↑
-| style="background: #F5F5F5; text-align: center;" |↓/Normal
-| style="background: #F5F5F5; text-align: center;" |↑
-| style="background: #F5F5F5; text-align: center;" | --
-|-
-! style="background: #DCDCDC; text-align: center;" |Tertiary hyperparathyroidism
-| style="background: #F5F5F5;" |Continuous elevation of [[parathyroid hormone]] (PTH) even after successful treatment of the secondary cause of  elevated [[parathyroid hormone]]. [[Parathyroid hormone]] causes increase in serum calcium.
-| style="background: #F5F5F5;" |
-* Usually present with history of [[kidney transplant]]
-* Usually [[hyperplasia]] of all four [[parathyroid glands]]
-| style="background: #F5F5F5; text-align: center;" |↑
-| style="background: #F5F5F5; text-align: center;" |↑
-| style="background: #F5F5F5; text-align: center;" |↑
-| style="background: #F5F5F5; text-align: center;" | --
-|-
-! colspan="2" style="background: #DCDCDC; text-align: center;" |[[Familial hypocalciuric hypercalcemia]]
-| style="background: #F5F5F5;" |This is a [[genetic disorder]] caused my [[mutation]] in [[calcium-sensing receptor]] gene.
-| style="background: #F5F5F5;" |
-* A benign condition
-* Does not require treatment
-| style="background: #F5F5F5; text-align: center;" |Normal/↑
-| style="background: #F5F5F5; text-align: center;" |Normal/↑
-| style="background: #F5F5F5; text-align: center;" | --
-| style="background: #F5F5F5; text-align: center;" | --
-| style="background: #F5F5F5;" |
-* Urinary calcium/creatinine clearance ratio
-|-
-! rowspan="4" style="background: #DCDCDC; text-align: center;" |'''Malignancy'''<ref name="pmid26713296">{{cite journal |vauthors=Mirrakhimov AE |title=Hypercalcemia of Malignancy: An Update on Pathogenesis and Management |journal=N Am J Med Sci |volume=7 |issue=11 |pages=483–93 |year=2015 |pmid=26713296 |pmc=4683803 |doi=10.4103/1947-2714.170600 |url=}}</ref>
-! style="background: #DCDCDC; text-align: center;" |Humoral hypercalcemia of malignancy<ref name="pmid1346019">{{cite journal |vauthors=Ratcliffe WA, Hutchesson AC, Bundred NJ, Ratcliffe JG |title=Role of assays for parathyroid-hormone-related protein in investigation of hypercalcaemia |journal=Lancet |volume=339 |issue=8786 |pages=164–7 |year=1992 |pmid=1346019 |doi=10.1016/0140-6736(92)90220-W |url=}}</ref><ref name="pmid7962324">{{cite journal |vauthors=Ikeda K, Ohno H, Hane M, Yokoi H, Okada M, Honma T, Yamada A, Tatsumi Y, Tanaka T, Saitoh T |title=Development of a sensitive two-site immunoradiometric assay for parathyroid hormone-related peptide: evidence for elevated levels in plasma from patients with adult T-cell leukemia/lymphoma and B-cell lymphoma |journal=J. Clin. Endocrinol. Metab. |volume=79 |issue=5 |pages=1322–7 |year=1994 |pmid=7962324 |doi=10.1210/jcem.79.5.7962324 |url=}}</ref><ref name="pmid12679445">{{cite journal |vauthors=Horwitz MJ, Tedesco MB, Sereika SM, Hollis BW, Garcia-Ocaña A, Stewart AF |title=Direct comparison of sustained infusion of human parathyroid hormone-related protein-(1-36) [hPTHrP-(1-36)] versus hPTH-(1-34) on serum calcium, plasma 1,25-dihydroxyvitamin D concentrations, and fractional calcium excretion in healthy human volunteers |journal=J. Clin. Endocrinol. Metab. |volume=88 |issue=4 |pages=1603–9 |year=2003 |pmid=12679445 |doi=10.1210/jc.2002-020773 |url=}}</ref>
-| style="background: #F5F5F5;" |[[Tumor]] cells secretes [[parathyroid hormone-related protein]] ([[PTHrP]]) which has similar action as [[parathyroid hormone]].
-| style="background: #F5F5F5;" |
-* Most common cause of [[malignancy]] related [[hypercalcemia]]
-* Usually present with [[solid tumors]]
-| style="background: #F5F5F5; text-align: center;" | --
-| style="background: #F5F5F5; text-align: center;" |↑
-| style="background: #F5F5F5; text-align: center;" |↓/Normal
-| style="background: #F5F5F5; text-align: center;" |↑ [[PTHrP]]
-Normal/↑ calcitriol
-| style="background: #F5F5F5;" |
-* [[Chest X-rays|Chest X-ray]]
-* [[CT scan]]
-* [[MRI]]
-|-
-! style="background: #DCDCDC; text-align: center;" |Osteolytic tumors
-| style="background: #F5F5F5;" |[[Multiple myeloma]] produces [[osteolysis]] of [[bones]] causing [[hypercalcemia]]. [[Osteolytic metasteses]] can cause [[bone resorption]] causing [[hypercalcemia]].
-| style="background: #F5F5F5;" |
-* Commonly present in [[multiple myeloma]] and [[breast cancer]]
-| style="background: #F5F5F5; text-align: center;" |↓
-| style="background: #F5F5F5; text-align: center;" |↑
-| style="background: #F5F5F5; text-align: center;" | --
-| style="background: #F5F5F5; text-align: center;" | --
-| style="background: #F5F5F5;" |
-* [[DXA]]
-* [[X-ray]]
-* [[Mammography]]
-* [[Ultrasound]]
-* [[ESR]]
-* [[Serum protein electrophoresis]]
-|-
-! style="background: #DCDCDC; text-align: center;" |Production of calcitirol
-| style="background: #F5F5F5;" |Some tumors has ectopic activity of 1-alpha-hydroxylase leading to increased production of [[calcitriol]]. [[Calcitriol]] is active form of [[vitamin D]] and causes [[hypercalcemia]].
-| style="background: #F5F5F5;" |
-* Commonly present in [[lymphomas]] and in some [[Ovarian cancer|ovarian germ cell tumors]]
-| style="background: #F5F5F5; text-align: center;" | --
-| style="background: #F5F5F5; text-align: center;" |↑
-| style="background: #F5F5F5; text-align: center;" | --
-| style="background: #F5F5F5; text-align: center;" |↑ [[Calcitriol]]
-| style="background: #F5F5F5;" |
-* [[CT scan]]
-* [[MRI]]
-|-
-! style="background: #DCDCDC; text-align: center;" |Ectopic parathyroid hormone<ref name="pmid16263810">{{cite journal |vauthors=VanHouten JN, Yu N, Rimm D, Dotto J, Arnold A, Wysolmerski JJ, Udelsman R |title=Hypercalcemia of malignancy due to ectopic transactivation of the parathyroid hormone gene |journal=J. Clin. Endocrinol. Metab. |volume=91 |issue=2 |pages=580–3 |year=2006 |pmid=16263810 |doi=10.1210/jc.2005-2095 |url=}}</ref>
-| style="background: #F5F5F5;" |Some tumors leads to [[Ectopia|ectopic]] production of [[parathyroid hormone]].
-| style="background: #F5F5F5;" |
-* In rare instances, [[small cell carcinoma of lung]] may produce [[hypercalcemia]] by this process
-| style="background: #F5F5F5; text-align: center;" |↑
-| style="background: #F5F5F5; text-align: center;" |↑
-| style="background: #F5F5F5; text-align: center;" |↓/Normal
-| style="background: #F5F5F5; text-align: center;" |Normal/↑ [[calcitriol]]
-| style="background: #F5F5F5;" |
-* [[Chest X-rays|Chest X-ray]]
-* [[CT scan]]
-* [[MRI]]
-|-
-! rowspan="2" style="background: #DCDCDC; text-align: center;" |'''Medication induced'''
-! style="background: #DCDCDC; text-align: center;" |Lithium<ref name="pmid2918061">{{cite journal |vauthors=Mallette LE, Khouri K, Zengotita H, Hollis BW, Malini S |title=Lithium treatment increases intact and midregion parathyroid hormone and parathyroid volume |journal=J. Clin. Endocrinol. Metab. |volume=68 |issue=3 |pages=654–60 |year=1989 |pmid=2918061 |doi=10.1210/jcem-68-3-654 |url=}}</ref>
-| style="background: #F5F5F5;" |[[Lithium]] lowers [[Urinary System|urinary]] [[calcium]] and causes [[hypercalcemia]]. [[Lithium]] has been reported to cause an increase in [[parathyroid hormone]] and enlargement if [[parathyroid gland]] after weeks to months of therapy.
-| style="background: #F5F5F5;" |
-* History of [[mood disorder]]
-| style="background: #F5F5F5; text-align: center;" |↑
-| style="background: #F5F5F5; text-align: center;" |↑
-| style="background: #F5F5F5; text-align: center;" | --
-| style="background: #F5F5F5; text-align: center;" | --
-| style="background: #F5F5F5;" |
-* [[Lithium]] levels
-|-
-! style="background: #DCDCDC; text-align: center;" |Thiazide diuretics
-| style="background: #F5F5F5;" |[[Thiazide diuretics]] lowers [[urinary]] [[calcium]] [[excretion]] and causes [[hypercalcemia]].
-| style="background: #F5F5F5;" |
-* History of [[cardiac]] disorder
-* Rarely causes [[hypercalcemia]]
-| style="background: #F5F5F5; text-align: center;" | --
-| style="background: #F5F5F5; text-align: center;" |↑
-| style="background: #F5F5F5; text-align: center;" | --
-| style="background: #F5F5F5; text-align: center;" | --
-| style="background: #F5F5F5;" | --
-|-
-! rowspan="2" style="background: #DCDCDC; text-align: center;" |'''Nutritional'''
-! style="background: #DCDCDC; text-align: center;" |Milk-alkali syndrome
-| style="background: #F5F5F5;" |[[Hypercalcemia]] is be caused by high intake of [[calcium carbonate]].
-| style="background: #F5F5F5;" |
-* History of
-** High milk intake
-** Excess calcium intake for treating:
-*** [[Osteoporosis]]
-*** [[Dyspepsia]]
-* May lead to [[metabolic alkalosis]] and [[renal insufficiency]].
-| style="background: #F5F5F5; text-align: center;" | --
-| style="background: #F5F5F5; text-align: center;" |↑
-| style="background: #F5F5F5; text-align: center;" | --
-| style="background: #F5F5F5; text-align: center;" | --
-| style="background: #F5F5F5;" |
-* [[Renal function tests]]
-|-
-! style="background: #DCDCDC; text-align: center;" |Vitamin D toxicity
-| style="background: #F5F5F5;" |Excess [[vitamin D]] causes increased [[absorption]] of [[calcium]] from [[intestine]] causing [[hypercalcemia]].
-| style="background: #F5F5F5;" |
-* History of:
-** Excess intake [[vitamin D]]
-** Excess milk fortified with [[vitamin D]]<ref name="pmid1313547">{{cite journal |vauthors=Jacobus CH, Holick MF, Shao Q, Chen TC, Holm IA, Kolodny JM, Fuleihan GE, Seely EW |title=Hypervitaminosis D associated with drinking milk |journal=N. Engl. J. Med. |volume=326 |issue=18 |pages=1173–7 |year=1992 |pmid=1313547 |doi=10.1056/NEJM199204303261801 |url=}}</ref>
-** Topical application of vitamin D analogue [[calcipotriol]]<ref name="pmid8120527">{{cite journal |vauthors=Hoeck HC, Laurberg G, Laurberg P |title=Hypercalcaemic crisis after excessive topical use of a vitamin D derivative |journal=J. Intern. Med. |volume=235 |issue=3 |pages=281–2 |year=1994 |pmid=8120527 |doi= |url=}}</ref>
-| style="background: #F5F5F5; text-align: center;" | --
-| style="background: #F5F5F5; text-align: center;" |↑
-| style="background: #F5F5F5; text-align: center;" | --
-| style="background: #F5F5F5; text-align: center;" |↑ [[Vitamin D]] ([[calcidiol]] and/or [[calcitriol]])
-| style="background: #F5F5F5;" | --
-|-
-! style="background: #DCDCDC; text-align: center;" |'''Granulomatous disease'''
-! style="background: #DCDCDC; text-align: center;" |Sarcoidosis<ref name="pmid9215298">{{cite journal |vauthors=Dusso AS, Kamimura S, Gallieni M, Zhong M, Negrea L, Shapiro S, Slatopolsky E |title=gamma-Interferon-induced resistance to 1,25-(OH)2 D3 in human monocytes and macrophages: a mechanism for the hypercalcemia of various granulomatoses |journal=J. Clin. Endocrinol. Metab. |volume=82 |issue=7 |pages=2222–32 |year=1997 |pmid=9215298 |doi=10.1210/jcem.82.7.4074 |url=}}</ref>
-| style="background: #F5F5F5;" |[[Hypercalcemia]] is causes by endogeous production of [[calcitriol]] by disease-activated [[Macrophage|macrophages]].
-| style="background: #F5F5F5;" |
-* History of:
-** [[Cough]]
-** [[Dyspnea]]
-** [[Chest pain]]
-** [[Tiredness]] or [[weakness]]
-** [[Fever]]
-** [[Weight loss]]
-| style="background: #F5F5F5; text-align: center;" | --
-| style="background: #F5F5F5; text-align: center;" |↑
-| style="background: #F5F5F5; text-align: center;" | --
-| style="background: #F5F5F5; text-align: center;" |↑ [[Calcitriol]]
-↑ [[ACE]] levels
-| style="background: #F5F5F5;" |
-* [[Chest X-ray]]
-* [[Biopsy]]
-|}
-Sarcoidosis must be differentiated from other causes of diabetes insipidus.
-{| class="wikitable"
-!Type of DI
-!Subclass
-!Disease
-!Defining signs and symptoms
-!Lab/Imaging findings
-|-
-| rowspan="5" |Central
-| rowspan="3" |Acquired
-|[[Histiocytosis]]
-|
-* Bone lysis and [[Bone fracture|fracture]]
-* Purulent [[otitis media]]
-* [[Diabetes insipidus]] and delayed puberty
-* [[Maxillary]], [[mandibular]], and [[gingival]] disease
-* [[Rash]] and [[Erythematous|maculoerythematous]] skin lesions
-* Scaly, [[erythematous]] scalp patches
-* [[Lung]] involvement
-* [[GI bleeding]]
-* [[Lymphadenopathy|Lymph node enlargement]]<ref name="pmid1340034">{{cite journal| author=Ghosh KN, Bhattacharya A| title=Gonotrophic nature of Phlebotomus argentipes (Diptera: Psychodidae) in the laboratory. | journal=Rev Inst Med Trop Sao Paulo | year= 1992 | volume= 34 | issue= 2 | pages= 181-2 | pmid=1340034 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1340034  }} </ref>
-|
-* CD1a and CD45 +
-* Interleukin-17 (ILITA)
-[[Image:Langerhans Skull X ray.jpg|center|300px|thumb|Skull x-ray of a patient with Langerhan's histiocytosis showing lytic lesions - Case courtesy of Dr Hani Salam, Radiopaedia.org, rID: 9459]]
-|-
-|[[Craniopharyngioma]]
-|
-* [[Headache]]
-* [[Endocrine disorders|Endocrine dysfunction]]
-** [[Diabetes insipidus]]
-** [[Hypothyroidism]]
-** [[Adrenal failure]]
-** [[Diabetes insipidus]] (e.g., excessive fluid intake and urination)
-** Growth failure and [[delayed puberty]]
-|
-* [[Suprasellar]] calcified cyst on [[MRI]]
-[[Image:Craniopharyngioma-papillary-1.jpg|center|300px|thumb|Brain MRI showing suprasellar mass consistent with the diagnosis of craniopharyngioma - Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 16812]]
-|-
-|[[Sarcoidosis]]
-|
-* Systemic complaints
-** [[Fever]]
-** [[Anorexia]]
-** [[Arthralgias]]
-* Pulmonary complaints
-** [[Dyspnea on exertion]]
-** [[Cough]]
-** Chest pain,
-** [[Hemoptysis]] (rare)
-* [[Diabetes mellitus]]
-|
-* [[Hypercalcemia]]
-* [[Hypercalciuria]] ([[Granulomas|noncaseating granulomas]])
-* Elevated [[alkaline phosphatase]]
-* [[Serum amyloid A]] (SAA)
-* [[Angiotensin-converting enzyme|ACE]] levels may be elevated
-[[Image:Neurosarcoidosis.jpg|center|300px|thumb|Contrast-enhanced patches in a patient previously diagnosed with lung sarcoidosis - Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 10930]]
-|-
-| rowspan="2" |Congenital
-|[[Hydrocephalus]]
-|
-* Cognitive deterioration
-* [[Headaches]]
-* [[Neck pain]]
-* [[Blurred vision]]
-* [[Unsteady gait]]
-* [[Incontinence]] such as [[polyuria]]
-|Dilated [[ventricles]] on [[Computed tomography|CT]] and [[Magnetic resonance imaging|MRI]]
-[[Image:Obstructive-hydrocephalus.jpg|center|300px|thumb|Obstructive hydrocephalus showing dilated lateral ventricles - Case courtesy of Dr Paul Simkin, Radiopaedia.org, rID: 30453]]
-|-
-|[[Wolfram syndrome|Wolfram Syndrome]] (DIDMOAD)
-|
-* [[Diabetes insipidus|Diabetes Insipidus]]
-* [[Diabetes mellitus|Diabetes Mellitus]]
-* [[Optic atrophy|Optic Atrophy]]
-* [[Deafness]]
-|
-* Negative [[islet cell]] antibodies
-* [[Optic atrophy]] on [[electroretinogram]]
-* [[Deafness]] on [[audiogram]]
-* [[Atrophy]] of brain stem on [[Magnetic resonance imaging|MRI]]
-|-
-| rowspan="5" |[[Nephrogenic diabetes insipidus|Nephrogenic]]
-| rowspan="5" |[[Acquired disorder|Acquired]]
-|Drug-induced ([[demeclocycline]], [[lithium]])
-|
-* [[Polyuria]]
-* [[Polydipsia]]
-* [[Nocturia]]
-|
-* [[Urine osmolality]] <100 mmol/
-* [[Arginine vasopressin]] level >4.6 pmol/
-* Little or no response to administration of  exogenous [[arginine vasopressin]]
-|-
-|[[Hypercalcemia]]
-|
-* [[Polyuria]]
-* [[Polydipsia]]
-* [[Gastrointestinal]] disturbances
-* [[Bone fracture|Pathological fractures]]
-* [[Confusion]]
-* [[Palpitations]] and [[cardiac arrhythmias]]
-|
-* Ca levels greater than 11 meq/L
-|-
-|[[Hypokalemia]]
-|
-* [[Polyuria]]
-* [[Hyporeflexia]]
-* [[Palpitations]] and [[cardiac arrhythmias]]
-|
-* K levels less than 3meq/L on CBC
-|-
-|[[Multiple myeloma]]
-|
-* Pathologic [[bone fractures]]
-* [[Bleeding]]
-* [[Hypercalcemia]] leading to [[polyuria]]
-* [[Infection]]
-* [[Hyperviscosity]]
-* [[Anemia]]
-|
-* [[IgG]] or [[IgA]] spike on [[serum protein electrophoresis]]
-* [[Monoclonal antibody|Monoclonal M spike]]
-* Disordered [[plasma cell]] proliferation on [[bone marrow biopsy]]
-[[Image:Multiple-myeloma-skeletal-survey.jpg|center|300px|thumb|Skeletal survey in a patient with multiple myeloma showing multiple lytic lesions - Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 7682]]
-|-
-|[[Sickle-cell disease|Sickle cell disease]]
-|
-* [[Chronic pain]]
-* [[Anemia]]
-* [[Aplastic crisis]]
-* Splenic sequestration
-* [[Infection]]
-* [[Isosthenuria]] presenting with [[polyuria]]
-|
-* [[Hemoglobin]] level is 5-9 g/dL
-* [[Hematocrit]] is decreased to 17-29%
-* [[Peripheral blood smear|Peripheral blood smears]] demonstrate [[Target cell|target cells]], elongated cells, and characteristic sickle erythrocytes
-* MRI can demonstrate [[avascular necrosis]] of the [[femoral]] and [[humeral]] heads
-[[Image:Sickle cells.jpg|center|300px|thumb|Blood film showing the sickle cells - By Dr Graham Beards - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=18421017]]
-|-
-| colspan="2" |Primary polydipsia
-|[[Psychogenic]]
-|
-* [[Polyuria]]
-* [[Polydipsia]]
-* [[Nocturia]]
-|
-* Dry mucus membrane
-* History of [[psychiatric disorders]]
-|-
-| colspan="3" |Gestational diabetes insipidus
-|
-* [[Polyuria]]
-* [[Polydipsia]]
-* [[Nocturia]]
-* [[Pregnancy]]
-|
-* Dry mucus membranes
-* [[Pregnancy]]
-|-
-| colspan="3" |[[Diabetes mellitus]]
-|
-* [[Polyuria]]
-* [[Polydipsia]]
-* [[Nocturia]]
-* [[Weight gain (patient information)|Weight gain]]
-|
-* Elevated blood sugar levels >126
-* Elevated [[HbA1c]] > 6.5
-|}
 ==References==
-{{Reflist|2}}
-[[Category:Pulmonology]]
-[[Category:Rheumatology]]
-{{WH}}
-{{WS}}