Bronchiolitis differential diagnosis: Difference between revisions

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==Overview==
==Overview==
Bronchiolitis must be differentiated from other [[respiratory]] and [[cardiac]] diseases that are presented with similar clinical manifestations. Based on [[cough]] and [[dyspnea]], bronchiolitis is differentiated from [[asthma]], [[COPD]], [[pneumonia]], [[congestive heart failure]], diffuse idiopathic neuroendocrine cell hyperplasia, [[tuberculosis]], [[pertussis]], [[foreign body aspiration]], [[pulmonary embolism]] and [[Interstitial Pneumonia|Harmann-Rich syndrome]].
Bronchiolitis must be differentiated from other [[respiratory]] and [[cardiac]] diseases that are presented with similar clinical manifestations. Based on [[cough]] and [[dyspnea]], bronchiolitis is differentiated from [[asthma]], [[COPD]], [[pneumonia]], [[congestive heart failure]], diffuse [[idiopathic]] [[neuroendocrine cell]] [[hyperplasia]], [[tuberculosis]], [[pertussis]], [[foreign body aspiration]], [[pulmonary embolism]] and [[Interstitial Pneumonia|Harmann-Rich syndrome]].


==Differentiating bronchiolitis from other diseases==
==Differentiating bronchiolitis from other diseases==
Bronchiolitis must be differentiated from other respiratory and cardiac diseases that can cause the same clinical manifestations like [[cough]] and [[dyspnea]]. These diseases include [[asthma]], [[COPD]], [[pneumonia]], [[congestive heart failure]], diffuse idiopathic neuroendocrine cell hyperplasia, [[tuberculosis]], [[pertussis]], [[foreign body aspiration]], [[pulmonary embolism]] and [[Interstitial Pneumonia|Harmann-Rich syndrome]].<ref name="pmid27180590">{{cite journal| author=Liu WY, Yu Q, Yue HM, Zhang JB, Li L, Wang XY et al.| title=[The distribution characteristics of etiology of chronic cough in Lanzhou]. | journal=Zhonghua Jie He He Hu Xi Za Zhi | year= 2016 | volume= 39 | issue= 5 | pages= 362-7 | pmid=27180590 | doi=10.3760/cma.j.issn.1001-0939.2016.05.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27180590  }} </ref><ref name="pmid28452705">{{cite journal| author=Lin L, Chen Z, Cao Y, Sun G| title=Normal saline solution nasal-pharyngeal irrigation improves chronic cough associated with allergic rhinitis. | journal=Am J Rhinol Allergy | year= 2017 | volume= 31 | issue= 2 | pages= 96-104 | pmid=28452705 | doi=10.2500/ajra.2017.31.4418 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28452705  }} </ref><ref name="pmid28454456">{{cite journal| author=Jiang S, Li J, Zeng Q, Liang J| title=Pulmonary artery intimal sarcoma misdiagnosed as pulmonary embolism: A case report. | journal=Oncol Lett | year= 2017 | volume= 13 | issue= 4 | pages= 2713-2716 | pmid=28454456 | doi=10.3892/ol.2017.5775 | pmc=5403205 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28454456  }} </ref><ref name="pmid26169577">{{cite journal| author=Mosley JD, Shaffer CM, Van Driest SL, Weeke PE, Wells QS, Karnes JH et al.| title=A genome-wide association study identifies variants in KCNIP4 associated with ACE inhibitor-induced cough. | journal=Pharmacogenomics J | year= 2016 | volume= 16 | issue= 3 | pages= 231-7 | pmid=26169577 | doi=10.1038/tpj.2015.51 | pmc=4713364 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26169577  }} </ref><ref name="cdc">Environmental Triggers of Asthma. Differential Diagnosis of Asthma. Environmental Health and Medicine Education. Agency for Toxic Substances and Disease Registry. Available at: http://www.atsdr.cdc.gov/csem/csem.asp?csem=32&po=5. Accessed on February 25, 2016</ref>
[[Bronchiolitis]] must be differentiated from other respiratory and cardiac diseases that can cause the same clinical manifestations like [[cough]] and [[dyspnea]]. These diseases include [[asthma]], [[COPD]], [[pneumonia]], [[congestive heart failure]], diffuse idiopathic neuroendocrine cell hyperplasia, [[tuberculosis]], [[pertussis]], [[foreign body aspiration]], [[pulmonary embolism]] and [[Interstitial Pneumonia|Harmann-Rich syndrome]].<ref name="pmid27180590">{{cite journal| author=Liu WY, Yu Q, Yue HM, Zhang JB, Li L, Wang XY et al.| title=[The distribution characteristics of etiology of chronic cough in Lanzhou]. | journal=Zhonghua Jie He He Hu Xi Za Zhi | year= 2016 | volume= 39 | issue= 5 | pages= 362-7 | pmid=27180590 | doi=10.3760/cma.j.issn.1001-0939.2016.05.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27180590  }} </ref><ref name="pmid28452705">{{cite journal| author=Lin L, Chen Z, Cao Y, Sun G| title=Normal saline solution nasal-pharyngeal irrigation improves chronic cough associated with allergic rhinitis. | journal=Am J Rhinol Allergy | year= 2017 | volume= 31 | issue= 2 | pages= 96-104 | pmid=28452705 | doi=10.2500/ajra.2017.31.4418 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28452705  }} </ref><ref name="pmid28454456">{{cite journal| author=Jiang S, Li J, Zeng Q, Liang J| title=Pulmonary artery intimal sarcoma misdiagnosed as pulmonary embolism: A case report. | journal=Oncol Lett | year= 2017 | volume= 13 | issue= 4 | pages= 2713-2716 | pmid=28454456 | doi=10.3892/ol.2017.5775 | pmc=5403205 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28454456  }} </ref><ref name="pmid26169577">{{cite journal| author=Mosley JD, Shaffer CM, Van Driest SL, Weeke PE, Wells QS, Karnes JH et al.| title=A genome-wide association study identifies variants in KCNIP4 associated with ACE inhibitor-induced cough. | journal=Pharmacogenomics J | year= 2016 | volume= 16 | issue= 3 | pages= 231-7 | pmid=26169577 | doi=10.1038/tpj.2015.51 | pmc=4713364 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26169577  }} </ref><ref name="cdc">Environmental Triggers of Asthma. Differential Diagnosis of Asthma. Environmental Health and Medicine Education. Agency for Toxic Substances and Disease Registry. Available at: http://www.atsdr.cdc.gov/csem/csem.asp?csem=32&po=5. Accessed on February 25, 2016</ref>


{| class="wikitable"
{| class="wikitable"
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* [[Pulmonary function test]] to exclude other [[lung diseases]]<ref name="pmid18339530">{{cite journal| author=Ghanei M, Tazelaar HD, Chilosi M, Harandi AA, Peyman M, Akbari HM et al.| title=An international collaborative pathologic study of surgical lung biopsies from mustard gas-exposed patients. | journal=Respir Med | year= 2008 | volume= 102 | issue= 6 | pages= 825-30 | pmid=18339530 | doi=10.1016/j.rmed.2008.01.016 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18339530  }} </ref>
* [[Pulmonary function test]] to exclude other [[lung diseases]]<ref name="pmid18339530">{{cite journal| author=Ghanei M, Tazelaar HD, Chilosi M, Harandi AA, Peyman M, Akbari HM et al.| title=An international collaborative pathologic study of surgical lung biopsies from mustard gas-exposed patients. | journal=Respir Med | year= 2008 | volume= 102 | issue= 6 | pages= 825-30 | pmid=18339530 | doi=10.1016/j.rmed.2008.01.016 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18339530  }} </ref>
|
|
* CT scan shows
* CT scan shows:
** Intense bronchiolar mural [[inflammation]]   
** Intense bronchiolar mural [[inflammation]]   
** [[bronchial]] wall thickening  
** [[bronchial]] wall thickening  
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* Serum examination shows elevated level of esoinophils due to [[allergy]]   
* Serum examination shows elevated level of esoinophils due to [[allergy]]   
|
|
* CT scan shows  
* CT scan shows:
** Dilated [[bronchi]]
** Dilated [[bronchi]]
** Bronchial wall thickening
** Bronchial wall thickening
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* [[Sputum culture]]   
* [[Sputum culture]]   
|
|
* EKG may show
* EKG may show:
** [[P pulmonale]]  
** [[P pulmonale]]  
** [[right ventricular hypertrophy]]  
** [[right ventricular hypertrophy]]  
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** [[Sputum culture]]
** [[Sputum culture]]
|
|
* X ray is performed to detect
* X ray is performed to detect:
** [[pleural effusion]]  
** [[pleural effusion]]  
** Inflitrates within the [[lungs]].  
** Inflitrates within the [[lungs]].  
* CT scan shows  
* CT scan shows:
** [[Consolidation (medicine)|Consolidation]]  
** [[Consolidation (medicine)|Consolidation]]  
** Ground glass appearance  
** Ground glass appearance  
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**Acute:Centrally located [[thrombus]] occluding the vessel
**Acute:Centrally located [[thrombus]] occluding the vessel
**Chronic:Eccentric changes in the [[vessel wall]], recanalization in the thrombous and arterial web  
**Chronic:Eccentric changes in the [[vessel wall]], recanalization in the thrombous and arterial web  
* EKG is not specific or sensitive in PE diagnosis but it may show  
* EKG is not specific or sensitive in PE diagnosis but it may show:
** [[T wave inversion]]  
** [[T wave inversion]]  
** [[P pulmonale]]  
** [[P pulmonale]]  
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* Other lab tests are done to exclude other diseases  
* Other lab tests are done to exclude other diseases  
|
|
* Chest X ray may show  
* Chest X ray may show:
** Bilateral airway opacification  
** Bilateral airway opacification  
* CT scan may show
* CT scan may show
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* Lab tests to evaluate the [[ventilation]] function  
* Lab tests to evaluate the [[ventilation]] function  
|
|
* Chest X ray shows
* Chest X ray shows:
** Hyperinflation  
** Hyperinflation  
** Mediastinal shift   
** Mediastinal shift   

Revision as of 12:36, 26 July 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2]

Overview

Bronchiolitis must be differentiated from other respiratory and cardiac diseases that are presented with similar clinical manifestations. Based on cough and dyspnea, bronchiolitis is differentiated from asthma, COPD, pneumonia, congestive heart failure, diffuse idiopathic neuroendocrine cell hyperplasia, tuberculosis, pertussis, foreign body aspiration, pulmonary embolism and Harmann-Rich syndrome.

Differentiating bronchiolitis from other diseases

Bronchiolitis must be differentiated from other respiratory and cardiac diseases that can cause the same clinical manifestations like cough and dyspnea. These diseases include asthma, COPD, pneumonia, congestive heart failure, diffuse idiopathic neuroendocrine cell hyperplasia, tuberculosis, pertussis, foreign body aspiration, pulmonary embolism and Harmann-Rich syndrome.[1][2][3][4][5]

Diseases Symptoms Signs Diagosis
Fever Cough Chest pain Wheezes Crackles Tachycardia Lab tests Imaging
Bronchiolitis +/- Dry - + + +/-
Asthma - Dry/Productive - + - -
  • Lab tests to exclude other diseases
  • Serum examination shows elevated level of esoinophils due to allergy
  • CT scan shows:
    • Dilated bronchi
    • Bronchial wall thickening
    • Air trapping
COPD + Productive - + + +
Bacterial pneumonia + Productive + + + +/-
Pulmonary embolism +/- Bloody + + + +
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia[9] - Dry - + - -
  • Pulmonary function test shows obstructive lung disease
Tuberculosis + Bloody + - - -
  • Sputum culture:
    • Three successive positive culture for M. tuberculosis confirms the diagnosis[10]
    • Presence of acid fast bacilli in sputum smear indicates high extent tuberculosis
  • CT scan may show:[12]
  • EKG may have abnormalities in case pleural effussion associated with TB.
Interstitial pneumonitis (Hamman - Rich syndrome) + Productive - - + -
Foreign body aspiration + Bloody + + - -
  • Chest X ray shows:
Pertussis + Dry - - -
  • No remarkable imaging findings
Congestive heart failure - Dry/Productive + while walking - - +
  • EKG to detect underlying cause
  • Chest x ray shows cardiomegaly
  • Echocardiography is done:

References

  1. ↑ Liu WY, Yu Q, Yue HM, Zhang JB, Li L, Wang XY; et al. (2016). "[The distribution characteristics of etiology of chronic cough in Lanzhou]". Zhonghua Jie He He Hu Xi Za Zhi. 39 (5): 362–7. doi:10.3760/cma.j.issn.1001-0939.2016.05.006. PMID 27180590.
  2. ↑ Lin L, Chen Z, Cao Y, Sun G (2017). "Normal saline solution nasal-pharyngeal irrigation improves chronic cough associated with allergic rhinitis". Am J Rhinol Allergy. 31 (2): 96–104. doi:10.2500/ajra.2017.31.4418. PMID 28452705.
  3. ↑ Jiang S, Li J, Zeng Q, Liang J (2017). "Pulmonary artery intimal sarcoma misdiagnosed as pulmonary embolism: A case report". Oncol Lett. 13 (4): 2713–2716. doi:10.3892/ol.2017.5775. PMC 5403205. PMID 28454456.
  4. ↑ Mosley JD, Shaffer CM, Van Driest SL, Weeke PE, Wells QS, Karnes JH; et al. (2016). "A genome-wide association study identifies variants in KCNIP4 associated with ACE inhibitor-induced cough". Pharmacogenomics J. 16 (3): 231–7. doi:10.1038/tpj.2015.51. PMC 4713364. PMID 26169577.
  5. ↑ Environmental Triggers of Asthma. Differential Diagnosis of Asthma. Environmental Health and Medicine Education. Agency for Toxic Substances and Disease Registry. Available at: http://www.atsdr.cdc.gov/csem/csem.asp?csem=32&po=5. Accessed on February 25, 2016
  6. ↑ Ghanei M, Tazelaar HD, Chilosi M, Harandi AA, Peyman M, Akbari HM; et al. (2008). "An international collaborative pathologic study of surgical lung biopsies from mustard gas-exposed patients". Respir Med. 102 (6): 825–30. doi:10.1016/j.rmed.2008.01.016. PMID 18339530.
  7. ↑ Lazović B, Svenda MZ, Mazić S, Stajić Z, Delić M (2013). "Analysis of electrocardiogram in chronic obstructive pulmonary disease patients". Med Pregl. 66 (3–4): 126–9. PMID 23653989.
  8. ↑ Cvitanic O, Marino PL (1989). "Improved use of arterial blood gas analysis in suspected pulmonary embolism". Chest. 95 (1): 48–51. PMID 2491801. Retrieved 2012-04-30. Unknown parameter |month= ignored (help)
  9. ↑ Nassar AA, Jaroszewski DE, Helmers RA, Colby TV, Patel BM, Mookadam F (2011). "Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia: a systematic overview". Am J Respir Crit Care Med. 184 (1): 8–16. doi:10.1164/rccm.201010-1685PP. PMID 21471097.
  10. ↑ Drobniewski F, Caws M, Gibson A, Young D (2003). "Modern laboratory diagnosis of tuberculosis". Lancet Infect Dis. 3 (3): 141–7. PMID 12614730.
  11. ↑ Riccardo Piccazzo, Francesco Paparo & Giacomo Garlaschi (2014). "Diagnostic accuracy of chest radiography for the diagnosis of tuberculosis (TB) and its role in the detection of latent TB infection: a systematic review". The Journal of rheumatology. Supplement. 91: 32–40. doi:10.3899/jrheum.140100. PMID 24788998. Unknown parameter |month= ignored (help)
  12. ↑ Jeong Min Ko, Hyun Jin Park & Chi Hong Kim (2014). "Pulmonary Changes of Pleural Tuberculosis: Up-to-Date CT Imaging". Chest. doi:10.1378/chest.14-0196. PMID 25086249. Unknown parameter |month= ignored (help)
  13. ↑ Pertussis (whooping coug). Diagnosis confirmation. CDC.gov. Accessed on June 22, 2017
  14. ↑ Pertussis (whooping cough). Specimen collection. CDC.gov. Accessed on June 22, 2017
  15. ↑ Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL (2013). "2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". J. Am. Coll. Cardiol. 62 (16): e147–239. doi:10.1016/j.jacc.2013.05.019. PMID 23747642.
  16. ↑ D'Aloia A, Vizzardi E, Metra M (2016). "Can Carbohydrate Antigen-125 Be a New Biomarker to Guide Heart Failure Treatment?: The CHANCE-HF Trial". JACC Heart Fail. 4 (11): 844–846. doi:10.1016/j.jchf.2016.09.001. PMID 27810078.
  17. ↑ Agha SA, Kalogeropoulos AP, Shih J, Georgiopoulou VV, Giamouzis G, Anarado P, Mangalat D, Hussain I, Book W, Laskar S, Smith AL, Martin R, Butler J (2009). "Echocardiography and risk prediction in advanced heart failure: incremental value over clinical markers". J. Card. Fail. 15 (7): 586–92. doi:10.1016/j.cardfail.2009.03.002. PMID 19700135.

References


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