Caplans syndrome differential diagnosis: Difference between revisions
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! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Disease}} | |||
! style="background: #4479BA; width: 400px;" |{{fontcolor|#FFF|Findings}} | |||
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Bacterial pneumonia]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Sudden onset of symptoms, such as high [[fever]], [[cough]], [[purulent]] [[sputum]], [[chest pain]], [[leukocytosis]], chest X-ray shows consolidation. | |||
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| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Bronchogenic carcinoma]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" |may be asymptomatic, usually at older ages (> 50 years old), [[cough]], [[hemoptysis]], [[weight loss]] | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Brucellosis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" |[[Fever]], [[anorexia]], [[night sweats]], [[malaise]],[[back pain]] , [[headache]], and [[depression]]. History of exposure to infected animal | |||
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| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Hodgkin lymphoma]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" |[[Fever]], [[night sweats]], [[pruritus]], painless [[adenopathy]], [[mediastinal mass]] | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Mycoplasmal pneumonia]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Gradual onset of [[dry cough]], [[headache]], [[malaise]], [[sore throat]]. Diffuse bilateral infiltrates on [[chest X-ray]]. | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Sarcoidosis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Non-[[caseating]] [[granulomas]] in lungs and other organs, bilateral [[hilar]] [[lymphadenopathy]], mostly in African American females. | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Caplan syndrome | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
|- | |||
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" |<small>Adapted from Mandell, Douglas, and Bennett's principles and practice of infectious diseases 2010 </small> | |||
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{| class="wikitable" | |||
!Causes of | |||
|- | lung cavities | ||
!Differentiating Features | |||
| | !Differentiating radiological findings | ||
!Diagnosis | |||
| | confirmation | ||
|- | |||
| | |||
*[[Malignancy]] ([[Lung cancer|Primary lung cance<nowiki/>r]]) | |||
| | |||
*Elderly male or female <ref name="pmid4353362">{{cite journal |vauthors=Chaudhuri MR |title=Primary pulmonary cavitating carcinomas |journal=Thorax |volume=28 |issue=3 |pages=354–66 |year=1973 |pmid=4353362 |pmc=470041 |doi= |url=}}</ref> | |||
*Chronic smokers | |||
*Presents with a [[low-grade fever]], absence of [[leukocytosis]], systemic complaints [[weight loss]], [[fatigue]] | |||
*Absence of factors that predispose to [[gastric content aspiration]], no response to [[antibiotics]] within 10 days | |||
*[[Hemoptysis]] is commonly associated with [[bronchogenic carcinoma]] | |||
| | |||
*A coin-shaped lesion with thick wall(>15mm) is seen on CXR with less ground glass opacities | |||
*[[Bronchoalveolar lavage]] [[cytology]] shows malignant cells | |||
| | |||
*[[Biopsy]] of lung | |||
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*Pulmonary [[Tuberculosis, pulmonary|Tuberculosis]] | |||
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*Mostly in endemic areas | |||
*Symptoms include [[productive cough]],[[night sweats]], [[fever]] and [[weight loss]] | |||
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*CXR and CT demonstrates [[Internal|cavities]] in the upper lobe of the lung | |||
| | |||
*[[Sputum]] smear-positive for [[acid-fast bacilli]] and nucleic acid amplification tests (NAAT) is used on sputum or any sterile fluid for rapid diagnosis and is positive for mycobacteria. | |||
|- | |- | ||
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*[[Necrotizing Pulmonary Infections|Necrotizing]] [[Pneumonia]] | |||
| | |||
*Any age group | |||
*Acute, [[fulminant]] life threating complication of prior infection | |||
*>100.4F fever, with [[Hemodynamically unstable|hemodynamic]] instability | |||
*Worsening [[pneumonia]]-like symptoms | |||
| | |||
*CXR demonstrates multiple cavitary lesions | |||
*[[Pleural effusion]] and [[empyema]] are common findings | |||
| | |||
*[[Complete blood count|CBC]] is positive for the causative organism | |||
|- | |- | ||
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*Loculated [[empyema]] | |||
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*Children and elderly are at risk | |||
*Pleuritic [[chest pain]], [[dry cough]], [[fever]] with chills | |||
*Dullness to [[Percussion of the lungs|percussion]] decreased [[breath sounds]], and reduced vocal resonance on examination | |||
| | |||
*[[Empyema]] appears lenticular in shape and has a thin wall with smooth luminal margins | |||
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*[[Thoracocentesis]] | |||
|- | |- | ||
| | | | ||
| | *[[Granulomatosis with polyangiitis]] ([[Wegener's granulomatosis|Wegener's]]) | ||
| | |||
*Women are more commonly effected than man. | |||
*Kidneys are also involved | |||
*Upper respiratory tract symptoms , perforation of [[nasal septum]], [[chronic sinusitis]], [[otitis media]], [[mastoiditis]]. | |||
*Lower respiratory tract symptoms, [[hemoptysis]], [[cough]], [[dyspnea]]. | |||
| | *Renal symptoms, [[hematuria]], red cell [[casts]] | ||
| | |||
| | *Pulmonary nodules with cavities and infiltrates are a frequent manifestation of CXR | ||
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| | | | ||
| | *Positive for [[P-ANCA]] | ||
*Biopsy of the affected tissue shows necrotizing [[granulomas]] <ref name="pmid10377211">{{cite journal |vauthors=Langford CA, Hoffman GS |title=Rare diseases.3: Wegener's granulomatosis |journal=Thorax |volume=54 |issue=7 |pages=629–37 |year=1999 |pmid=10377211 |pmc=1745525 |doi= |url=}}</ref> | |||
| | |||
|- | |- | ||
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*[[Rheumatoid nodule]] | |||
| | |||
*Elderly females of 40-50 age group | |||
*Manifestation of [[rheumatoid arthritis]] | |||
*Presents with other systemic symptoms including symmetric [[arthritis]] of the small joints of the hands and feet and morning stiffness are common manifestations. | |||
| | |||
*Pulmonary nodules with cavitation are present in the upper lobe ([[Caplan syndrome]]) on Xray. | |||
| | |||
| | *Positive for both [[rheumatoid factor]] and anti-cyclic citrullinated peptide [[Antibody|antibody.]] | ||
|- | |- | ||
| | | | ||
*[[Sarcoidosis]] | |||
| | |||
*More common in African-American females | |||
| | *Often [[asymptomatic]] except for [[Lymphadenopathy|enlarged lymph nodes]] | ||
*Associated with [[restrictive lung disease]] | |||
*[[Erythema nodosum]] | |||
*[[Lupus pernio]] (skin lesions on face resembling lupus) | |||
*[[Bell's palsy|Bell palsy]] | |||
| | *[[Epithelioid]] [[granuloma]]<nowiki/>s containing microscopic [[Schaumann bodies|Schaumann]] and asteroid bodies | ||
| | | | ||
*On CXR bilateral [[Lymphadenopathy|adenopathy]] and coarse reticular opacities are seen. | |||
| | *CT of the chest demonstrates extensive [[Hilar lymphadenopathy|hilar]] and mediastinal adenopathy | ||
| | *Additional findings on CT include [[fibrosis]] (honeycomb, linear, or associated with bronchial distortion), pleural thickening, and ground-glass opacities. | ||
| | |||
*Biopsy of lung reveals non-[[caseating]] [[granuloma]] | |||
|- | |- | ||
| | | | ||
| | *[[Bronchiolitis obliterans]] ([[Cryptogenic organizing pneumonia]]) | ||
| | | | ||
*Rare condition and mimics [[asthma]], [[pneumonia]] and [[emphysema]] | |||
*It is due to [[drug]] or [[toxin]] exposure, [[autoimmune diseases]], [[viral infections]], or [[radiation injury]] | |||
| | *Individuals working in industries are at high risk | ||
| | *Presents with [[Fever|feve]]<nowiki/>r, [[cough]], [[wheezing]] and [[shortness of breath]] over weeks to months, | ||
| | | | ||
| | *Common appearance on CT is patchy [[Consolidation (medicine)|consolidation,]]<nowiki/>often accompanied by ground-glass opacities and nodules. | ||
| | |||
| | *Biopsy of the lung <ref name="pmid19561910">{{cite journal |vauthors=Al-Ghanem S, Al-Jahdali H, Bamefleh H, Khan AN |title=Bronchiolitis obliterans organizing pneumonia: pathogenesis, clinical features, imaging and therapy review |journal=Ann Thorac Med |volume=3 |issue=2 |pages=67–75 |year=2008 |pmid=19561910 |pmc=2700454 |doi=10.4103/1817-1737.39641 |url=}}</ref> | ||
*[[Pulmonary function tests]] demonstrate low fev1/fvc | |||
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|- | |- | ||
| | | | ||
| | *[[Langerhans cell histiocytosis|Langerhans]] cell [[Langerhans cell histiocytosis|Histiocytosis]] | ||
| | |||
*Exclusively occurs in smokers, with a peak age of onset 20-40 years. | |||
*Clinical presentation is variable, but symptoms generally include months of dry [[cough]], [[fever]], [[night sweats]] and [[weight loss]]. | |||
*Skin is involved in 80% of the cases, scaly [[erythematous rash]] is typical. | |||
| | |||
*Thin-walled cystic cavities are the usual radiographic manifestation, observed in over 50% of patients by either CXR or CT scans. | |||
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*Biopsy of the lung | |||
|- | |- | ||
| | |Caplan syndrome | ||
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|} | |} | ||
<references /> | |||
==References== | ==References== |
Revision as of 21:31, 16 June 2021
Caplans syndrome Microchapters |
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Caplans syndrome differential diagnosis On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Caplan syndrome must be differentiated from Asbestosis, Silicosis, and Tuberculsosis.
Differentiating Caplan syndrome from other Diseases
Caplan syndrome must be differentiated from asbestosis, silicosis.
Disease | Findings |
---|---|
Bacterial pneumonia | Sudden onset of symptoms, such as high fever, cough, purulent sputum, chest pain, leukocytosis, chest X-ray shows consolidation. |
Bronchogenic carcinoma | may be asymptomatic, usually at older ages (> 50 years old), cough, hemoptysis, weight loss |
Brucellosis | Fever, anorexia, night sweats, malaise,back pain , headache, and depression. History of exposure to infected animal |
Hodgkin lymphoma | Fever, night sweats, pruritus, painless adenopathy, mediastinal mass |
Mycoplasmal pneumonia | Gradual onset of dry cough, headache, malaise, sore throat. Diffuse bilateral infiltrates on chest X-ray. |
Sarcoidosis | Non-caseating granulomas in lungs and other organs, bilateral hilar lymphadenopathy, mostly in African American females. |
Caplan syndrome | |
Adapted from Mandell, Douglas, and Bennett's principles and practice of infectious diseases 2010 |
Causes of
lung cavities |
Differentiating Features | Differentiating radiological findings | Diagnosis
confirmation |
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Caplan syndrome |
- ↑ Chaudhuri MR (1973). "Primary pulmonary cavitating carcinomas". Thorax. 28 (3): 354–66. PMC 470041. PMID 4353362.
- ↑ Langford CA, Hoffman GS (1999). "Rare diseases.3: Wegener's granulomatosis". Thorax. 54 (7): 629–37. PMC 1745525. PMID 10377211.
- ↑ Al-Ghanem S, Al-Jahdali H, Bamefleh H, Khan AN (2008). "Bronchiolitis obliterans organizing pneumonia: pathogenesis, clinical features, imaging and therapy review". Ann Thorac Med. 3 (2): 67–75. doi:10.4103/1817-1737.39641. PMC 2700454. PMID 19561910.