Wheeze differential diagnosis

Etiology on the basis of anatomy	Diseases	Clinical manifestations								Diagnosis					Other features
		Symptoms					Physical exam					Imaging
		Onset	Cough	Dyspnea	Fever	Slurred speech	Cyanosis	Clubbing	Auscultation	Labs	Pulmonary function testing	Chest imaging	Other	Gold standard
Extrathoracic upper airway diseases	Laryngeal edema (Anaphylaxis)	Acute	-	✔	-	✔	✔	-	Hoarseness Stridor	High levels of serum tryptase Incrieased levels of plasmahistamine Sking test	Not specific	Not required	Not required	Acute onset with one of them: Respiratory compromised Reduced blood pressure (BP) Two or more after the exposure to a likely allergern Respiratory compromised Reduced BP Gastrointestinalsymptoms Skin-mucosal involment BP reduced after exposure of a known allergen Adult BP systolic<90 mmHg Children: Low systolic BP	Nasal discharge, altered mental status, redness and hives of the skin Common allergens: food, insect stings, biologic materials, natural rubber latex, etc
	Cricoarytenoid arthritis	Acute	✔	✔	-	✔	-	-	Hoarseness Stridor	Test for Rheumatoid arthritis	Forced inspiratory flowdecreased Forced expiratory flowdecreased	Clear chest	Hyperdense intra-articular sclerotic cricoid and arytenoid cartilages in CT	Direct laryngoscopy	Cartilageerosion can lead on joint luxation and inmovilization of the cord
	Vocal fold edema/Hematoma/Paralysis	Acute	✔	✔	-	✔	-	-	Hoarseness Short breathing	Not specific	Variable	Clear chest	Not required	Laryngoscopy	Associated to neck surgery
	Paradoxical vocal fold motion	Acute	✔	✔	-	✔	-	-	Inspiratory stridor	Hypercapnia in Arterial blood gaseswhen distress is severe	Forced insiparatory flowdecrease but normal between episodes	Clear chest	CT and Color flow Dopplerto rule out other diseases	Abnormal adduction of vocal fold visualized inLaryngoscopy	Throat tightness, choking sensation Associated to exercise, asthma, postextubation, etc
	Laryngeal stenosis
	Laryngocele
	Epiglottitis (supraglottitis)	Acute	-	✔	✔	✔	-	-	Hoarseness Stridor	Elevated white blood count Epiglottal culture	Normal function	Clear chest	More than 8 mm of size epiglottal and distend hypopharynx  in neck x-ray	Laryngoscopy where is visualizd a edematous epiglottis	Tripod posture Drooling Tenderness of the anterior part of the neck
	Goiter
	Postnasal drip syndrome
	Relapsing polychondritis
	Retropharyngeal abscess
	Tonsillar hypertrophy
	Tumor of pharynx/larynx/upper trachea
Central airway diseases (Intrathoracic upper airway obstruction)	Mediastinal mass/lymphadenopathy
	Respiratory papillomatosis
	Tracheobronchomalacia
	Tracheal stenosis
	Tracheal and bronchial tumors
	Vascular ring or aneurysm
Lower airway obstruction	Bronchiectasis
	Bronchiolitis
	Carcinoid syndrome
	Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH)
	Heart failure
	Noncardiogenic pulmonary edema
	Parasitic infection with VLM (eg, Ascaris Strongyloides, filaria)
	Pulmonary thromboembolism
	Reactive airways dysfunction syndrome
	Tracheobronchomalacia

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