Wheeze differential diagnosis: Difference between revisions

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* Respiratory compromise
* Respiratory compromise
* Reduced [[blood pressure]] ([[Blood pressure|BP]])
* Reduced [[blood pressure]] ([[Blood pressure|BP]])
Two or more after the exposure to a likely allergern
Two or more after the exposure to a likely [[allergen]]
* Respiratory compromise
* Respiratory compromise
* Reduced [[Blood pressure|BP]]
* Reduced [[Blood pressure|BP]]
* [[Gastrointestinal tract|Gastrointestinal]]<nowiki/>symptoms
* [[Gastrointestinal tract|Gastrointestinal]]<nowiki/>symptoms
* [[Skin and soft-tissue infections|Skin-mucosa]]<nowiki/>l involment
* [[Skin and soft-tissue infections|Skin-mucosa]]<nowiki/>l involvement


[[Blood pressure|BP]] reduced after exposure of a known [[allergen]]
[[Blood pressure|BP]] reduced after exposure of a known [[allergen]]
Line 64: Line 64:
* Children: Low [[Systolic blood pressure|systolic BP]] 
* Children: Low [[Systolic blood pressure|systolic BP]] 
|
|
* [[Nasal discharge]], [[altered mental status]], redness and hives of the [[skin]]
* [[Nasal discharge]], [[altered mental status]], redness and [[hives]] of the [[skin]]
* Common [[Allergen|allergens]]: food, insect sting, biologic materials, natural rubber latex, etc
* Common [[Allergen|allergens]]: Food, insect sting, biologic materials, natural rubber latex, etc
|-
|-
|Cricoarytenoid arthritis
|Cricoarytenoid arthritis
Line 86: Line 86:
* Clear chest
* Clear chest
|
|
* Hyperdense intra-articular sclerotic [[Cricoid cartilage|cricoid]] and [[arytenoid cartilage]]<nowiki/>s in [[Computed tomography|CT]] <ref name="pmid22884484">{{cite journal |vauthors=Greco A, Fusconi M, Macri GF, Marinelli C, Polettini E, Benincasa AT, de Vincentiis M |title=Cricoarytenoid joint involvement in rheumatoid arthritis: radiologic evaluation |journal=Am J Otolaryngol |volume=33 |issue=6 |pages=753–5 |date= 2012 |pmid=22884484 |doi=10.1016/j.amjoto.2012.06.004 |url= |author=}}</ref>
* Hyperdense intra-articular sclerotic [[Cricoid cartilage|cricoid]] and [[arytenoid cartilage]]<nowiki/>s in [[Computed tomography|CT]]<ref name="pmid22884484">{{cite journal |vauthors=Greco A, Fusconi M, Macri GF, Marinelli C, Polettini E, Benincasa AT, de Vincentiis M |title=Cricoarytenoid joint involvement in rheumatoid arthritis: radiologic evaluation |journal=Am J Otolaryngol |volume=33 |issue=6 |pages=753–5 |date= 2012 |pmid=22884484 |doi=10.1016/j.amjoto.2012.06.004 |url= |author=}}</ref>
|
|
* [[Laryngoscopy|Direct laryngoscopy]]
* [[Laryngoscopy|Direct laryngoscopy]]

Revision as of 17:00, 26 February 2018

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 - ✔ - ✔ ✔ -
  • Not specific
  • Not required
  • Not required

Acute onset with one of them:

Two or more after the exposure to a likely allergen

BP reduced after exposure of a known allergen

Cricoarytenoid arthritis Acute ✔ ✔ - ✔ - -
  • Clear chest
Vocal fold edema/hematoma/paralysis[2] Acute ✔ ✔ - ✔ - -
  • Not specific
  • Variable
  • Clear chest
  • Not required
Paradoxical vocal fold motion Acute ✔ ✔ - ✔ - -
  • Clear chest
  • CT and color flow doppler to rule out other diseases[4]
Laryngeal stenosis[6] Acute, Chronic ✔ ✔ - ✔ ✔ -
  • Not specific
  • FV loop variable
  • Clear chest
Laryngocele Chronic ✔ ✔ - - - -
  • Not specific
  • Normal function
  • Clear chest
Epiglottitis (supraglottitis) Acute - ✔ ✔ ✔ - -
  • Elevated white blood count
  • Epiglottal culture
  • Normal function
  • Clear chest
  • Tripod posture
  • Drooling
  • Tenderness of the anterior part of the neck
Goiter Chronic ✔ ✔ - - - -
  • Airflow limitation of the volume loop depend on the size and localization[10]
Postnasal drip syndrome Acute ✔ ✔ - - - -
  • Increase of IgE
  • Positive intradermic test[13]
  • Clear chest
  • Clinical diagnosis
Relapsing polychondritis Acute ✔ ✔ ✔ - - -
  • Variable  flow volume loop
  • Tracheal narrowing
  • Cartilaginous calicification, bronchial Wall thickness and tracheal narrowing observed in  CT 
  • MRI can distinguish fibrosis from inflammation 
  • Cartilaginous calicification, bronchial wall thickness and tracheal narrowing observed in  CT [14]
  • MRI can distinguish fibrosis from inflammation 

Mc Adam criteria: [15]

  • Involment of cartilage, ears, ribs. nose and eyes
Retropharyngeal abscess Subacute - ✔ ✔ ✔ - -
  • Normal function
  • Neck CT or presence of pus during the surgical procedure [17]
  • Pain with neck extension
  • Dysphagia
  • Head in sniffing position
Tonsillar hypertrophy Acute, chronic - ✔ - ✔ hyponasal speech - -
  • Not specific
  • Flow loop shows inspiratory slowing
  • Clear chest
  • Not required
  • More in children and adolescents
Tumor of pharynx/larynx/upper trachea Chronic ✔ ✔ - - - -
  • Not specific
  • Flow loop shows inspiratory slowing
  • Not requered
  • CT provide information of the grade of invation
  • MRI can make a difference between tumors in the mucos or bone marrow [19]
Central airway diseases

(Intrathoracic upper airway obstruction)

Mediastinal mass/lymphadenopathy Chronic ✔ ✔ ✔ - - -
  • Size, location and density of the mass can be observed
  • In chest CT is observed location, size, tissue characteristic and relationship with other structures of the mass
  • Information of posterior mediastinal mass can be provided in chest or spine MRI [21]
Respiratory papillomatosis Chronic ✔ ✔ - ✔ - -
  • Not specific
  • Not specific
Tracheobronchomalacia Chronic ✔ ✔ - - - -
  • Not specifc
  • Airway compression from other structures
Tracheal stenosis Acute - ✔ - - ✔ -
  • Not specific
  • FV loop variable
  • Extension of the narrowing observed in CT or MRI
  • Long segment stenosis incompatible with survival [26]
Tracheal and bronchial tumors Chronic ✔ ✔ - - - -
  • Not specific
  • FV loop variable
Vascular ring or aneurysm Chronic ✔ ✔ - - - -
  • Not required
  • Usually asymptomatic
  • Chest or abdominal pain appears when other structures are compressed
Lower airway obstruction Bronchiectasis Chronic ✔ ✔ - - - ✔
  • Tram lines or end-on ring shadows in chest CT [30]
Bronchiolitis Acute ✔ ✔ ✔ - ✔ . For bacterial infection in neonates:
  • Hyperinflation
  • Mosaic attenuation
  • Increased bronchial wall [31]
  • Bronchoscopy to rule out other diseases
  • Clinical diagnosis
Carcinoid syndrome Chronic - ✔ - - - -
  • Not specific
  • Enlargement of the heart [33]
  • Liver metastases are visualized in MRI
Heart failure Chronic ✔ ✔ - - - -
  • Not required
  • Clinical diagnosis (test are supportive)
  • High levels of BNP and pro-BNP[36]
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) [37] Chronic ✔ ✔ - - - -
  • Not specific
  • Mosaic pattern and nodules observed in chest CT
  • Single neuroendocrine cell and/ or linear proliferation of the cells that involves bronchiolar epitelium
Noncardiogenic pulmonary edema Acute ✔ ✔ - - ✔ -
  • Bilatera alveolar linfiltration
  • Bilateral opacities in CT

According to Berlin definition:[38]

  • One week of new or worse respiratory symptoms or clinical insult
  • Symptoms can not be explain by cardiacdisease
  • Bilateral opacities in chest X-Ray or CT
  • Compromised oxygenation
  • High altitute pulmonary edema (HAPE)
  • Neurogenic pulmonary edema
Parasitic infection with VLM (eg, Ascaris Strongyloides, filaria) Acute ✔ ✔ ✔ - - -
  • Not specific
  • Bilateral peribronchial infiltration
  • Parenchymal infiltration
  • Subpleural nodules, ground-glass opacities observed in chest CT [40]
  • Larve in biopsy
Pulmonary thromboembolism  Acute, subacute, Chronic ✔ ✔ - - - -
  • Not required
Reactive airways dysfunction syndrome Acute ✔ ✔ - - - -
  • Normal or hyperinflation
  • CT to rule out other diseases
 Clinical diagnosis:
  • History of exposure
  • Acute onset with sympotoms in 24h
  • Airway obstruction > 3 months [44]
  • Burning sensation in the throat
  • Chest pain
  • High dose of inhalation of the irritant

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References

  1. ↑ 1.0 1.1 Greco A, Fusconi M, Macri GF, Marinelli C, Polettini E, Benincasa AT, de Vincentiis M (2012). "Cricoarytenoid joint involvement in rheumatoid arthritis: radiologic evaluation". Am J Otolaryngol. 33 (6): 753–5. doi:10.1016/j.amjoto.2012.06.004. PMID 22884484.
  2. ↑ Ishman SL, Halum SL, Patel NJ, Kerschner JE, Merati AL (October 2006). "Management of vocal paralysis: a comparison of adult and pediatric practices". Otolaryngol Head Neck Surg. 135 (4): 590–4. doi:10.1016/j.otohns.2006.04.014. PMID 17011423.
  3. ↑ Forrest LA, Husein T, Husein O (April 2012). "Paradoxical vocal cord motion: classification and treatment". Laryngoscope. 122 (4): 844–53. doi:10.1002/lary.23176. PMID 22434681.
  4. ↑ Nastasi KJ, Howard DA, Raby RB, Lew DB, Blaiss MS (June 1997). "Airway fluoroscopic diagnosis of vocal cord dysfunction syndrome". Ann. Allergy Asthma Immunol. 78 (6): 586–8. doi:10.1016/S1081-1206(10)63220-6. PMID 9207723.
  5. ↑ Chiang T, Marcinow AM, deSilva BW, Ence BN, Lindsey SE, Forrest LA (March 2013). "Exercise-induced paradoxical vocal fold motion disorder: diagnosis and management". Laryngoscope. 123 (3): 727–31. doi:10.1002/lary.23654. PMID 23097011.
  6. ↑ Nair S, Nilakantan A, Sood A, Gupta A, Gupta A (September 2016). "Challenges in the Management of Laryngeal Stenosis". Indian J Otolaryngol Head Neck Surg. 68 (3): 294–9. doi:10.1007/s12070-015-0936-2. PMC 4961642. PMID 27508129.
  7. ↑ Bogdasarian RS, Olson NR (1980). "Posterior glottic laryngeal stenosis". Otolaryngol. Head Neck Surg. 88 (6): 765–72. PMID 7208045.
  8. ↑ Chu L, Gussack GS, Orr JB, Hood D (April 1994). "Neonatal laryngoceles. A cause for airway obstruction". Arch. Otolaryngol. Head Neck Surg. 120 (4): 454–8. PMID 8166980.
  9. ↑ Glynn F, Fenton JE (May 2008). "Diagnosis and management of supraglottitis (epiglottitis)". Curr Infect Dis Rep. 10 (3): 200–4. PMID 18510881.
  10. ↑ Al-Bazzaz F, Grillo H, Kazemi H (May 1975). "Response to exercise in upper airway obstruction". Am. Rev. Respir. Dis. 111 (5): 631–40. doi:10.1164/arrd.1975.111.5.631. PMID 1130755.
  11. ↑ Bashist B, Ellis K, Gold RP (March 1983). "Computed tomography of intrathoracic goiters". AJR Am J Roentgenol. 140 (3): 455–60. doi:10.2214/ajr.140.3.455. PMID 6600532.
  12. ↑ Knudsen N, Perrild H, Christiansen E, Rasmussen S, Dige-Petersen H, Jørgensen T (March 2000). "Thyroid structure and size and two-year follow-up of solitary cold thyroid nodules in an unselected population with borderline iodine deficiency". Eur. J. Endocrinol. 142 (3): 224–30. PMID 10700715.
  13. ↑ Yu L, Xu X, Lv H, Qiu Z (May 2015). "Advances in upper airway cough syndrome". Kaohsiung J. Med. Sci. 31 (5): 223–8. doi:10.1016/j.kjms.2015.01.005. PMID 25910556.
  14. ↑ Behar JV, Choi YW, Hartman TA, Allen NB, McAdams HP (January 2002). "Relapsing polychondritis affecting the lower respiratory tract". AJR Am J Roentgenol. 178 (1): 173–7. doi:10.2214/ajr.178.1.1780173. PMID 11756115.
  15. ↑ McAdam LP, O'Hanlan MA, Bluestone R, Pearson CM (May 1976). "Relapsing polychondritis: prospective study of 23 patients and a review of the literature". Medicine (Baltimore). 55 (3): 193–215. PMID 775252.
  16. ↑ Knorr TL, Sinha V. PMID 28722903. Missing or empty |title= (help)
  17. ↑ Lazor JB, Cunningham MJ, Eavey RD, Weber AL (December 1994). "Comparison of computed tomography and surgical findings in deep neck infections". Otolaryngol Head Neck Surg. 111 (6): 746–50. doi:10.1177/019459989411100608. PMID 7991254.
  18. ↑ Jazi SM, Barati B, Kheradmand A (December 2011). "Treatment of adenotonsillar hypertrophy: A prospective randomized trial comparing azithromycin vs. fluticasone". J Res Med Sci. 16 (12): 1590–7. PMC 3434901. PMID 22973368.
  19. ↑ "CDC - Head and Neck Cancers".
  20. ↑ Shamberger RC, Holzman RS, Griscom NT, Tarbell NJ, Weinstein HJ, Wohl ME (September 1995). "Prospective evaluation by computed tomography and pulmonary function tests of children with mediastinal masses". Surgery. 118 (3): 468–71. PMID 7652680.
  21. ↑ Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L (February 2013). "A diagnostic approach to the mediastinal masses". Insights Imaging. 4 (1): 29–52. doi:10.1007/s13244-012-0201-0. PMC 3579993. PMID 23225215.
  22. ↑ "Laryngotracheobronchial papillomatosis: findings on computed tomography scans of the chest".
  23. ↑ Aquino SL, Shepard JA, Ginns LC, Moore RH, Halpern E, Grillo HC, McLoud TC (2001). "Acquired tracheomalacia: detection by expiratory CT scan". J Comput Assist Tomogr. 25 (3): 394–9. PMID 11351189.
  24. ↑ Majid A, Gaurav K, Sanchez JM, Berger RL, Folch E, Fernandez-Bussy S, Ernst A, Gangadharan SP (July 2014). "Evaluation of tracheobronchomalacia by dynamic flexible bronchoscopy. A pilot study". Ann Am Thorac Soc. 11 (6): 951–5. doi:10.1513/AnnalsATS.201312-435BC. PMID 24960030.
  25. ↑ Altman KW, Wetmore RF, Mahboubi S (June 1998). "Comparison of endoscopy and radiographic fluoroscopy in the evaluation of pediatric congenital airway abnormalities". Int. J. Pediatr. Otorhinolaryngol. 44 (1): 43–6. PMID 9720679.
  26. ↑ Chiu PP, Rusan M, Williams WG, Caldarone CA, Kim PC (February 2006). "Long-term outcomes of clinically significant vascular rings associated with congenital tracheal stenosis". J. Pediatr. Surg. 41 (2): 335–41. doi:10.1016/j.jpedsurg.2005.11.034. PMID 16481247.
  27. ↑ 27.0 27.1 Stevic R, Milenkovic B (November 2016). "Tracheobronchial tumors". J Thorac Dis. 8 (11): 3401–3413. doi:10.21037/jtd.2016.11.24. PMC 5179373. PMID 28066620.
  28. ↑ Miller WT (October 2001). "Thoracic aortic aneurysms: plain film findings". Semin Roentgenol. 36 (4): 288–94. PMID 11715324.
  29. ↑ Polverino E, Goeminne PC, McDonnell MJ, Aliberti S, Marshall SE, Loebinger MR, Murris M, Cantón R, Torres A, Dimakou K, De Soyza A, Hill AT, Haworth CS, Vendrell M, Ringshausen FC, Subotic D, Wilson R, Vilaró J, Stallberg B, Welte T, Rohde G, Blasi F, Elborn S, Almagro M, Timothy A, Ruddy T, Tonia T, Rigau D, Chalmers JD (September 2017). "European Respiratory Society guidelines for the management of adult bronchiectasis". Eur. Respir. J. 50 (3). doi:10.1183/13993003.00629-2017. PMID 28889110.
  30. ↑ Milliron B, Henry TS, Veeraraghavan S, Little BP (2015). "Bronchiectasis: Mechanisms and Imaging Clues of Associated Common and Uncommon Diseases". Radiographics. 35 (4): 1011–30. doi:10.1148/rg.2015140214. PMID 26024063.
  31. ↑ 31.0 31.1 Devakonda A, Raoof S, Sung A, Travis WD, Naidich D (April 2010). "Bronchiolar disorders: a clinical-radiological diagnostic algorithm". Chest. 137 (4): 938–51. doi:10.1378/chest.09-0800. PMID 20371529.
  32. ↑ 32.0 32.1 Mota JM, Sousa LG, Riechelmann RP (2016). "Complications from carcinoid syndrome: review of the current evidence". Ecancermedicalscience. 10: 662. doi:10.3332/ecancer.2016.662. PMC 4990058. PMID 27594907.
  33. ↑ Mota JM, Sousa LG, Riechelmann RP (2016). "Complications from carcinoid syndrome: review of the current evidence". Ecancermedicalscience. 10: 662. doi:10.3332/ecancer.2016.662. PMC 4990058. PMID 27594907.
  34. ↑ 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 (October 2013). "2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines". Circulation. 128 (16): 1810–52. doi:10.1161/CIR.0b013e31829e8807. PMID 23741057.
  35. ↑ Weintraub NL, Collins SP, Pang PS, Levy PD, Anderson AS, Arslanian-Engoren C, Gibler WB, McCord JK, Parshall MB, Francis GS, Gheorghiade M (November 2010). "Acute heart failure syndromes: emergency department presentation, treatment, and disposition: current approaches and future aims: a scientific statement from the American Heart Association". Circulation. 122 (19): 1975–96. doi:10.1161/CIR.0b013e3181f9a223. PMID 20937981.
  36. ↑ Doust JA, Glasziou PP, Pietrzak E, Dobson AJ (October 2004). "A systematic review of the diagnostic accuracy of natriuretic peptides for heart failure". Arch. Intern. Med. 164 (18): 1978–84. doi:10.1001/archinte.164.18.1978. PMID 15477431.
  37. ↑ Davies SJ, Gosney JR, Hansell DM, Wells AU, du Bois RM, Burke MM, Sheppard MN, Nicholson AG (March 2007). "Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia: an under-recognised spectrum of disease". Thorax. 62 (3): 248–52. doi:10.1136/thx.2006.063065. PMC 2117154. PMID 17099078.
  38. ↑ Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS (June 2012). "Acute respiratory distress syndrome: the Berlin Definition". JAMA. 307 (23): 2526–33. doi:10.1001/jama.2012.5669. PMID 22797452.
  39. ↑ Rubinsky-Elefant G, Hirata CE, Yamamoto JH, Ferreira MU (January 2010). "Human toxocariasis: diagnosis, worldwide seroprevalences and clinical expression of the systemic and ocular forms". Ann Trop Med Parasitol. 104 (1): 3–23. doi:10.1179/136485910X12607012373957. PMID 20149289.
  40. ↑ Sakai S, Shida Y, Takahashi N, Yabuuchi H, Soeda H, Okafuji T, Hatakenaka M, Honda H (June 2006). "Pulmonary lesions associated with visceral larva migrans due to Ascaris suum or Toxocara canis: imaging of six cases". AJR Am J Roentgenol. 186 (6): 1697–702. doi:10.2214/AJR.04.1507. PMID 16714661.
  41. ↑ Stein PD, Goldhaber SZ, Henry JW, Miller AC (January 1996). "Arterial blood gas analysis in the assessment of suspected acute pulmonary embolism". Chest. 109 (1): 78–81. PMID 8549223.
  42. ↑ Pipavath SN, Godwin JD (September 2008). "Acute pulmonary thromboembolism: a historical perspective". AJR Am J Roentgenol. 191 (3): 639–41. doi:10.2214/AJR.07.3989. PMID 18716087.
  43. ↑ 43.0 43.1 Remy-Jardin M, Pistolesi M, Goodman LR, Gefter WB, Gottschalk A, Mayo JR, Sostman HD (November 2007). "Management of suspected acute pulmonary embolism in the era of CT angiography: a statement from the Fleischner Society". Radiology. 245 (2): 315–29. doi:10.1148/radiol.2452070397. PMID 17848685.
  44. ↑ 44.0 44.1 Brooks SM, Weiss MA, Bernstein IL (September 1985). "Reactive airways dysfunction syndrome (RADS). Persistent asthma syndrome after high level irritant exposures". Chest. 88 (3): 376–84. PMID 4028848.

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