Bronchiolitis differential diagnosis: Difference between revisions
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| +/- | | +/- | ||
| | | | ||
* | * [[ELISA]] and [[immunoassays]] may be done in case of [[RSV]] infection | ||
* [[Pulmonary function test]] | * [[Pulmonary function test]] 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> | ||
| | | | ||
* | * CT scan shows | ||
** Intense bronchiolar mural [[inflammation]] of cellular bronchiolitis leading to centrilobular [[nodules]] that are usually associated with the tree-in-bud pattern and [[bronchial]] wall thickening | |||
|- | |- | ||
|[[Asthma]] | |[[Asthma]] | ||
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* Serum examination shows elevated level of esoinophils due to [[allergy]]. | * Serum examination shows elevated level of esoinophils due to [[allergy]]. | ||
| | | | ||
* CT scan shows | * CT scan shows | ||
** Dilated [[bronchi]] | |||
** Bronchial wall thickening | |||
** Air trapping | |||
|- | |- | ||
|[[COPD]] | |[[COPD]] | ||
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* [[Sputum culture]] | * [[Sputum culture]] | ||
| | | | ||
* EKG may show [[P pulmonale]] | * EKG may show | ||
* CT scan is more sensitive in diagnosing COPD than X ray | ** [[P pulmonale]] | ||
** [[right ventricular hypertrophy]] and 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 | |||
|- | |- | ||
|[[Bacterial pneumonia]] | |[[Bacterial pneumonia]] | ||
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| +/- | | +/- | ||
| | | | ||
* Diagnosis depends | * Diagnosis depends on presentation and physical examination | ||
* Laboratory tests | * Laboratory tests | ||
* [[Sputum culture]]. | ** [[arterial blood gases]] may show [[hypoxia]] and [[acidosis]] | ||
** [[Sputum culture]]. | |||
| | | | ||
* X ray is performed to detect [[pleural effusion]] | * X ray is performed to detect | ||
* CT scan shows [[Consolidation (medicine)| | ** [[pleural effusion]] | ||
** Inflitrates within the [[lungs]]. | |||
* CT scan shows | |||
** [[Consolidation (medicine)|Consolidation]] | |||
** Ground glass appearance. | |||
|- | |- | ||
|[[Pulmonary embolism]] | |[[Pulmonary embolism]] | ||
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| + | | + | ||
| | | | ||
* Arterial blood gases may show:<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 | |||
**[[Hypoxemia]] | **[[Hypoxemia]] | ||
**[[Hypocapnia]] | **[[Hypocapnia]] | ||
**[[Respiratory alkalosis]] | **[[Respiratory alkalosis]] | ||
**Increased alveolar-arterial gradient | **Increased alveolar-arterial gradient | ||
*[[D-dimer]] assay to rule out other diseases like [[DVT]] | |||
* [[Hypercoagulability]] tests for patients with: | |||
** Unprovoked [[venous thrombosis]] at an early age (< 40 years) | |||
** Family history of [[VTE]] syndromes | |||
*Routine blood tests are non specific | |||
| | | | ||
* CT [[pulmonary angiography]] is the gold standard imaging to diagnose | * CT [[pulmonary angiography]] is the gold standard imaging to diagnose pulmonary embolism. CT may show: | ||
**Acute:Centrally located [[thrombus]] | **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 [[T wave inversion]] | * EKG is not specific or sensitive in PE diagnosis but it may show | ||
* Chest X ray is performed to exclude other differentials | ** [[T wave inversion]] | ||
** [[P pulmonale]] | |||
** [[sinus tachycardia]] | |||
* Chest X ray is performed to exclude other differentials | |||
|- | |- | ||
|Diffuse idiopathic pulmonary neuroendocrine 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> | |Diffuse idiopathic pulmonary neuroendocrine 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> | ||
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* Pulmonary function test shows obstructive lung disease. | * Pulmonary function test shows obstructive lung disease. | ||
| | | | ||
* CT scan | * CT scan show | ||
** Multiple [[nodules]] | |||
** [[Ground glass opacification on CT|Ground glass]] appearance | |||
** [[Bronchiectasis]]. | |||
|- | |- | ||
|[[Tuberculosis]] | |[[Tuberculosis]] | ||
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| - | | - | ||
| | | | ||
* Sputum culture: | * 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> | ||
** Presence of acid fast bacilli in sputum smear indicates high extent tuberculosis | |||
| | | | ||
* Chest X ray is an important diagnostic imaging procedure in TB diagnosis. | * 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 | ||
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| pmid = 24788998 | | pmid = 24788998 | ||
}}</ref> | }}</ref> | ||
** Parenchymal infilration | |||
** Hilar [[adenopathy]] | |||
**[[Nodules]] | |||
**[[Pleural effusion (patient information)|Pleural effusion]] | |||
* CT scan may show:<ref>{{Cite journal | |||
*CT scan | |||
| author = [[Jeong Min Ko]], [[Hyun Jin Park]] & [[Chi Hong Kim]] | | author = [[Jeong Min Ko]], [[Hyun Jin Park]] & [[Chi Hong Kim]] | ||
| title = Pulmonary Changes of Pleural Tuberculosis: Up-to-Date CT Imaging | | title = Pulmonary Changes of Pleural Tuberculosis: Up-to-Date CT Imaging | ||
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| doi = 10.1378/chest.14-0196 | | doi = 10.1378/chest.14-0196 | ||
| pmid = 25086249 | | pmid = 25086249 | ||
}}</ref> | }}</ref> | ||
**Micronodules | ** Micronodules | ||
**[[Cavitation]] | ** [[Cavitation]] | ||
**[[Consolidation (medicine)|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. | ||
|- | |- | ||
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| - | | - | ||
| | | | ||
* Arterial blood gases: [[hypoxemia]] | * Arterial blood gases may show: | ||
* Other lab tests are | ** [[hypoxemia]] | ||
** PaO2/FiO2 less than 200 mmHg indicating [[acute respiratory distress syndrome]] | |||
* Other lab tests are done to exclude other diseases | |||
| | | | ||
* Chest X ray | * Chest X ray may show | ||
* CT scan | ** Bilateral airway opacification | ||
* [[Bronchoscopy]] | * CT scan may show | ||
* Lung biopsy is | ** [[Ground glass opacification on CT|Ground glass]] appearance. | ||
* [[Bronchoscopy]] to exclude other causes such as: | |||
** [[alveolar]] [[hemorrhage]] | |||
** [[lymphoma]]. | |||
* Lung biopsy is done: | |||
** In unclear cases; to confirm [[Interstitial pneumonitis|acute interstitial pneumonitis]] | |||
** Exclude other causes of [[Acute respiratory distress syndrome|ARDS]] | |||
|- | |- | ||
|[[Foreign body aspiration]] | |[[Foreign body aspiration]] | ||
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| - | | - | ||
| | | | ||
* Lab tests | * Lab tests to evaluate the [[ventilation]] function | ||
| | | | ||
* Chest X ray shows | * Chest X ray shows | ||
** Hyperinflation | |||
** Mediastinal shift | |||
** [[atelectasis]] | |||
|- | |- | ||
|[[Pertussis]] | |[[Pertussis]] | ||
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| - | | - | ||
| | | | ||
* Nasopharyngeal swab for [[Polymerase chain reaction|PCR testing | * Nasopharyngeal swab for [[Polymerase chain reaction|PCR testing]] | ||
* [[Sputum culture]] | * [[Sputum culture]] | ||
* Serology to detect [[pertussis toxin]] | * 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]] | ||
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| + | | + | ||
| | | | ||
*Routine lab tests | *Routine lab tests to identify the cause of the [[heart failure]]: | ||
**Renal function tests including [[urinalysis]] and [[Electrolyte|electrolytes]] | **Renal function tests including [[urinalysis]] and [[Electrolyte|electrolytes]] | ||
**[[Complete blood count]] | **[[Complete blood count]] | ||
**[[Thyroid]] studies | **[[Thyroid]] studies in patients being treated with concomitant therapy such as [[amiodarone]] | ||
*Biomarkers: | *Biomarkers: | ||
** | **[[BNP]] or [[NT-proBNP]]<ref name="pmid23747642">{{cite journal |vauthors=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 |title=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 |journal=J. Am. Coll. Cardiol. |volume=62 |issue=16 |pages=e147–239 |year=2013 |pmid=23747642 |doi=10.1016/j.jacc.2013.05.019 |url=}}</ref> | ||
** | **Cardiac Troponin T or I | ||
**Carbohydrate Antigen 125<ref name="pmid27810078">{{cite journal| author=D'Aloia A, Vizzardi E, Metra M| title=Can Carbohydrate Antigen-125 Be a New Biomarker to Guide Heart Failure Treatment?: The CHANCE-HF Trial. | journal=JACC Heart Fail | year= 2016 | volume= 4 | issue= 11 | pages= 844-846 | pmid=27810078 | doi=10.1016/j.jchf.2016.09.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27810078 }} </ref> | **Carbohydrate Antigen 125<ref name="pmid27810078">{{cite journal| author=D'Aloia A, Vizzardi E, Metra M| title=Can Carbohydrate Antigen-125 Be a New Biomarker to Guide Heart Failure Treatment?: The CHANCE-HF Trial. | journal=JACC Heart Fail | year= 2016 | volume= 4 | issue= 11 | pages= 844-846 | pmid=27810078 | doi=10.1016/j.jchf.2016.09.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27810078 }} </ref> | ||
| | | | ||
* EKG | * EKG to detect underlying cause | ||
* Chest x ray shows cardiomegaly | * Chest x ray shows cardiomegaly | ||
* Echocardiography | * Echocardiography: | ||
** to determine [[stroke volume]] | |||
** to assess type of heart failure<ref name="pmid19700135">{{cite journal |vauthors=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 |title=Echocardiography and risk prediction in advanced heart failure: incremental value over clinical markers |journal=J. Card. Fail. |volume=15 |issue=7 |pages=586–92 |year=2009 |pmid=19700135 |doi=10.1016/j.cardfail.2009.03.002 |url=}}</ref> | |||
|} | |} | ||
Revision as of 17:59, 25 July 2017
Bronchiolitis Microchapters |
Diagnosis |
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Case Studies |
Bronchiolitis differential diagnosis On the Web |
American Roentgen Ray Society Images of Bronchiolitis differential diagnosis |
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 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.
Differentiating bronchiolitis from other diseases
Bronchiolitis must be differentiated from other respiratory and cardiac diseases that can cause the same 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 | - | + | + | +/- |
|
|
Asthma | - | Dry/Productive | - | + | - | - |
|
|
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 | + | + | - | - |
|
|
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.
- ↑ 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.