Capillary leak syndrome differential diagnosis

Capillary leak syndrome Microchapters
Home
Patient Information
Overview
Historical Perspective
Pathophysiology
Causes
Differentiating Capillary leak syndrome from other Diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT Scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Surgery
Medical Therapy
Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Capillary leak syndrome differential diagnosis On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Capillary leak syndrome differential diagnosis All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Capillary leak syndrome differential diagnosis
CDC on Capillary leak syndrome differential diagnosis
Capillary leak syndrome differential diagnosis in the news
Blogs on Capillary leak syndrome differential diagnosis
Directions to Hospitals Treating Capillary leak syndrome
Risk calculators and risk factors for Capillary leak syndrome differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: M. Hassan, M.B.B.S

Overview

As capillary leak syndrome has overlapping clinical and laboratory findings with various other conditions, it should be considered as the diagnosis of exclusion. Some common ones include Adrenal insufficiency, Anaphylaxis, Carcinoid Syndrome, Chronic Heart Failure, Enteropathy, Gleich syndrome, Hereditary angioedema, Inferior vena cava syndrome, Mastocytosis, Nephrotic syndrome, Ovarian hyperstimulation syndrome, Pancreatitis, Pheochromocytoma, Primary amyloidosis, Sepsis and Toxic shock syndrome. Some other conditions that should be considered as a differential diagnosis include Differentiation syndrome, Engraftment syndrome, Hemophagocytic lymphohistiocytosis, Viral hemorrhagic fevers, Snakebite envenomation, Ricin poisoning, as well as multiple autoimmune conditions.

Differential diagnosis

Due to overlapping clinical and laboratory findings of capillary leak syndrome with other conditions, it is considered as the diagnosis of exclusion. SCLS should be differentiated from many possible differential diagnoses many of which may have overlapping symptoms such as hypotension, flushing and hypoalbuminemia with resultant edema. Such conditions include Adrenal insufficiency, Anaphylaxis, Carcinoid Syndrome, Chronic Heart Failure, Enteropathy, Gleich syndrome, Hereditary angioedema, Inferior vena cava syndrome, Mastocytosis, Nephrotic syndrome, Ovarian hyperstimulation syndrome, Pancreatitis, Pheochromocytoma, Primary amyloidosis, Sepsis and Toxic shock syndrome.

Differential diagnosis

Disorder	Similarities to Systemic capillary leak syndrome	Distinguishing features	Investigations to confirm Differential Diagnosis
Adrenal insufficiency	Hypotension	Fatigue Anorexia Weight loss Abdominal pain Nausea Vomiting Lethargy	Hyponatremia Hyperkalemia Eosinophilia Episodic hypoglycemia Mild metabolic acidosis
Anaphylaxis (Idiopathic)	Hypotension Flushing	Normal albumin Hives Laryngeal edema Elevated serum tryptase	Primarily based on clinical diagnosis Elevated levels of tryptase and histamine
Carcinoid Syndrome	Hypotension Flushing	Absence of edema Elevated serotonin metabolites	Elevated Urinary 5-hydroxyindoleacetic acid Elevated plasma levels of Chromogranin A (CgA) Other biochemical markersinclude: Substance P, Neurotensin, Bradykinin, hCG , Neuropeptide L, Pancreatic polypeptide
Chronic Heart Failure	Edema (of the ankles)	Breathlessness Orthopnoea Paroxysmal nocturnal dyspnoea Fatigue Reduced exercise tolerance and Increased recovery time	Elevated Natriuretic Peptides (BNP or NT-proBNP)
Enteropathy with protein loss	Edema Hypoalbuminemia	Diarrhea	Differs according to underlying subtype of enteropathy
Gleich syndrome	Cyclical edema	Urticaria Eosinophilia Elevated IgM Normal albumin	Hypereosinophilic
Hereditary angioedema	Edema	Normotension Visceral effusions	Decreased levels of C1 esterase inhibitor
Inferior vena cava syndrome	Lower extremity edema Hypotension	Irreversible hypotension Normal albumin	Diagnosed using imaging modalities such as Duplex Ultrasound or CT abdomen and pelvis
Mastocytosis (Mast cell disease)	Hypotension Flushing	Urticaria pigmentosa Elevated serum tryptase	Elevated serum tryptase
Nephrotic syndrome	Edema Hypoalbuminemia	Proteinuria	24-hour urine collection shows proteinuria > 3.5g/24 hrs
Ovarian hyperstimulation syndrome	Hypotension Hypovolemia Edema	Visceral effusions	Diagnosed with imaging modalities
Pancreatitis	Hypotension Hypoalbuminemia	Severe abdominal pain Nausea Vomiting Elevated amylase	Elevated amylase and lipase CT scan findings
Pheochromocytoma	Hypotension Flushing	Hypertension Palpitations Anxiety Sweating Headaches Elevated norepinephrine and epinephrine metabolites	Elevated 24-hour urine fractionated metanephrines and catecholamines Elevated urinary vanillyl mandelic acid
Polycythemia vera	Severe leukocytosis Erythrocytosis Thrombocytosis	Normotension Normal albumin Absence of edema	Abnormal CBC values: Erythrocytosis, Increased hemoglobin, Thrombocytosis, Leukocytosis, Increased basophils and eosinophils
Primary amyloidosis	Generalized edema (Anasarca)	Bleeding tendency Frothy urine Chest pain Numbness or tingling Early satiety Joint pains	Beta-2-microglobulin Serum protein electrophoresis Immunoglobulin levels
Sepsis	Hypotension Edema	Normal albumin Acute respiratory distress syndrome	Elevated WBC Fever May be accompanied by DIC with raised PT, aPTT, and D-dimer
Toxic shock syndrome	Hypotension	Normal albumin Desquamating rash Nausea Vomiting Renal failure Mucosal hyperemia Delirium	Elevated WBC Fever Metabolic acidosis