Rhinosinusitis differential diagnosis: Difference between revisions

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*Vascular headaches
*Vascular headaches
*[[Temporal arteritis]]
*[[Temporal arteritis]]
*Nasal foreign body  
*Nasal foreign body
 
{| style="border: 0px; font-size: 85%; margin: 3px; width:1000px;" align="center"
 
|+
! style="background: #4479BA; color:#FFF;  width: 150px;" | Disease
! style="background: #4479BA; color:#FFF;  width: 200px;" | History
! style="background: #4479BA; color:#FFF;  width: 200px;" | Physical examination
! style="background: #4479BA; color:#FFF;  width: 200px;" | Laboratory or radiological findings
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  Acute viral nasopharyngitis<ref name="pmid12517470">{{cite journal |vauthors=Heikkinen T, Järvinen A |title=The common cold |journal=Lancet |volume=361 |issue=9351 |pages=51–9 |year=2003 |pmid=12517470 |doi=10.1016/S0140-6736(03)12162-9 |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
* Symptoms start with [[sore throat]]
* [[Nasal congestion]] and [[runny nose]]
* [[Cough]] that may persist after the resolution of the other symptoms
* [[Fever]] is not common
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Nasal mucosa]] is [[congested]] and [[Hyperaemia|hyperemic]]
* [[Pharynx]] is typically normal
| style="padding: 5px 5px; background: #F5F5F5;" |
* Diagnosis is usually clinical and lab tests are rarely needed
* The virus can be [[Culture medium|cultured]] on human lung cells but results take time
* [[PCR]] is rapid and accurate test but done only in [[immunocompromised]] patients when the [[virus]] strain needs to be known
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  [[Allergic rhinitis]]<ref name="pmid20232579">{{cite journal |vauthors=Pawankar R, Bunnag C, Chen Y, Fukuda T, Kim YY, Le LT, Huong le TT, O'Hehir RE, Ohta K, Vichyanond P, Wang DY, Zhong N, Khaltaev N, Bousquet J |title=Allergic rhinitis and its impact on asthma update (ARIA 2008)--western and Asian-Pacific perspective |journal=Asian Pac. J. Allergy Immunol. |volume=27 |issue=4 |pages=237–43 |year=2009 |pmid=20232579 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
* Characterized by repeated paroxysms of [[rhinorrhea]], [[sneezing]] and [[cough]].
* Symptoms may be related to a specific season of the year, hence the name “seasonal allergies”.
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Rhinorrhea]] fluid is usually clear and watery.
* Examination of the nose reveals a crease below the [[nasal bridge]] from repeated pulling of the nose secondary to irritation.
* [[Edema]] in the area below the eye if associated [[conjunctivitis]] is present.<ref name="pmid11449200">{{cite journal |vauthors=Skoner DP |title=Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis |journal=J. Allergy Clin. Immunol. |volume=108 |issue=1 Suppl |pages=S2–8 |year=2001 |pmid=11449200 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
* Skin testing using intradermal prick skin tests to determine the specific [[allergens]] causing [[allergic rhinitis]].
* Serum immune assays to determine [[IgE|IgE levels]] in the [[serum]].
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  [[Acute sinusitis]]<ref name="pmid9347786">{{cite journal |vauthors=Low DE, Desrosiers M, McSherry J, Garber G, Williams JW, Remy H, Fenton RS, Forte V, Balter M, Rotstein C, Craft C, Dubois J, Harding G, Schloss M, Miller M, McIvor RA, Davidson RJ |title=A practical guide for the diagnosis and treatment of acute sinusitis |journal=CMAJ |volume=156 Suppl 6 |issue= |pages=S1–14 |year=1997 |pmid=9347786 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
* Presents with symptoms similar to [[URTI|URTIs]] ([[sneezing]], [[cough]] and [[runny nose]])
* Symptoms last for a longer time (about 10 days) with the peak of symptoms between 4th and 6th days.
* Usually, [[acute sinusitis]] is not associated with [[fever]]<ref name="pmid7242607">{{cite journal |vauthors= |title=Acute maxillary sinusitis |journal=N. Engl. J. Med. |volume=305 |issue=4 |pages=226–7 |year=1981 |pmid=7242607 |doi=10.1056/NEJM198107233050419 |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
* Inspection may show [[erythema]] and [[edema]] over the involved [[sinus]]
* Palpation of [[sinuses]] shows [[tenderness]] on palpation
* [[Transillumination]] of the sinuses may show opacity.
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[X ray]] and [[CT]] may show air fluid level or bubbles in the affected sinus.
* [[Culture medium|Culture]] of the nasal secretions is of limited use in [[acute sinusitis]] as nasal secretions may be contaminated by [[Flora|nasal flora]].
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | [[Infectious mononucleosis]]<ref name="pmid4864269">{{cite journal |vauthors=Niederman JC, McCollum RW, Henle G, Henle W |title=Infectious mononucleosis. Clinical manifestations in relation to EB virus antibodies |journal=JAMA |volume=203 |issue=3 |pages=205–9 |year=1968 |pmid=4864269 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
* Symptoms of [[pharyngitis]]: [[sore throat]] and [[Dysphagia|difficult swallowing]]
* [[Fever]]
* [[Fatigue]]
* [[Lymphadenopathy]] especially in the posterior cervical region
| style="padding: 5px 5px; background: #F5F5F5;" |
* Abdominal examination reveals [[splenomegaly]]
* [[Maculopapular rash]] may be present
| style="padding: 5px 5px; background: #F5F5F5;" |
* Positive monospot test
* Elevated [[liver enzymes]]
|}
 
==References==  
==References==  


Revision as of 19:12, 24 July 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2]

Overview

Rhinosinusitis must be differentiated from other diseases that may present with a headache and/or respiratory symptoms.

Differential Diagnosis

Rhinosinusitis must be differentiated from:[1][2][3]

Disease History Physical examination Laboratory or radiological findings
Acute viral nasopharyngitis[4]
  • Diagnosis is usually clinical and lab tests are rarely needed
  • The virus can be cultured on human lung cells but results take time
  • PCR is rapid and accurate test but done only in immunocompromised patients when the virus strain needs to be known
Allergic rhinitis[5]
  • Characterized by repeated paroxysms of rhinorrhea, sneezing and cough.
  • Symptoms may be related to a specific season of the year, hence the name “seasonal allergies”.
  • Rhinorrhea fluid is usually clear and watery.
  • Examination of the nose reveals a crease below the nasal bridge from repeated pulling of the nose secondary to irritation.
  • Edema in the area below the eye if associated conjunctivitis is present.[6]
Acute sinusitis[7]
Infectious mononucleosis[9]

References

  1. ↑ Slavin RG, Spector SL, Bernstein IL, Kaliner MA, Kennedy DW, Virant FS; et al. (2005). "The diagnosis and management of sinusitis: a practice parameter update". J Allergy Clin Immunol. 116 (6 Suppl): S13–47. PMID 16416688.
  2. ↑ Fagnan LJ (1998). "Acute sinusitis: a cost-effective approach to diagnosis and treatment". Am Fam Physician. 58 (8): 1795–802, 805–6. PMID 9835855.
  3. ↑ Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Ashok Kumar K, Kramper M; et al. (2015). "Clinical practice guideline (update): adult sinusitis". Otolaryngol Head Neck Surg. 152 (2 Suppl): S1–S39. doi:10.1177/0194599815572097. PMID 25832968.
  4. ↑ Heikkinen T, Järvinen A (2003). "The common cold". Lancet. 361 (9351): 51–9. doi:10.1016/S0140-6736(03)12162-9. PMID 12517470.
  5. ↑ Pawankar R, Bunnag C, Chen Y, Fukuda T, Kim YY, Le LT, Huong le TT, O'Hehir RE, Ohta K, Vichyanond P, Wang DY, Zhong N, Khaltaev N, Bousquet J (2009). "Allergic rhinitis and its impact on asthma update (ARIA 2008)--western and Asian-Pacific perspective". Asian Pac. J. Allergy Immunol. 27 (4): 237–43. PMID 20232579.
  6. ↑ Skoner DP (2001). "Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis". J. Allergy Clin. Immunol. 108 (1 Suppl): S2–8. PMID 11449200.
  7. ↑ Low DE, Desrosiers M, McSherry J, Garber G, Williams JW, Remy H, Fenton RS, Forte V, Balter M, Rotstein C, Craft C, Dubois J, Harding G, Schloss M, Miller M, McIvor RA, Davidson RJ (1997). "A practical guide for the diagnosis and treatment of acute sinusitis". CMAJ. 156 Suppl 6: S1–14. PMID 9347786.
  8. ↑ "Acute maxillary sinusitis". N. Engl. J. Med. 305 (4): 226–7. 1981. doi:10.1056/NEJM198107233050419. PMID 7242607.
  9. ↑ Niederman JC, McCollum RW, Henle G, Henle W (1968). "Infectious mononucleosis. Clinical manifestations in relation to EB virus antibodies". JAMA. 203 (3): 205–9. PMID 4864269.

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