Bronchiolitis differential diagnosis: Difference between revisions
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==Overview== | ==Overview== | ||
[[Bronchiolitis]] must be differentiated from other [[respiratory]] and [[cardiac]] diseases that present with similar clinical manifestations. Based on [[cough]] and [[dyspnea]], bronchiolitis | [[Bronchiolitis]] must be differentiated from other [[respiratory]] and [[cardiac]] diseases that present with similar clinical manifestations. Based on [[cough]] and [[dyspnea]], bronchiolitis should be differentiated from [[asthma]], [[COPD]], [[pneumonia]], [[congestive heart failure]], [[diffuse]] [[idiopathic]] [[neuroendocrine]] [[Hyperplasia|cell hyperplasia]], [[tuberculosis]], [[pertussis]], [[foreign body aspiration]], [[pulmonary embolism]], and [[Interstitial Pneumonia|Harman-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 | [[Bronchiolitis]] must be differentiated from other respiratory and cardiac diseases that can cause the similar clinical manifestations like [[cough]] and [[dyspnea]]. These diseases include [[asthma]], [[COPD]], [[pneumonia]], [[congestive heart failure]], [[diffuse]] [[idiopathic]] [[neuroendocrine]] [[Hyperplasia|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" | ||
| Line 38: | Line 38: | ||
* [[CT scan]] shows: | * [[CT scan]] shows: | ||
** Intense [[Bronchiolar epithelium|bronchiolar]] mural [[inflammation]] | ** Intense [[Bronchiolar epithelium|bronchiolar]] mural [[inflammation]] | ||
** [[ | ** [[Bronchial]] wall thickening | ||
** Centrilobular [[nodules]] with tree-in-bud pattern | ** Centrilobular [[nodules]] with tree-in-bud pattern | ||
|- | |- | ||
| Line 71: | Line 71: | ||
* EKG may show: | * EKG may show: | ||
** [[P pulmonale]] | ** [[P pulmonale]] | ||
** [[ | ** [[Right ventricular hypertrophy]] | ||
** Narrow QRS<ref name="pmid23653989">{{cite journal| author=Lazović B, Svenda MZ, Mazić S, Stajić Z, Delić M| title=Analysis of electrocardiogram in chronic obstructive pulmonary disease patients. | journal=Med Pregl | year= 2013 | volume= 66 | issue= 3-4 | pages= 126-9 | pmid=23653989 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23653989 }} </ref> | ** Narrow [[QRS]]<ref name="pmid23653989">{{cite journal| author=Lazović B, Svenda MZ, Mazić S, Stajić Z, Delić M| title=Analysis of electrocardiogram in chronic obstructive pulmonary disease patients. | journal=Med Pregl | year= 2013 | volume= 66 | issue= 3-4 | pages= 126-9 | pmid=23653989 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23653989 }} </ref> | ||
* CT scan is more sensitive in diagnosing COPD than X ray | * CT scan is more sensitive in diagnosing COPD than X-ray | ||
|- | |- | ||
|[[Bacterial pneumonia]] | |[[Bacterial pneumonia]] | ||
| Line 85: | Line 85: | ||
* Diagnosis depends on presentation and physical examination | * Diagnosis depends on presentation and physical examination | ||
* Laboratory tests | * Laboratory tests | ||
** [[ | ** [[Arterial blood gases]] may show [[hypoxia]] and [[acidosis]] | ||
** [[Sputum culture]] | ** [[Sputum culture]] | ||
| | | | ||
* X ray is performed to detect: | * X-ray is performed to detect: | ||
** [[ | ** [[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 opacification on CT|Ground glass appearance]] | ||
|- | |- | ||
|[[Pulmonary embolism]] | |[[Pulmonary embolism]] | ||
| Line 114: | Line 114: | ||
*Routine blood tests are non specific | *Routine blood tests are non specific | ||
| | | | ||
* CT [[pulmonary angiography]] is the gold standard imaging to diagnose pulmonary embolism. CT may show: | * CT [[pulmonary angiography]] is the gold standard imaging to diagnose [[pulmonary embolism]]. CT may show: | ||
**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]] | ||
** [[ | ** [[Sinus tachycardia]] | ||
* Chest X ray to exclude other differentials | * Chest X-ray to exclude other differentials | ||
|- | |- | ||
|Diffuse idiopathic | |[[Diffuse]] [[idiopathic]] [[neuroendocrine]] [[Hyperplasia|cell hyperplasia]]<ref name="pmid21471097">{{cite journal| author=Nassar AA, Jaroszewski DE, Helmers RA, Colby TV, Patel BM, Mookadam F| title=Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia: a systematic overview. | journal=Am J Respir Crit Care Med | year= 2011 | volume= 184 | issue= 1 | pages= 8-16 | pmid=21471097 | doi=10.1164/rccm.201010-1685PP | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21471097 }} </ref> | ||
| - | | - | ||
|Dry | |Dry | ||
| Line 136: | Line 136: | ||
** Multiple [[nodules]] | ** Multiple [[nodules]] | ||
** [[Ground glass opacification on CT|Ground glass]] appearance | ** [[Ground glass opacification on CT|Ground glass]] appearance | ||
** [[Bronchiectasis]] | ** [[Bronchiectasis]] | ||
|- | |- | ||
|[[Tuberculosis]] | |[[Tuberculosis]] | ||
| Line 147: | Line 147: | ||
| | | | ||
* Sputum culture: | * Sputum culture: | ||
** Three successive positive | ** Three successive positive cultures for ''[[Mycobacterium tuberculosis|M. tuberculosis]]'' confirms the diagnosis<ref name="pmid12614730">{{cite journal |author=Drobniewski F, Caws M, Gibson A, Young D |title=Modern laboratory diagnosis of tuberculosis |journal=Lancet Infect Dis |volume=3 |issue=3 |pages=141-7 |year=2003 |id=PMID 12614730}}</ref> | ||
** Presence of acid fast bacilli in sputum smear indicates high extent tuberculosis | ** Presence of acid fast bacilli in sputum smear indicates high extent tuberculosis | ||
| | | | ||
* Chest X ray is an important diagnostic imaging procedure in TB diagnosis. X ray may show:<ref>{{Cite journal | * Chest X-ray is an important diagnostic imaging procedure in TB diagnosis. X-ray may show:<ref>{{Cite journal | ||
| author = [[Riccardo Piccazzo]], [[Francesco Paparo]] & [[Giacomo Garlaschi]] | | author = [[Riccardo Piccazzo]], [[Francesco Paparo]] & [[Giacomo Garlaschi]] | ||
| title = Diagnostic accuracy of chest radiography for the diagnosis of tuberculosis (TB) and its role in the detection of latent TB infection: a systematic review | | title = Diagnostic accuracy of chest radiography for the diagnosis of tuberculosis (TB) and its role in the detection of latent TB infection: a systematic review | ||
| Line 179: | Line 179: | ||
** [[Consolidation (medicine)|Consolidation]] | ** [[Consolidation (medicine)|Consolidation]] | ||
**Interlobular septal thickening | **Interlobular septal thickening | ||
*EKG may have abnormalities in case pleural | *EKG may have abnormalities in the case of pleural effusion associated with TB. | ||
|- | |- | ||
| Line 191: | Line 191: | ||
| | | | ||
* Arterial blood gases may show: | * Arterial blood gases may show: | ||
** [[ | ** [[Hypoxemia]] | ||
** PaO2/FiO2 less than 200 mmHg indicating [[acute respiratory distress syndrome]] | ** PaO2/FiO2 less than 200 mmHg indicating [[acute respiratory distress syndrome]] | ||
* 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 | ||
** [[Ground glass opacification on CT|Ground glass]] appearance | ** [[Ground glass opacification on CT|Ground glass]] appearance | ||
* [[Bronchoscopy]] to exclude other causes such as: | * [[Bronchoscopy]] to exclude other causes such as: | ||
** [[ | ** [[Alveolar]] [[hemorrhage]] | ||
** [[lymphoma]] | ** [[lymphoma]] | ||
* Lung biopsy is done: | * Lung biopsy is done: | ||
** In unclear cases; to confirm [[Interstitial pneumonitis|acute interstitial pneumonitis]] | ** In unclear cases; to confirm [[Interstitial pneumonitis|acute interstitial pneumonitis]] | ||
| Line 216: | Line 216: | ||
* 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 | ||
| Line 253: | Line 253: | ||
| | | | ||
* EKG to detect underlying cause | * EKG to detect underlying cause | ||
* Chest | * Chest X-ray shows cardiomegaly | ||
* Echocardiography is done: | * Echocardiography is done: | ||
** To determine [[stroke volume]] | ** To determine [[stroke volume]] | ||
Revision as of 15:47, 8 August 2017
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Risk calculators and risk factors for Bronchiolitis differential diagnosis |
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 present with similar clinical manifestations. Based on cough and dyspnea, bronchiolitis should be differentiated from asthma, COPD, pneumonia, congestive heart failure, diffuse idiopathic neuroendocrine cell hyperplasia, tuberculosis, pertussis, foreign body aspiration, pulmonary embolism, and Harman-Rich syndrome.
Differentiating bronchiolitis from other diseases
Bronchiolitis must be differentiated from other respiratory and cardiac diseases that can cause the similar 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 | - | + | + | +/- |
|
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| Asthma | - | Dry/Productive | - | + | - | - |
|
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| COPD | + | Productive | - | + | + | + |
|
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| Bacterial pneumonia | + | Productive | + | + | + | +/- |
|
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| Pulmonary embolism | +/- | Bloody | + | + | + | + |
|
|
| Diffuse idiopathic neuroendocrine cell hyperplasia[9] | - | Dry | - | + | - | - |
|
|
| Tuberculosis | + | Bloody | + | - | - | - |
|
|
| Interstitial pneumonitis (Hamman - Rich syndrome) | + | Productive | - | - | + | - |
|
|
| Foreign body aspiration | + | Bloody | + | + | - | - |
|
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| Pertussis | + | Dry | - | - | - |
|
| |
| Congestive heart failure | - | Dry/Productive | + while walking | - | - | + |
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References
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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
- ↑ 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.
- ↑ 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.
- ↑ 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) - ↑ 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.
- ↑ Drobniewski F, Caws M, Gibson A, Young D (2003). "Modern laboratory diagnosis of tuberculosis". Lancet Infect Dis. 3 (3): 141–7. PMID 12614730.
- ↑ 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) - ↑ 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) - ↑ Pertussis (whooping coug). Diagnosis confirmation. CDC.gov. Accessed on June 22, 2017
- ↑ Pertussis (whooping cough). Specimen collection. CDC.gov. Accessed on June 22, 2017
- ↑ 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.
- ↑ 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.
- ↑ 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.