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, | 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]]. | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Bronchiolitis must be differentiated from other respiratory and cardiac diseases that can cause the same clinical manifestations like cough and | Bronchiolitis must be differentiated from other respiratory and cardiac diseases that can cause the same clinical manifestations like [[cough]] and [[dyspnea]].<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="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><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="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="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> | ||
===Differentiating bronchiolitis based on cough and dysnea=== | ===Differentiating bronchiolitis based on cough and dysnea=== | ||
Based on cough and dyspnea, bronchiolitis is differentiated from asthma, COPD, pneumonia, congestive heart failure, diffuse idiopathic neuroendocrine cell hyperplasia, tuberculosis, | 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]]. | ||
{| class="wikitable" | {| class="wikitable" | ||
| Line 29: | Line 29: | ||
!Imaging | !Imaging | ||
|- | |- | ||
|Bronchiolitis | |[[Bronchiolitis]] | ||
| +/- | | +/- | ||
|Dry | |Dry | ||
| Line 38: | Line 38: | ||
| +/- | | +/- | ||
| | | | ||
* Viral tests like ELISA and immunoassays may be done in case of RSV infection. | * Viral tests like [[ELISA]] and [[immunoassays]] may be done in case of [[RSV]] infection. | ||
* Pulmonary function test is performed 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]] is performed 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> | ||
| | | | ||
* In CT scan, intense bronchiolar mural inflammation of cellular bronchiolitis results in centrilobular nodules that are usually associated with the tree-in-bud pattern and bronchial wall thickening | * In CT scan, intense bronchiolar mural [[inflammation]] of cellular bronchiolitis results in centrilobular [[nodules]] that are usually associated with the tree-in-bud pattern and [[bronchial]] wall thickening | ||
|- | |- | ||
|Asthma | |[[Asthma]] | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|Dry/Productive | |Dry/Productive | ||
| Line 49: | Line 49: | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| - | | - | ||
| | | + [[Pulmonary edema]] | ||
| - | | - | ||
| | | | ||
* Lab tests are performed to exclude other diseases. | * Lab tests are performed to exclude other diseases. | ||
* Serum examination shows elevated level of esoinophils due to allergy. | * Serum examination shows elevated level of esoinophils due to [[allergy]]. | ||
| | | | ||
* CT scan shows dilated bronchi, bronchial wall thickening and air trapping. | * CT scan shows dilated [[bronchi]], bronchial wall thickening and air trapping. | ||
|- | |- | ||
|COPD | |[[COPD]] | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
|Productive | |Productive | ||
| Line 67: | Line 67: | ||
| | | | ||
* Spirometry: FEV1/FVC < 70% | * Spirometry: FEV1/FVC < 70% | ||
* Atrial blood gases: hypoxemia and hypercapnia | * Atrial blood gases: [[hypoxemia]] and [[hypercapnia]] | ||
* Sputum culture | * [[Sputum culture]] | ||
| | | | ||
* EKG may show P pulmonale, right ventricular hypertrophy and low 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> | * EKG may show [[P pulmonale]], [[right ventricular hypertrophy]] and low 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]] | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
|Productive | |Productive | ||
| Line 83: | Line 83: | ||
| | | | ||
* Diagnosis depends mainly on the presentation and physical examination. | * Diagnosis depends mainly on the presentation and physical examination. | ||
* Laboratory tests: arterial blood gases may show hypoxia and acidosis. | * Laboratory tests: [[arterial blood gases]] may show [[hypoxia]] and [[acidosis]]. | ||
* Sputum culture. | * [[Sputum culture]]. | ||
| | | | ||
* X ray is performed to detect pleural effusion and inflitrates within the lungs. | * X ray is performed to detect [[pleural effusion]] and inflitrates within the [[lungs]]. | ||
* CT scan shows consolidation and ground glass appearance. | * CT scan shows [[Consolidation (medicine)|consolidation]] and ground glass appearance. | ||
|- | |- | ||
|Pulmonary embolism | |[[Pulmonary embolism]] | ||
| +/- | | +/- | ||
|Bloody | |Bloody | ||
| Line 98: | Line 98: | ||
| + | | + | ||
| | | | ||
* D-dimer level test is performed to rule out other diseases like DVT. | * [[D-dimer]] level test is performed to rule out other diseases like [[DVT]]. | ||
* Routine blood tests are non specific. | * Routine blood tests are non specific. | ||
* Hypercoagulability tests are performed in patients with unprovoked venous thrombosis at an early age (< 40 years) and family history of VTE syndromes. | * [[Hypercoagulability]] tests are performed in patients with unprovoked [[venous thrombosis]] at an early age (< 40 years) and family history of [[VTE]] syndromes. | ||
*Arterial blood gases show the following:<ref name="pmid2491801">{{cite journal |author=Cvitanic O, Marino PL |title=Improved use of arterial blood gas analysis in suspected pulmonary embolism |journal=[[Chest]] |volume=95 |issue=1 |pages=48–51 |year=1989 |month=January |pmid=2491801 |doi= |url=http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=2491801 |accessdate=2012-04-30}}</ref> | *Arterial blood gases show the following:<ref name="pmid2491801">{{cite journal |author=Cvitanic O, Marino PL |title=Improved use of arterial blood gas analysis in suspected pulmonary embolism |journal=[[Chest]] |volume=95 |issue=1 |pages=48–51 |year=1989 |month=January |pmid=2491801 |doi= |url=http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=2491801 |accessdate=2012-04-30}}</ref> | ||
**Hypoxemia | **[[Hypoxemia]] | ||
**Hypocapnia | **[[Hypocapnia]] | ||
**Respiratory alkalosis | **[[Respiratory alkalosis]] | ||
**Increased alveolar-arterial gradient | **Increased alveolar-arterial gradient | ||
| | | | ||
* CT pulmonary angiography is the gold standard imaging to diagnose the pulmonary embolism. It shows the following: | * CT [[pulmonary angiography]] is the gold standard imaging to diagnose the pulmonary embolism. It shows the following: | ||
**Acute:Centrally located thrombus or occluding the vessel. | **Acute:Centrally located [[thrombus]] or 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 T wave inversion, P pulmonale and sinus tachycardia. | * EKG is not specific or sensitive in PE diagnosis but it may show [[T wave inversion]], [[P pulmonale]] and [[sinus tachycardia]]. | ||
* Chest X ray is performed to exclude other differentials. | * Chest X ray is performed to exclude other differentials. | ||
|- | |- | ||
| Line 124: | Line 124: | ||
* Pulmonary function test shows obstructive lung disease | * Pulmonary function test shows obstructive lung disease | ||
| | | | ||
* CT scan shows multiple nodules , ground glass appearance and bronchiectasis. | * CT scan shows multiple [[nodules]] , ground glass appearance and bronchiectasis. | ||
|- | |- | ||
|Tuberculosis | |[[Tuberculosis]] | ||
| + | | + | ||
|Bloody | |Bloody | ||
| Line 135: | Line 135: | ||
| - | | - | ||
| | | | ||
* Sputum culture: three successive positive culture for 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> | * Sputum culture: three successive positive culture 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> | ||
* The presence of acid fast bacilli in sputum smear indicates to high extent tuberculosis. | * The presence of acid fast bacilli in sputum smear indicates to high extent tuberculosis. | ||
| | | | ||
| Line 151: | Line 151: | ||
**Parenchymal infilration | **Parenchymal infilration | ||
**Hilar | **Hilar [[adenopathy]] | ||
**Nodules | **[[Nodules]] | ||
**pleural effusion | **[[Pleural effusion (patient information)|pleural effusion]] | ||
*CT scan shows the following:<ref>{{Cite journal | *CT scan shows the following:<ref>{{Cite journal | ||
| author = [[Jeong Min Ko]], [[Hyun Jin Park]] & [[Chi Hong Kim]] | | author = [[Jeong Min Ko]], [[Hyun Jin Park]] & [[Chi Hong Kim]] | ||
| Line 164: | Line 164: | ||
}}</ref> | }}</ref> | ||
**Micronodules | **Micronodules | ||
**Cavitation | **[[Cavitation]] | ||
**Consolidation | **[[Consolidation (medicine)|Consolidation]] | ||
**Interlobular septal thickening | **Interlobular septal thickening | ||
* EKG may have abnormalities in case pleural effussion associated with TB. | * EKG may have abnormalities in case pleural effussion associated with TB. | ||
|- | |- | ||
|Interstitial pneumonitis (Hamman - Rich syndrome) | |[[Hamman-Rich syndrome|Interstitial pneumonitis]] (Hamman - Rich syndrome) | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
|Productive | |Productive | ||
| Line 179: | Line 179: | ||
| - | | - | ||
| | | | ||
* Arterial blood gases: hypoxemia and PaO2/FiO2 less than 200 mmHg which indicates acute respiratory distress syndrome. | * Arterial blood gases: [[hypoxemia]] and PaO2/FiO2 less than 200 mmHg which indicates [[acute respiratory distress syndrome]]. | ||
* Other lab tests are usually used to exclude other diseases. | * Other lab tests are usually used to exclude other diseases. | ||
| | | | ||
* Chest X ray shows bilateral airway opacification. | * Chest X ray shows bilateral airway opacification. | ||
* CT scan shows ground glass appearance. | * CT scan shows ground glass appearance. | ||
* Bronchoscopy may be performed to exclude other causes like alveolar hemorrhage and lymphoma. | * [[Bronchoscopy]] may be performed to exclude other causes like [[alveolar]] [[hemorrhage]] and [[lymphoma]]. | ||
* Lung biopsy is a last step in diagnosis of acute interstitial | * Lung biopsy is a last step in diagnosis of [[Interstitial pneumonitis|acute interstitial pneumonitis]] in order to confirm the disease and exclude other causes of [[Acute respiratory distress syndrome|ARDS]]. | ||
|- | |- | ||
|Foreign body aspiration | |[[Foreign body aspiration]] | ||
| + | | + | ||
|Bloody | |Bloody | ||
| Line 196: | Line 196: | ||
| - | | - | ||
| | | | ||
* Lab tests are performed to evaluate the ventilation function. | * Lab tests are performed to evaluate the [[ventilation]] function. | ||
| | | | ||
* Chest X ray shows hyperinflation, mediastinal shift and atelectasis. | * Chest X ray shows hyperinflation, mediastinal shift and [[atelectasis]]. | ||
|- | |- | ||
|Pertussis | |[[Pertussis]] | ||
| + | | + | ||
|Dry | |Dry | ||
| Line 209: | Line 209: | ||
| - | | - | ||
| | | | ||
* Nasopharyngeal swab for PCR testing. | * Nasopharyngeal swab for [[Polymerase chain reaction|PCR testing.]] | ||
* Sputum culture | * [[Sputum culture]] | ||
* Serology to detect pertussis toxin.<ref name="CDC4">[http://www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-confirmation.html Pertussis (whooping coug). Diagnosis confirmation. CDC.gov. Accessed on June 22, 2017]</ref><ref name="CDC3">[http://www.cdc.gov/pertussis/clinical/diagnostic-testing/specimen-collection.html Pertussis (whooping cough). Specimen collection. CDC.gov. Accessed on June 22, 2017] </ref> | * Serology to detect [[pertussis toxin]].<ref name="CDC4">[http://www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-confirmation.html Pertussis (whooping coug). Diagnosis confirmation. CDC.gov. Accessed on June 22, 2017]</ref><ref name="CDC3">[http://www.cdc.gov/pertussis/clinical/diagnostic-testing/specimen-collection.html Pertussis (whooping cough). Specimen collection. CDC.gov. Accessed on June 22, 2017] </ref> | ||
| | | | ||
* No remarkable imaging findings. | * No remarkable imaging findings. | ||
|- | |- | ||
|Congestive heart failure | |[[Congestive heart failure]] | ||
| - | | - | ||
|Dry/Productive | |Dry/Productive | ||
Revision as of 23:44, 22 June 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.
Differential Diagnosis
Bronchiolitis must be differentiated from other respiratory and cardiac diseases that can cause the same clinical manifestations like cough and dyspnea.[1][2][3][4][5]
Differentiating bronchiolitis based on cough and dysnea
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.
| Diseases | Symptoms | Signs | Diagosis | ||||||
|---|---|---|---|---|---|---|---|---|---|
| Fever | Cough | Chest pain | Wheezes | Crackles | Edema | Tachycardia | Lab tests | Imaging | |
| Bronchiolitis | +/- | Dry | - | + | + | - | +/- |
|
|
| Asthma | - | Dry/Productive | - | + | - | + Pulmonary edema | - |
|
|
| COPD | + | Productive | - | + | + | + | + |
|
|
| Bacterial pneumonia | + | Productive | + | + | + | - | +/- |
|
|
| Pulmonary embolism | +/- | Bloody | + | + | + | + | + |
|
|
| Diffuse idiopathic pulmonary 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 | - | - | + | + |
|
|
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.
- ↑ 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
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.