Diaphragmatic paralysis differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Diaphragmatic paralysis}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Diaphragmatic_paralysis]]
{{CMG}}; {{AE}}  
{{CMG}}; {{AE}} {{MA}}


==Overview==
==Overview==
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
Unilateral diaphragmatic paralysis must be differentiated from eventration of the [[diaphragm]]. Eventration of the diaphragm is an abnormal elevation of the  hemidiaphragm. [[Bilateral]] diaphragmatic paralysis must be differentiated from other diseases that cause elevation of the diaphragm such as pleural adhesions, subpulmonic effusions, [[obesity]], [[ascites]], abdominal organomegaly and [[ileus]]. Diaphragmatic paralysis must be differentiated from other disease that cause [[dyspnea]] such as [[dermatomyositis]], [[polymyositis]], [[rib fracture]], [[Pleural effusion|pleural effusions]], [[amyotrophic lateral sclerosis]].  


OR
==Differentiating diaphragmatic paralysis from other Diseases  ==
Unilateral diaphragmatic paralysis must be differentiated from eventration of the diaphragm. Eventration of the diaphragm is an abnormal elevation of the  hemidiaphragm that some parts of hemidiaphragm are replaced by [[fibrous tissue]].  Clinical manifestations of eventration of the [[diaphragm]] include [[asymptomatic]], [[infection]] and [[respiratory distress]].<ref name="RavisagarAbhinav2015">{{cite journal|last1=Ravisagar|first1=Patel|last2=Abhinav|first2=Singh|last3=Mathur|first3=R.M.|last4=Anula|first4=Sisodia|title=Eventration of diaphragm presenting as recurrent respiratory tract infections – A case report|journal=Egyptian Journal of Chest Diseases and Tuberculosis|volume=64|issue=1|year=2015|pages=291–293|issn=04227638|doi=10.1016/j.ejcdt.2014.10.002}}</ref> 


[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
[[Bilateral]] diaphragmatic paralysis must be differentiated from other diseases that cause elevation of the diaphragm such as:   
* Pleural adhesions   
* Subpulmonic effusions 
* [[Obesity]] with decreased chest wall compliance   
* [[Ascites]]   
* [[Abdominal]] [[organomegaly]]   
* [[Ileus]] 
'''Diaphragmatic paralysis must be differentiated from other disease that cause dyspnea such as:'''


==Differentiating diaphragmatic paralysis from other Diseases==
<small>'''''Abbreviations:''''' '''ABG ('''[[arterial blood gas]]'''); ACE ('''[[Angiotensin-converting enzyme|angiotensin converting enzyme]]'''); BMI ('''[[body mass index]]'''); CBC ('''[[Complete blood counts|complete blood count]]'''); CSF ('''[[cerebrospinal fluid]]'''); CXR ('''[[chest X-ray]]'''); DOE ('''dyspnea on [[exercise]]'''); ECG ('''[[electrocardiogram]]'''); FEF ('''[[Spirometry|forced expiratory flow rate]]'''); FEV1 ('''[[forced expiratory volume]]'''); FVC ('''[[forced vital capacity]]'''); JVD ('''[[jugular vein distention]]''');''' '''MCV ('''[[mean corpuscular volume]]'''); Plt ('''[[platelet]]'''); RV ('''[[residual volume]]'''); SIADH ('''[[syndrome of inappropriate antidiuretic hormone]]'''); TSH ('''[[thyroid stimulating hormone]]'''); Vt ('''[[tidal volume]]''');''' '''WBC ('''[[White blood cells|white blood cell]]''');'''</small>  
Unilateral diaphragmatic paralysis must be diffrentiated from eventration of the diaphragm. Eventration of the diaphragam is an abnormal elevation of the  hemidiaphragm that some parts of hemidiaphragm are replaced by fibrous tissue.  Clinical manifetations of diaphragmatic paralysis  include asymptomatic, infection and respiratory distress.<ref name="RavisagarAbhinav2015" />


Bilateral diaphragmatic paralysis must be differentiated from other diseases that cause elevation of the diaphragm such as   
<small><small>
* Pleural adhesions   
{|
* Subpulmonic effusions 
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
* Obesity with decreased chest wall compliance   
! colspan="3" rowspan="3" |Organ system
* Ascites   
! rowspan="3" |Diseases
* Abdominal organomegaly   
! colspan="13" |Clinical manifestations
* Ileus 
! colspan="5" rowspan="2" |Diagnosis
The differential diagnosis of bilateral diaphragmatic elevation on the plain chest radiograph includes subpulmonic effusions, pleural adhesions, obesity with decreased chest wall and abdominal compliance, and subdiaphragmatic processes such as ascites, organomegaly, and ileus.<ref name="RavisagarAbhinav2015">{{cite journal|last1=Ravisagar|first1=Patel|last2=Abhinav|first2=Singh|last3=Mathur|first3=R.M.|last4=Anula|first4=Sisodia|title=Eventration of diaphragm presenting as recurrent respiratory tract infections – A case report|journal=Egyptian Journal of Chest Diseases and Tuberculosis|volume=64|issue=1|year=2015|pages=291–293|issn=04227638|doi=10.1016/j.ejcdt.2014.10.002}}</ref>
! rowspan="3" |Other features
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! colspan="8" |Symptoms
! colspan="5" |Physical exam
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Loss of consciousness
!Agitation
!Weight loss
!Fever
!Chest pain
!Cough
!Orthopnea
!DOE
!Cyanosis
!Clubbing
!JVD
!Peripheral edema
!Auscultation
!CBC
!ABG
!Imaging
!Spirometry
!Gold standard
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
! rowspan="14" |Acute Dyspnea
! rowspan="9" |[[Respiratory system]]
![[Head]] and [[Neck]],
Upper [[airway]]
![[Aspiration]]<ref name="pmid25581840">{{cite journal| author=O'Horo JC, Rogus-Pulia N, Garcia-Arguello L, Robbins J, Safdar N| title=Bedside diagnosis of dysphagia: a systematic review. | journal=J Hosp Med | year= 2015 | volume= 10 | issue= 4 | pages= 256-65 | pmid=25581840 | doi=10.1002/jhm.2313 | pmc=4607509 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25581840  }}</ref>
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |Diminished [[breath sounds]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |[[Atelectasis]]
! style="background: #F5F5F5; padding: 5px;" |↓[[Tidal volume|Vt]], ↑[[Residual volume|RV]]
! style="background: #F5F5F5; padding: 5px;" |[[Bronchoscopy]]
! style="background: #F5F5F5; padding: 5px;" |[[Choking]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
! rowspan="8" |[[Chest]] and [[Pleurae|Pleura]],
Lower [[airway]]
!'''[[Atelectasis]]'''
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |Diminished [[breath sounds]], [[Wheeze]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |↓[[Oxygen|O2]], Normal/↓[[CO2]]
! style="background: #F5F5F5; padding: 5px;" |Collapsed lung lobe, [[Fissure|fissures]]<nowiki/>displacement
! style="background: #F5F5F5; padding: 5px;" |↓ [[FVC]]
! style="background: #F5F5F5; padding: 5px;" |[[CT scan|Chest CT scan]]
! style="background: #F5F5F5; padding: 5px;" |[[Surgical procedure]], [[Aspiration]],  
[[Mechanical ventilation]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
![[Bronchitis]]<ref name="CantinBankier2009">{{cite journal|last1=Cantin|first1=Luce|last2=Bankier|first2=Alexander A.|last3=Eisenberg|first3=Ronald L.|title=Bronchiectasis|journal=American Journal of Roentgenology|volume=193|issue=3|year=2009|pages=W158–W171|issn=0361-803X|doi=10.2214/AJR.09.3053}}</ref>
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |[[Rhonchi]] 
! style="background: #F5F5F5; padding: 5px;" |↑[[WBC]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |[[Physical examination|Physical exam]]
! style="background: #F5F5F5; padding: 5px;" |[[Rhonchi]] relieved by [[Dextromethorphan|cough]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
![[Bronchiolitis]]<ref name="pmid23562737">{{cite journal |vauthors=Holbro A, Lehmann T, Girsberger S, Stern M, Gambazzi F, Lardinois D, Heim D, Passweg JR, Tichelli A, Bubendorf L, Savic S, Hostettler K, Grendelmeier P, Halter JP, Tamm M |title=Lung histology predicts outcome of bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation |journal=Biol. Blood Marrow Transplant. |volume=19 |issue=6 |pages=973–80 |year=2013 |pmid=23562737 |doi=10.1016/j.bbmt.2013.03.017 |url=}}</ref>
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |[[Wheeze]] and [[Crackles]]
! style="background: #F5F5F5; padding: 5px;" |↑[[WBC]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Bronchovascular markings
! style="background: #F5F5F5; padding: 5px;" |↓[[Tidal volume|Vt]]
! style="background: #F5F5F5; padding: 5px;" |[[Clinical]] assessment
! style="background: #F5F5F5; padding: 5px;" |[[Respiratory syncytial virus|Respiratory syncytial virus (RSV)]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
![[Lung carcinoma]]<ref name="pmid22054876">{{cite journal| author=Dela Cruz CS, Tanoue LT, Matthay RA| title=Lung cancer: epidemiology, etiology, and prevention. | journal=Clin Chest Med | year= 2011 | volume= 32 | issue= 4 | pages= 605-44 | pmid=22054876 | doi=10.1016/j.ccm.2011.09.001 | pmc=3864624 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22054876  }}</ref>
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |[[Wheeze]] and [[Crackles]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Mass lesion, [[hilar lymphadenopathy]]
! style="background: #F5F5F5; padding: 5px;" |↓[[Tidal volume|Vt]], ↑[[Residual volume|RV]]
! style="background: #F5F5F5; padding: 5px;" |[[Bronchoscopy]] 
! style="background: #F5F5F5; padding: 5px;" |Paraneoplastic syndromes, such as [[Syndrome of inappropriate antidiuretic hormone|SIADH]] and [[Lambert-Eaton myasthenic syndrome|lambert-Eaton]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
![[Pneumonia]]<ref name="pmid25165554">{{cite journal| author=Simonetti AF, Viasus D, Garcia-Vidal C, Carratalà J| title=Management of community-acquired pneumonia in older adults. | journal=Ther Adv Infect Dis | year= 2014 | volume= 2 | issue= 1 | pages= 3-16 | pmid=25165554 | doi=10.1177/2049936113518041 | pmc=4072047 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25165554  }}</ref>
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |[[Wheeze]], [[Rhonchi]], and [[Crackles]]
! style="background: #F5F5F5; padding: 5px;" |↑[[WBC]], [[neutrophilia]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |[[Consolidation (medicine)|Lobar consolidation]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |[[Chest X-ray]] and CT Scan
! style="background: #F5F5F5; padding: 5px;" |[[productive cough]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
![[Pneumothorax]]<ref name="pmid17621614">{{cite journal| author=Currie GP, Alluri R, Christie GL, Legge JS| title=Pneumothorax: an update. | journal=Postgrad Med J | year= 2007 | volume= 83 | issue= 981 | pages= 461-5 | pmid=17621614 | doi=10.1136/pgmj.2007.056978 | pmc=2600088 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17621614  }}</ref>
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |Diminished [[breath sounds]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |↓[[Oxygen|O2]], ↑[[CO2]]
! style="background: #F5F5F5; padding: 5px;" |Radiolucency without [[lung]] marking
! style="background: #F5F5F5; padding: 5px;" |↓[[Tidal volume|Vt]]
! style="background: #F5F5F5; padding: 5px;" |CXR and [[Computed tomography|Chest CT scan]]
! style="background: #F5F5F5; padding: 5px;" |[[Tracheal deviation]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
![[Pulmonary embolism]]<ref name="pmid23940438">{{cite journal| author=Bĕlohlávek J, Dytrych V, Linhart A| title=Pulmonary embolism, part I: Epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism. | journal=Exp Clin Cardiol | year= 2013 | volume= 18 | issue= 2 | pages= 129-38 | pmid=23940438 | doi= | pmc=3718593 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23940438  }}</ref>
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |[[Respiratory alkalosis]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |[[Lung|Pulmonary]] [[CT angiography]]
! style="background: #F5F5F5; padding: 5px;" |[[Pleuritic chest pain]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
![[Rib fractures]] ([[flail chest]])<ref name="pmid27984449">{{cite journal |vauthors=Swart E, Laratta J, Slobogean G, Mehta S |title=Operative Treatment of Rib Fractures in Flail Chest Injuries: A Meta-analysis and Cost-Effectiveness Analysis |journal=J Orthop Trauma |volume=31 |issue=2 |pages=64–70 |date=February 2017 |pmid=27984449 |doi=10.1097/BOT.0000000000000750 |url= |author=}}</ref>
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |[[Respiratory acidosis]]
! style="background: #F5F5F5; padding: 5px;" |Fracture marks
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |[[Chest X-ray]]
! style="background: #F5F5F5; padding: 5px;" |[[Pneumothorax]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
! colspan="2" rowspan="2" |[[Cardiovascular system]]
![[Pericardial tamponade]]<ref name="pmid12481882">{{cite journal |vauthors=van Steijn JH, Sleijfer DT, van der Graaf WT, van der Sluis A, Nieboer P |title=How to diagnose cardiac tamponade |journal=Neth J Med |volume=60 |issue=8 |pages=334–8 |year=2002 |pmid=12481882 |doi= |url=}}</ref>
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |[[Muffled heart sounds]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Water bottle appearance [[Cardiomegaly|enlarged heart]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |[[Echocardiography]]
! style="background: #F5F5F5; padding: 5px;" |Fluid accumulation in [[pericardium]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
![[Pulmonary edema]]<ref name="MartindaleNoble2013">{{cite journal|last1=Martindale|first1=Jennifer L.|last2=Noble|first2=Vicki E.|last3=Liteplo|first3=Andrew|title=Diagnosing pulmonary edema|journal=European Journal of Emergency Medicine|volume=20|issue=5|year=2013|pages=356–360|issn=0969-9546|doi=10.1097/MEJ.0b013e32835c2b88}}</ref>
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |Basal [[Crackles|crackle]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |[[Respiratory alkalosis]]
! style="background: #F5F5F5; padding: 5px;" |Bat wing pattern, air bronchograms
! style="background: #F5F5F5; padding: 5px;" |↓[[Tidal volume|Vt]], ↑[[Residual volume|RV]]
! style="background: #F5F5F5; padding: 5px;" |[[Coronary catheterization|Cardiac Catheterization]]
! style="background: #F5F5F5; padding: 5px;" |[[Tachypnea]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
! colspan="2" rowspan="3" |[[Central nervous system]]
![[Stroke]]
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |[[Intracranial hemorrhage|Intracranial infarct or hemorrhage]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |[[Brain]] [[MRI]]
! style="background: #F5F5F5; padding: 5px;" |[[Paralysis]] or [[Paresthesias|paresthesia]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
![[Encephalitis]]<ref name="pmid15489354">{{cite journal| author=Debiasi RL, Tyler KL| title=Molecular methods for diagnosis of viral encephalitis. | journal=Clin Microbiol Rev | year= 2004 | volume= 17 | issue= 4 | pages= 903-25, table of contents | pmid=15489354 | doi=10.1128/CMR.17.4.903-925.2004 | pmc=523566 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15489354  }}</ref>
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |↑[[WBC]], [[neutrophilia]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |[[CSF]] [[PCR]]
! style="background: #F5F5F5; padding: 5px;" |[[Confusion]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
![[Traumatic brain injury]]<ref name="pmid22033563">{{cite journal| author=McAllister TW| title=Neurobiological consequences of traumatic brain injury. | journal=Dialogues Clin Neurosci | year= 2011 | volume= 13 | issue= 3 | pages= 287-300 | pmid=22033563 | doi= | pmc=3182015 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22033563  }}</ref>
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |[[Respiratory acidosis]]
! style="background: #F5F5F5; padding: 5px;" |[[Intracerebral hemorrhage]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |[[Ct scan|Brain CT scan]]
! style="background: #F5F5F5; padding: 5px;" |[[Lucid interval]]
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! colspan="3" rowspan="3" |Organ system
! rowspan="3" |Diseases
! colspan="13" |Clinical manifestations
! colspan="5" rowspan="2" |Diagnosis
! rowspan="3" |Other features
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! colspan="8" |Symptoms
! colspan="5" |Physical exam
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Loss of consciousness
!Agitation
!Weight loss
!Fever
!Chest pain
!Cough
!Orthopnea
!DOE
!Cyanosis
!Clubbing
!JVD
!Peripheral edema
!Auscultation
!CBC
!ABG
!Imaging
!Spirometry
!Gold standard
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
! rowspan="18" |Chronic Dyspnea
! rowspan="9" |[[Respiratory system]]
! rowspan="2" |[[Head]] and [[Neck]],


EVENTRATION OF THE DIAPHRAGM — Eventration of the diaphragm is a disorder in which all or part of the diaphragmatic muscle is replaced by fibroelastic tissue, leading to a thinned and pliable central portion of the diaphragm.
Upper [[airway]]
![[Goiter]]<ref name="pmid22430090">{{cite journal |vauthors=Stang MT, Armstrong MJ, Ogilvie JB, Yip L, McCoy KL, Faber CN, Carty SE |title=Positional dyspnea and tracheal compression as indications for goiter resection |journal=Arch Surg |volume=147 |issue=7 |pages=621–6 |date=July 2012 |pmid=22430090 |doi=10.1001/archsurg.2012.96 |url= |author=}}</ref>
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |[[Blood test]] ([[TSH]], [[T4]])
! style="background: #F5F5F5; padding: 5px;" |[[Weight gain]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
![[Laryngeal cancer|Laryngeal adenocarcinoma]]<ref name="pmid7956433">{{cite journal |vauthors=Schwenk NR, Schapira RM, Byrd JC |title=Laryngeal carcinoma presenting as platypnea |journal=Chest |volume=106 |issue=5 |pages=1609–11 |date=November 1994 |pmid=7956433 |doi= |url= |author=}}</ref>
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |[[Stridor]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |↓[[Oxygen|O2]], ↑[[CO2]]
! style="background: #F5F5F5; padding: 5px;" |[[Retropharyngeal space|Retropharyngeal tissue]] thickness
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |[[Laryngoscopy]]
! style="background: #F5F5F5; padding: 5px;" |[[Choking]] sensation
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
! rowspan="7" |[[Chest]] and [[Pleura]],
Lower [[airway]]
![[COPD]]<ref name="pmid25177479">{{cite journal| author=Qureshi H, Sharafkhaneh A, Hanania NA| title=Chronic obstructive pulmonary disease exacerbations: latest evidence and clinical implications. | journal=Ther Adv Chronic Dis | year= 2014 | volume= 5 | issue= 5 | pages= 212-27 | pmid=25177479 | doi=10.1177/2040622314532862 | pmc=4131503 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25177479  }}</ref>
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |[[Wheeze|Expiratory wheeze]]
! style="background: #F5F5F5; padding: 5px;" |↑ [[RBC]]
! style="background: #F5F5F5; padding: 5px;" |[[Respiratory alkalosis]], [[Metabolic acidosis]]
! style="background: #F5F5F5; padding: 5px;" |↑ Bronchovascular markings, [[Cardiomegaly]]
! style="background: #F5F5F5; padding: 5px;" |↓ [[FEV1]]/[[FVC]]
! style="background: #F5F5F5; padding: 5px;" |[[Physical examination|Physical exam]] and
[[Spirometry]]
! style="background: #F5F5F5; padding: 5px;" |[[Heavy smoking]] history
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
![[Emphysema]]<ref name="pmid18453358">{{cite journal| author=Sharafkhaneh A, Hanania NA, Kim V| title=Pathogenesis of emphysema: from the bench to the bedside. | journal=Proc Am Thorac Soc | year= 2008 | volume= 5 | issue= 4 | pages= 475-7 | pmid=18453358 | doi=10.1513/pats.200708-126ET | pmc=2645322 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18453358  }}</ref>
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |[[Wheeze|Expiratory wheeze]], Hyperinflation
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |[[Respiratory alkalosis]], [[Metabolic acidosis]]
! style="background: #F5F5F5; padding: 5px;" |Flattening of [[diaphragm]], vertical [[heart]]
! style="background: #F5F5F5; padding: 5px;" |↓ [[FEV1]]/[[FVC]]
! style="background: #F5F5F5; padding: 5px;" |[[Physical examination|Physical exam]] and
[[Spirometry]]
! style="background: #F5F5F5; padding: 5px;" |[[Barrel chest]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
![[Pulmonary hypertension]]<ref name="pmid20407377">{{cite journal |vauthors=Sajkov D, Petrovsky N, Palange P |title=Management of dyspnea in advanced pulmonary arterial hypertension |journal=Curr Opin Support Palliat Care |volume=4 |issue=2 |pages=76–84 |date=June 2010 |pmid=20407377 |doi=10.1097/SPC.0b013e328338c1e0 |url= |author=}}</ref>
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |Accentuated [[S2]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |[[Hypoxia]] and [[acidosis]]
! style="background: #F5F5F5; padding: 5px;" |Enlarged [[Pulmonary arteries|'''pulmonary''' arteries]]
! style="background: #F5F5F5; padding: 5px;" |↑[[Physiologic]] [[Residual volume|RV]]
! style="background: #F5F5F5; padding: 5px;" |[[Cardiac catheterization]]
! style="background: #F5F5F5; padding: 5px;" |[[Syncope]],


Etiology — Eventration may be congenital or acquired; the congenital form reflects a failure of the fetal diaphragm to muscularize, whereas the acquired form is associated with phrenic nerve injury or is idiopathic [4,25]. The continuity of the diaphragm and normal attachments to the costal margin are maintained. (See "Eventration of the diaphragm in infants".)
[[Ascites]], [[Pleural effusion]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
![[Sarcoidosis]]<ref name="pmid14518232">{{cite journal |vauthors=Moher D, Cole CW, Hill GB |title=Epidemiology of abdominal aortic aneurysm: the effect of differing definitions |journal=Eur J Vasc Surg |volume=6 |issue=6 |pages=647–50 |date=November 1992 |pmid=1451823 |doi= |url= |author=}}</ref>
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |[[Crackles]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |↓[[Oxygen|O2]], ↑[[CO2]]
! style="background: #F5F5F5; padding: 5px;" |[[Hilar lymphadenopathy|Hilar adenopathy]]
! style="background: #F5F5F5; padding: 5px;" |↑ [[FEV1]]/[[FVC]]
! style="background: #F5F5F5; padding: 5px;" |[[Computed tomography|High resolution computed tomography (HRCT)]]
! style="background: #F5F5F5; padding: 5px;" |[[Hypercalcemia]], high [[Angiotensin-converting enzyme|ACE]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
![[Pleural effusion]]<ref name="pmid25978627">{{cite journal |vauthors=Thomas R, Jenkins S, Eastwood PR, Lee YC, Singh B |title=Physiology of breathlessness associated with pleural effusions |journal=Curr Opin Pulm Med |volume=21 |issue=4 |pages=338–45 |date=July 2015 |pmid=25978627 |pmc=5633324 |doi=10.1097/MCP.0000000000000174 |url= |author=}}</ref>
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |[[Egophony|Egophony ("E-to-A" change)]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Blunting of the [[Costophrenic angle|costophrenic]] and cardiophrenic angle
! style="background: #F5F5F5; padding: 5px;" |↓[[Tidal volume|Vt]], ↑[[Residual volume|RV]]
! style="background: #F5F5F5; padding: 5px;" |[[Pleural effusion causes|Light's criteria]]
! style="background: #F5F5F5; padding: 5px;" |↓[[Tactile fremitus]],  Asymmetrical [[chest expansion]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
![[Diaphragmatic paralysis]]<ref name="pmid27929389">{{cite journal| author=Dubé BP, Dres M| title=Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies. | journal=J Clin Med | year= 2016 | volume= 5 | issue= 12 | pages=  | pmid=27929389 | doi=10.3390/jcm5120113 | pmc=5184786 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27929389  }}</ref>
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Unilateral or bilateral [[Diaphragmatic dysfunction|diaphragmatic flattening]]
! style="background: #F5F5F5; padding: 5px;" |↓[[Tidal volume|Vt]], ↑[[Residual volume|RV]]
([[anatomical]])
! style="background: #F5F5F5; padding: 5px;" |[[CXR]] confirmed by [[fluoroscopic]] sniff test
! style="background: #F5F5F5; padding: 5px;" |[[Respiratory insufficiency]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
![[Tuberculosis]]<ref name="pmid16709993">{{cite journal| author=Campbell IA, Bah-Sow O| title=Pulmonary tuberculosis: diagnosis and treatment. | journal=BMJ | year= 2006 | volume= 332 | issue= 7551 | pages= 1194-7 | pmid=16709993 | doi=10.1136/bmj.332.7551.1194 | pmc=1463969 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16709993  }}</ref>
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |[[Rhonchi]], [[Wheezing]], [[Crackles]]
! style="background: #F5F5F5; padding: 5px;" |↑[[WBC]]
! style="background: #F5F5F5; padding: 5px;" |↓[[Oxygen|O2]], ↑[[CO2]]
! style="background: #F5F5F5; padding: 5px;" |Patchy [[Consolidation (medicine)|consolidation]] or poorly defined linear and nodular [[Opacity|opacities]]
! style="background: #F5F5F5; padding: 5px;" |[[Restrictive Lung Disease|Restrictive]], [[Obstructive lung disease|obstructive]], or mixed
! style="background: #F5F5F5; padding: 5px;" |[[Interferon-γ release assays|IFN-γ release assay (IGRA)]]


Clinical manifestations — In adults, diaphragmatic eventration is rarely symptomatic. When present, the symptoms associated with diaphragmatic eventration include dyspnea, palpitations, chest pain, dyspepsia, and recurrent pneumonia [26]. The degree of respiratory impairment ranges from the more common asymptomatic elevation of the diaphragmatic dome to the much less common degree of respiratory impairment seen in unilateral diaphragmatic paralysis. (See 'Clinical manifestations'above.)
[[Acid fast|Acid-fast staining]]
! style="background: #F5F5F5; padding: 5px;" |[[Night sweat]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
! colspan="2" rowspan="2" |[[Cardiovascular system]]
![[Constrictive pericarditis]]<ref name="pmid12481882" />
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |[[Muffled heart sounds]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |[[Calcification|Calcifications]] 
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |[[Computed tomography|Chest CT scan]]
! style="background: #F5F5F5; padding: 5px;" |[[Syncope]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
![[Pericardial effusion]]<ref name="pmid23236323">{{cite journal| author=Jung HO| title=Pericardial effusion and pericardiocentesis: role of echocardiography. | journal=Korean Circ J | year= 2012 | volume= 42 | issue= 11 | pages= 725-34 | pmid=23236323 | doi=10.4070/kcj.2012.42.11.725 | pmc=3518705 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23236323  }}</ref>
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |[[Muffled heart sounds]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Fluid density around the [[heart]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |[[M-mode echo: principles and classic findings|M-mode]] and [[Doppler echocardiography|2-dimensional Doppler echocardiography]]
! style="background: #F5F5F5; padding: 5px;" |[[Hoarseness]], [[Palpitation]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
! colspan="2" rowspan="4" |[[Neuromuscular disease]]
![[Amyotrophic lateral sclerosis]]<ref name="pmid17029274">{{cite journal |vauthors=Lechtzin N, Lange DJ, Davey C, Becker B, Mitsumoto H |title=Measures of dyspnea in patients with amyotrophic lateral sclerosis |journal=Muscle Nerve |volume=35 |issue=1 |pages=98–102 |date=January 2007 |pmid=17029274 |doi=10.1002/mus.20669 |url= |author=}}</ref>
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |↑[[WBC]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |↓[[Tidal volume|Vt]], ↑[[Residual volume|RV]]
! style="background: #F5F5F5; padding: 5px;" |Revised El Escorial criteria (clinical)
! style="background: #F5F5F5; padding: 5px;" |[[Muscle weakness]], [[Dysphagia]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
![[Polymyositis]]/[[dermatomyositis]]<ref name="pmid1246203">{{cite journal |vauthors=Schwarz MI, Matthay RA, Sahn SA, Stanford RE, Marmorstein BL, Scheinhorn DJ |title=Interstitial lung disease in polymyositis and dermatomyositis: analysis of six cases and review of the literature |journal=Medicine (Baltimore) |volume=55 |issue=1 |pages=89–104 |date=January 1976 |pmid=1246203 |doi= |url= |author=}}</ref>
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |↑[[WBC]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |↓[[Tidal volume|Vt]], ↑[[Residual volume|RV]]
! style="background: #F5F5F5; padding: 5px;" |[[Muscle biopsy]]
! style="background: #F5F5F5; padding: 5px;" |[[Muscle weakness]], [[Dermatomyositis physical examination|Heliotrope]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
![[Mitochondrial disease|Mitochondrial diseases]]<ref name="pmid21813873">{{cite journal| author=Heinicke K, Taivassalo T, Wyrick P, Wood H, Babb TG, Haller RG| title=Exertional dyspnea in mitochondrial myopathy: clinical features and physiological mechanisms. | journal=Am J Physiol Regul Integr Comp Physiol | year= 2011 | volume= 301 | issue= 4 | pages= R873-84 | pmid=21813873 | doi=10.1152/ajpregu.00001.2011 | pmc=3197343 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21813873  }}</ref>
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |[[Wheeze]]
! style="background: #F5F5F5; padding: 5px;" |↓[[WBC]], [[Platelet|Plt]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |↓[[Tidal volume|Vt]], ↑[[Residual volume|RV]]
! style="background: #F5F5F5; padding: 5px;" |[[Muscle biopsy]]
! style="background: #F5F5F5; padding: 5px;" |[[Myalgia|Muscle pain]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
![[McArdle disease|Glycolytic enzyme defects (e.g., McArdle)]]<ref name="pmid7603522">{{cite journal |vauthors=Tarui S |title=Glycolytic defects in muscle: aspects of collaboration between basic science and clinical medicine |journal=Muscle Nerve Suppl |volume=3 |issue= |pages=S2–9 |date= 1995 |pmid=7603522 |doi= |url= |author=}}</ref>
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |+/-
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |↓[[Tidal volume|Vt]], ↑[[Residual volume|RV]]
! style="background: #F5F5F5; padding: 5px;" |[[Muscle biopsy]] (ragged red fibers)
! style="background: #F5F5F5; padding: 5px;" |[[Myoglobinuria]],


The severe congenital diaphragmatic eventration seen in newborns is discussed separately. (See "Eventration of the diaphragm in infants".)
[[Muscle weakness]]
*[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
*[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
! colspan="2" rowspan="3" |[[Systemic]]
![[Ascites]]<ref name="pmid24336542">{{cite journal| author=Perri GA| title=Ascites in patients with cirrhosis. | journal=Can Fam Physician | year= 2013 | volume= 59 | issue= 12 | pages= 1297-9; e538-40 | pmid=24336542 | doi= | pmc=3860926 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24336542  }}</ref>
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Peritoneal fluid accumulation
! style="background: #F5F5F5; padding: 5px;" |↓[[Tidal volume|Vt]], ↑[[Residual volume|RV]]
! style="background: #F5F5F5; padding: 5px;" |[[Medical ultrasonography|Abdominal ultrasound]]
! style="background: #F5F5F5; padding: 5px;" |[[Abdominal distention]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
![[Kyphoscoliosis]]<ref name="pmid26083538">{{cite journal| author=Qiabi M, Chagnon K, Beaupré A, Hercun J, Rakovich G| title=Scoliosis and bronchial obstruction. | journal=Can Respir J | year= 2015 | volume= 22 | issue= 4 | pages= 206-8 | pmid=26083538 | doi= | pmc=4530852 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26083538  }}</ref>
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |[[Wheeze]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Deviated [[vertebral column]]
! style="background: #F5F5F5; padding: 5px;" |↓[[Tidal volume|Vt]], ↑[[Residual volume|RV]]
([[anatomical]])
! style="background: #F5F5F5; padding: 5px;" |[[X ray|Standing lateral spine radiograph]]
! style="background: #F5F5F5; padding: 5px;" |[[Low back pain]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
![[Obesity]]<ref name="pmid12090884">{{cite journal |vauthors=Sin DD, Jones RL, Man SF |title=Obesity is a risk factor for dyspnea but not for airflow obstruction |journal=Arch. Intern. Med. |volume=162 |issue=13 |pages=1477–81 |date=July 2002 |pmid=12090884 |doi= |url= |author=}}</ref>
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |-
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |↓[[Oxygen|O2]]
! style="background: #F5F5F5; padding: 5px;" |Normal
! style="background: #F5F5F5; padding: 5px;" |↓[[Tidal volume|Vt]], ↑[[Residual volume|RV]]
([[anatomical]])
! style="background: #F5F5F5; padding: 5px;" |[[Body mass index|BMI]]
! style="background: #F5F5F5; padding: 5px;" |Low [[stamina]],
[[Sweating]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;" |
|}</small></small>
[[es:Disnea]]
[[fr:Dyspnée]]
[[ja:呼吸困難]]
[[pt:Dispnéia]]
[[ru:Одышка]]
[[zh:呼吸困难]]
[[pl:Duszność]]


*As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4].
==References==


===Preferred Table===
{{WikiDoc Help Menu}}
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
! colspan="4" |History and Symptoms
! colspan="4" |Physical Examination
! colspan="4" |Laboratory Findings
! rowspan="2" |Other Findings
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Finding
1
!Finding 2
!Finding 3
!Finding
4
!Physical Finding 1
!Physical Finding 2
!Physical Finding 3
!Physical Finding 4
!Lab Test 1
!Lab Test 2
!Lab Test 3
!Lab Test 4
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 1
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 2
| style="background: #F5F5F5; padding: 5px;" |'''↑'''
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 3
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |↓
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 4
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 5
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differential Diagnosis}}
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! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Differentiating Features}}
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 1
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* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
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* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
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* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
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* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
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* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
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* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
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==References==
==References==
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Latest revision as of 21:22, 29 July 2020

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

Overview

Unilateral diaphragmatic paralysis must be differentiated from eventration of the diaphragm. Eventration of the diaphragm is an abnormal elevation of the hemidiaphragm. Bilateral diaphragmatic paralysis must be differentiated from other diseases that cause elevation of the diaphragm such as pleural adhesions, subpulmonic effusions, obesity, ascites, abdominal organomegaly and ileus. Diaphragmatic paralysis must be differentiated from other disease that cause dyspnea such as dermatomyositis, polymyositis, rib fracture, pleural effusions, amyotrophic lateral sclerosis.

Differentiating diaphragmatic paralysis from other Diseases

Unilateral diaphragmatic paralysis must be differentiated from eventration of the diaphragm. Eventration of the diaphragm is an abnormal elevation of the hemidiaphragm that some parts of hemidiaphragm are replaced by fibrous tissue. Clinical manifestations of eventration of the diaphragm include asymptomatic, infection and respiratory distress.[1]

Bilateral diaphragmatic paralysis must be differentiated from other diseases that cause elevation of the diaphragm such as:

Diaphragmatic paralysis must be differentiated from other disease that cause dyspnea such as:

Abbreviations: ABG (arterial blood gas); ACE (angiotensin converting enzyme); BMI (body mass index); CBC (complete blood count); CSF (cerebrospinal fluid); CXR (chest X-ray); DOE (dyspnea on exercise); ECG (electrocardiogram); FEF (forced expiratory flow rate); FEV1 (forced expiratory volume); FVC (forced vital capacity); JVD (jugular vein distention); MCV (mean corpuscular volume); Plt (platelet); RV (residual volume); SIADH (syndrome of inappropriate antidiuretic hormone); TSH (thyroid stimulating hormone); Vt (tidal volume); WBC (white blood cell);

Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Loss of consciousness Agitation Weight loss Fever Chest pain Cough Orthopnea DOE Cyanosis Clubbing JVD Peripheral edema Auscultation CBC ABG Imaging Spirometry Gold standard
Acute Dyspnea Respiratory system Head and Neck,

Upper airway

Aspiration[2] - + - - +/- + - - + - - - Diminished breath sounds Normal Normal Atelectasis ↓Vt, ↑RV Bronchoscopy Choking
Chest and Pleura,

Lower airway

Atelectasis - - - +/- +/- +/- - - +/- - - - Diminished breath sounds, Wheeze Normal ↓O2, Normal/↓CO2 Collapsed lung lobe, fissuresdisplacement ↓ FVC Chest CT scan Surgical procedure, Aspiration,

Mechanical ventilation

Bronchitis[3] - - - + + + - - - - - - Rhonchi  ↑WBC Normal Normal Normal Physical exam Rhonchi relieved by cough
Bronchiolitis[4] - - - + +/- + - - - - - - Wheeze and Crackles ↑WBC Normal Bronchovascular markings ↓Vt Clinical assessment Respiratory syncytial virus (RSV)
Lung carcinoma[5] - - + - - + - - + + - - Wheeze and Crackles Normal Normal Mass lesion, hilar lymphadenopathy ↓Vt, ↑RV Bronchoscopy  Paraneoplastic syndromes, such as SIADH and lambert-Eaton
Pneumonia[6] - - - + + + - - - - - - Wheeze, Rhonchi, and Crackles ↑WBC, neutrophilia Normal Lobar consolidation Normal Chest X-ray and CT Scan productive cough
Pneumothorax[7] - - - - + - - - - - +/- - Diminished breath sounds Normal ↓O2, ↑CO2 Radiolucency without lung marking ↓Vt CXR and Chest CT scan Tracheal deviation
Pulmonary embolism[8] - - - - + - - +/- - - - - Normal Normal Respiratory alkalosis Normal Normal Pulmonary CT angiography Pleuritic chest pain
Rib fractures (flail chest)[9] - + - - + - - - - - - - Normal Normal Respiratory acidosis Fracture marks Normal Chest X-ray Pneumothorax
Cardiovascular system Pericardial tamponade[10] +/- - - - + - +/- +/- - - + - Muffled heart sounds Normal Normal Water bottle appearance enlarged heart Normal Echocardiography Fluid accumulation in pericardium
Pulmonary edema[11] +/- + - + + + + + + + + + Basal crackle Normal Respiratory alkalosis Bat wing pattern, air bronchograms ↓Vt, ↑RV Cardiac Catheterization Tachypnea
Central nervous system Stroke + - - +/- - - - - - - - - Normal Normal Normal Intracranial infarct or hemorrhage Normal Brain MRI Paralysis or paresthesia
Encephalitis[12] + + - + - - - - - - - - Normal ↑WBC, neutrophilia Normal Normal Normal CSF PCR Confusion
Traumatic brain injury[13] + +/- - - - - - - - - - - Normal Normal Respiratory acidosis Intracerebral hemorrhage Normal Brain CT scan Lucid interval
Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Loss of consciousness Agitation Weight loss Fever Chest pain Cough Orthopnea DOE Cyanosis Clubbing JVD Peripheral edema Auscultation CBC ABG Imaging Spirometry Gold standard
Chronic Dyspnea Respiratory system Head and Neck,

Upper airway

Goiter[14] - - - - - - - - - - - + Normal Normal Normal Normal Normal Blood test (TSH, T4) Weight gain
Laryngeal adenocarcinoma[15] - - + - - +/- - - - - - - Stridor Normal ↓O2, ↑CO2 Retropharyngeal tissue thickness Normal Laryngoscopy Choking sensation
Chest and Pleura,

Lower airway

COPD[16] - - +/- - - + + + + + + +/- Expiratory wheeze ↑ RBC Respiratory alkalosis, Metabolic acidosis ↑ Bronchovascular markings, Cardiomegaly ↓ FEV1/FVC Physical exam and

Spirometry

Heavy smoking history
Emphysema[17] - - - - - +/- - - + + - - Expiratory wheeze, Hyperinflation Normal Respiratory alkalosis, Metabolic acidosis Flattening of diaphragm, vertical heart ↓ FEV1/FVC Physical exam and

Spirometry

Barrel chest
Pulmonary hypertension[18] - - - - +/- +/- - - +/- +/- + + Accentuated S2 Normal Hypoxia and acidosis Enlarged pulmonary arteries ↑Physiologic RV Cardiac catheterization Syncope,

Ascites, Pleural effusion

Sarcoidosis[19] - - +/- - +/- + - - + - - - Crackles Normal ↓O2, ↑CO2 Hilar adenopathy ↑ FEV1/FVC High resolution computed tomography (HRCT) Hypercalcemia, high ACE
Pleural effusion[20] - +/- + - + - +/- - - - +/- +/- Egophony ("E-to-A" change) Normal Normal Blunting of the costophrenic and cardiophrenic angle ↓Vt, ↑RV Light's criteria ↓Tactile fremitus, Asymmetrical chest expansion
Diaphragmatic paralysis[21] - - - +/- +/- +/- + + - - - - Normal Normal Normal Unilateral or bilateral diaphragmatic flattening ↓Vt, ↑RV

(anatomical)

CXR confirmed by fluoroscopic sniff test Respiratory insufficiency
Tuberculosis[22] - - + + + + - - +/- - - - Rhonchi, Wheezing, Crackles ↑WBC ↓O2, ↑CO2 Patchy consolidation or poorly defined linear and nodular opacities Restrictive, obstructive, or mixed IFN-γ release assay (IGRA)

Acid-fast staining

Night sweat
Cardiovascular system Constrictive pericarditis[10] - - - - + - + + - - + - Muffled heart sounds Normal Normal Calcifications  Normal Chest CT scan Syncope
Pericardial effusion[23] - - - +/- + + +/- +/- - - + - Muffled heart sounds Normal Normal Fluid density around the heart Normal M-mode and 2-dimensional Doppler echocardiography Hoarseness, Palpitation
Neuromuscular disease Amyotrophic lateral sclerosis[24] +/- - +/- - - - - - - - - - Normal ↑WBC Normal Normal ↓Vt, ↑RV Revised El Escorial criteria (clinical) Muscle weakness, Dysphagia
Polymyositis/dermatomyositis[25] - - +/- - + - - - - - - +/- Normal ↑WBC Normal Normal ↓Vt, ↑RV Muscle biopsy Muscle weakness, Heliotrope
Mitochondrial diseases[26] - - +/- - - - - - - - - - Wheeze ↓WBC, Plt Normal Normal ↓Vt, ↑RV Muscle biopsy Muscle pain
Glycolytic enzyme defects (e.g., McArdle)[27] +/- - - - - - - - - - - +/- Normal Normal Normal Normal ↓Vt, ↑RV Muscle biopsy (ragged red fibers) Myoglobinuria,

Muscle weakness

Systemic Ascites[28] - - - - - - - - - - - - Normal Normal Normal Peritoneal fluid accumulation ↓Vt, ↑RV Abdominal ultrasound Abdominal distention
Kyphoscoliosis[29] - - - - - - - - - - - - Wheeze Normal Normal Deviated vertebral column ↓Vt, ↑RV

(anatomical)

Standing lateral spine radiograph Low back pain
Obesity[30] - - - - - - - - - - - - Normal Normal ↓O2 Normal ↓Vt, ↑RV

(anatomical)

BMI Low stamina,

Sweating

References

Template:WikiDoc Sources

  1. ↑ Ravisagar, Patel; Abhinav, Singh; Mathur, R.M.; Anula, Sisodia (2015). "Eventration of diaphragm presenting as recurrent respiratory tract infections – A case report". Egyptian Journal of Chest Diseases and Tuberculosis. 64 (1): 291–293. doi:10.1016/j.ejcdt.2014.10.002. ISSN 0422-7638.
  2. ↑ O'Horo JC, Rogus-Pulia N, Garcia-Arguello L, Robbins J, Safdar N (2015). "Bedside diagnosis of dysphagia: a systematic review". J Hosp Med. 10 (4): 256–65. doi:10.1002/jhm.2313. PMC 4607509. PMID 25581840.
  3. ↑ Cantin, Luce; Bankier, Alexander A.; Eisenberg, Ronald L. (2009). "Bronchiectasis". American Journal of Roentgenology. 193 (3): W158–W171. doi:10.2214/AJR.09.3053. ISSN 0361-803X.
  4. ↑ Holbro A, Lehmann T, Girsberger S, Stern M, Gambazzi F, Lardinois D, Heim D, Passweg JR, Tichelli A, Bubendorf L, Savic S, Hostettler K, Grendelmeier P, Halter JP, Tamm M (2013). "Lung histology predicts outcome of bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation". Biol. Blood Marrow Transplant. 19 (6): 973–80. doi:10.1016/j.bbmt.2013.03.017. PMID 23562737.
  5. ↑ Dela Cruz CS, Tanoue LT, Matthay RA (2011). "Lung cancer: epidemiology, etiology, and prevention". Clin Chest Med. 32 (4): 605–44. doi:10.1016/j.ccm.2011.09.001. PMC 3864624. PMID 22054876.
  6. ↑ Simonetti AF, Viasus D, Garcia-Vidal C, Carratalà J (2014). "Management of community-acquired pneumonia in older adults". Ther Adv Infect Dis. 2 (1): 3–16. doi:10.1177/2049936113518041. PMC 4072047. PMID 25165554.
  7. ↑ Currie GP, Alluri R, Christie GL, Legge JS (2007). "Pneumothorax: an update". Postgrad Med J. 83 (981): 461–5. doi:10.1136/pgmj.2007.056978. PMC 2600088. PMID 17621614.
  8. ↑ Bĕlohlávek J, Dytrych V, Linhart A (2013). "Pulmonary embolism, part I: Epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism". Exp Clin Cardiol. 18 (2): 129–38. PMC 3718593. PMID 23940438.
  9. ↑ Swart E, Laratta J, Slobogean G, Mehta S (February 2017). "Operative Treatment of Rib Fractures in Flail Chest Injuries: A Meta-analysis and Cost-Effectiveness Analysis". J Orthop Trauma. 31 (2): 64–70. doi:10.1097/BOT.0000000000000750. PMID 27984449.
  10. ↑ 10.0 10.1 van Steijn JH, Sleijfer DT, van der Graaf WT, van der Sluis A, Nieboer P (2002). "How to diagnose cardiac tamponade". Neth J Med. 60 (8): 334–8. PMID 12481882.
  11. ↑ Martindale, Jennifer L.; Noble, Vicki E.; Liteplo, Andrew (2013). "Diagnosing pulmonary edema". European Journal of Emergency Medicine. 20 (5): 356–360. doi:10.1097/MEJ.0b013e32835c2b88. ISSN 0969-9546.
  12. ↑ Debiasi RL, Tyler KL (2004). "Molecular methods for diagnosis of viral encephalitis". Clin Microbiol Rev. 17 (4): 903–25, table of contents. doi:10.1128/CMR.17.4.903-925.2004. PMC 523566. PMID 15489354.
  13. ↑ McAllister TW (2011). "Neurobiological consequences of traumatic brain injury". Dialogues Clin Neurosci. 13 (3): 287–300. PMC 3182015. PMID 22033563.
  14. ↑ Stang MT, Armstrong MJ, Ogilvie JB, Yip L, McCoy KL, Faber CN, Carty SE (July 2012). "Positional dyspnea and tracheal compression as indications for goiter resection". Arch Surg. 147 (7): 621–6. doi:10.1001/archsurg.2012.96. PMID 22430090.
  15. ↑ Schwenk NR, Schapira RM, Byrd JC (November 1994). "Laryngeal carcinoma presenting as platypnea". Chest. 106 (5): 1609–11. PMID 7956433.
  16. ↑ Qureshi H, Sharafkhaneh A, Hanania NA (2014). "Chronic obstructive pulmonary disease exacerbations: latest evidence and clinical implications". Ther Adv Chronic Dis. 5 (5): 212–27. doi:10.1177/2040622314532862. PMC 4131503. PMID 25177479.
  17. ↑ Sharafkhaneh A, Hanania NA, Kim V (2008). "Pathogenesis of emphysema: from the bench to the bedside". Proc Am Thorac Soc. 5 (4): 475–7. doi:10.1513/pats.200708-126ET. PMC 2645322. PMID 18453358.
  18. ↑ Sajkov D, Petrovsky N, Palange P (June 2010). "Management of dyspnea in advanced pulmonary arterial hypertension". Curr Opin Support Palliat Care. 4 (2): 76–84. doi:10.1097/SPC.0b013e328338c1e0. PMID 20407377.
  19. ↑ Moher D, Cole CW, Hill GB (November 1992). "Epidemiology of abdominal aortic aneurysm: the effect of differing definitions". Eur J Vasc Surg. 6 (6): 647–50. PMID 1451823.
  20. ↑ Thomas R, Jenkins S, Eastwood PR, Lee YC, Singh B (July 2015). "Physiology of breathlessness associated with pleural effusions". Curr Opin Pulm Med. 21 (4): 338–45. doi:10.1097/MCP.0000000000000174. PMC 5633324. PMID 25978627.
  21. ↑ Dubé BP, Dres M (2016). "Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies". J Clin Med. 5 (12). doi:10.3390/jcm5120113. PMC 5184786. PMID 27929389.
  22. ↑ Campbell IA, Bah-Sow O (2006). "Pulmonary tuberculosis: diagnosis and treatment". BMJ. 332 (7551): 1194–7. doi:10.1136/bmj.332.7551.1194. PMC 1463969. PMID 16709993.
  23. ↑ Jung HO (2012). "Pericardial effusion and pericardiocentesis: role of echocardiography". Korean Circ J. 42 (11): 725–34. doi:10.4070/kcj.2012.42.11.725. PMC 3518705. PMID 23236323.
  24. ↑ Lechtzin N, Lange DJ, Davey C, Becker B, Mitsumoto H (January 2007). "Measures of dyspnea in patients with amyotrophic lateral sclerosis". Muscle Nerve. 35 (1): 98–102. doi:10.1002/mus.20669. PMID 17029274.
  25. ↑ Schwarz MI, Matthay RA, Sahn SA, Stanford RE, Marmorstein BL, Scheinhorn DJ (January 1976). "Interstitial lung disease in polymyositis and dermatomyositis: analysis of six cases and review of the literature". Medicine (Baltimore). 55 (1): 89–104. PMID 1246203.
  26. ↑ Heinicke K, Taivassalo T, Wyrick P, Wood H, Babb TG, Haller RG (2011). "Exertional dyspnea in mitochondrial myopathy: clinical features and physiological mechanisms". Am J Physiol Regul Integr Comp Physiol. 301 (4): R873–84. doi:10.1152/ajpregu.00001.2011. PMC 3197343. PMID 21813873.
  27. ↑ Tarui S (1995). "Glycolytic defects in muscle: aspects of collaboration between basic science and clinical medicine". Muscle Nerve Suppl. 3: S2–9. PMID 7603522.
  28. ↑ Perri GA (2013). "Ascites in patients with cirrhosis". Can Fam Physician. 59 (12): 1297–9, e538–40. PMC 3860926. PMID 24336542.
  29. ↑ Qiabi M, Chagnon K, Beaupré A, Hercun J, Rakovich G (2015). "Scoliosis and bronchial obstruction". Can Respir J. 22 (4): 206–8. PMC 4530852. PMID 26083538.
  30. ↑ Sin DD, Jones RL, Man SF (July 2002). "Obesity is a risk factor for dyspnea but not for airflow obstruction". Arch. Intern. Med. 162 (13): 1477–81. PMID 12090884.

References

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