Back pain differential diagnosis: Difference between revisions

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Revision as of 13:27, 22 March 2018

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

An expert algorithm to assist in the diagnosis of back pain can be found here

Overview

There are several life-threatening causes of back pain which need to be evaluated for first, which include; spinal cord or cauda equina compression, aortic dissection, aortic aneurysm, vertebral osteomyelitis, epidural abscess, and metastatic cancer. The other possible causes of back pain can be evaluated for by carefully assessing the nature of the pain, and obtaining a thorough patient history.

Differential Diagnosis

5 life threatening diseases to exclude immediately:^[1]^[2]^[3]^[4]^[2]^[3]^[5]^[6]^[7]^[8]^[9]^[10]^[11]^[12]^[13]^[14]^[15]^[16]^[17]
- Spinal cord or cauda equina compression
- Aortic dissection
- Aortic aneurysm
- Vertebral osteomyelitis
- Epidural abscess
- Metastatic cancer
The frequency of conditions exclusive of the above in a descending order is:
- Vertebral compression fracture
- Radiculopathy
- Spinal stenosis
- Ankylosing spondylitis
- Osteoarthritis
- Scoliosis
- Hyperkyphosis
- Psychologic distress
The frequency of conditions outside the spine exclusive of the above in a descending order is:
- Muscle spasm
- Prolonged sitting
- Piriformis syndrome
- Sacroiliac joint dysfunction
- Bertolotti's syndrome (Lumbosacral transitional vertebrae)

Differential Diagnosis of Back Pain:

Differential Diagnosis of Back Pain

Classification of pain in the back based on etiology	Diease	Clinical Manifestation		Diagnosis
Classification of pain in the back based on etiology	Diease	Symptoms	Signs	Lab findings	Imaging
Vascular	Aortic dissection
Vascular	Aortic aneurysm - Abdominal aneurysm - Thoracic aneurysm
Neurological	Spinal cord compression - Thoracic spine - Lumbar spine
	Cauda equina compression
	Radiculopathy
	Epidural abscess
Bone	Discitis
	Vertebral osteomyelitis
	Septic sacroilitis
	Vertebral compression fracture
	Spinal stenosis
	Osteoarthritis
	Ankylosing spondylitis
	Chronic recurrent focal osteomyelitis
	Scoliosis
	Hyperkyphosis
	Spondylosis - Spondylolisthesis
	Scheuermann (juvenile) kyphosis
	Disc herniation
	Sacroiliac joint dysfunction
	Bertolotti's syndrome (Lumbosacral transitional vertebrae)
Non-spinal infections	Pyomyositis
	Pyelonephritis
	Nephrolithiasis
	Pelvic inflammatory disease
	Pneumonia
	Endocarditis
	Myalgia
	Cystitis
	Cholelithiasis
	Appendicitis
	Inflammatory arthritis
Tumors	Osteoid osteoma
	Osteoblastoma
	Ewing sarcoma
	Osteosarcoma
	Lymphoma
	Prostate cancer
	Neurofibroma
	Leukemia
	Langerhan cell histocytosis (eosinophilic granulomas)
Muscle-related	Pyriformis syndrome
Miscellaneous	Herpes zoster
	Sickle cell anemia
	Syringomyelia
	Ureteropelvic junction obstruction
	Chronic pain syndrome
	Psychologic distress

References

↑ Chou R, Qaseem A, Owens DK, Shekelle P (February 2011). "Diagnostic imaging for low back pain: advice for high-value health care from the American College of Physicians". Ann. Intern. Med. 154 (3): 181–9. doi:10.7326/0003-4819-154-3-201102010-00008. PMID 21282698.
↑ ^2.0 ^2.1 Schiff D, O'Neill BP, Suman VJ (August 1997). "Spinal epidural metastasis as the initial manifestation of malignancy: clinical features and diagnostic approach". Neurology. 49 (2): 452–6. PMID 9270576.
↑ ^3.0 ^3.1 Deyo RA, Diehl AK (1988). "Cancer as a cause of back pain: frequency, clinical presentation, and diagnostic strategies". J Gen Intern Med. 3 (3): 230–8. PMID 2967893.
↑ Sun JC, Xu T, Chen KF, Qian W, Liu K, Shi JG, Yuan W, Jia LS (April 2014). "Assessment of cauda equina syndrome progression pattern to improve diagnosis". Spine. 39 (7): 596–602. doi:10.1097/BRS.0000000000000079. PMID 24150427.
↑ Jarvik JG, Deyo RA (October 2002). "Diagnostic evaluation of low back pain with emphasis on imaging". Ann. Intern. Med. 137 (7): 586–97. PMID 12353946.
↑ Underwood MR, Dawes P (November 1995). "Inflammatory back pain in primary care". Br. J. Rheumatol. 34 (11): 1074–7. PMID 8542211.
↑ "Acute low back problems in adults: assessment and treatment. Agency for Health Care Policy and Research". Clin Pract Guidel Quick Ref Guide Clin (14): iii–iv, 1–25. December 1994. PMID 7987418.
↑ Ropper AH, Zafonte RD (March 2015). "Sciatica". N. Engl. J. Med. 372 (13): 1240–8. doi:10.1056/NEJMra1410151. PMID 25806916.
↑ Delitto A, Piva SR, Moore CG, Fritz JM, Wisniewski SR, Josbeno DA, Fye M, Welch WC (April 2015). "Surgery versus nonsurgical treatment of lumbar spinal stenosis: a randomized trial". Ann. Intern. Med. 162 (7): 465–73. doi:10.7326/M14-1420. PMID 25844995.
↑ Papadopoulos EC, Khan SN (January 2004). "Piriformis syndrome and low back pain: a new classification and review of the literature". Orthop. Clin. North Am. 35 (1): 65–71. doi:10.1016/S0030-5898(03)00105-6. PMID 15062719.
↑ Hopayian K, Song F, Riera R, Sambandan S (December 2010). "The clinical features of the piriformis syndrome: a systematic review". Eur Spine J. 19 (12): 2095–109. doi:10.1007/s00586-010-1504-9. PMC 2997212. PMID 20596735.
↑ Potter NA, Rothstein JM (November 1985). "Intertester reliability for selected clinical tests of the sacroiliac joint". Phys Ther. 65 (11): 1671–5. PMID 2932746.
↑ Russel AS, Maksymowych W, LeClercq S (December 1981). "Clinical examination of the sacroiliac joints: a prospective study". Arthritis Rheum. 24 (12): 1575–7. PMID 7326071.
↑ Levangie PK (November 1999). "Four clinical tests of sacroiliac joint dysfunction: the association of test results with innominate torsion among patients with and without low back pain". Phys Ther. 79 (11): 1043–57. PMID 10534797.
↑ Riddle DL, Freburger JK (August 2002). "Evaluation of the presence of sacroiliac joint region dysfunction using a combination of tests: a multicenter intertester reliability study". Phys Ther. 82 (8): 772–81. PMID 12147007.
↑ Irwin RW, Watson T, Minick RP, Ambrosius WT (January 2007). "Age, body mass index, and gender differences in sacroiliac joint pathology". Am J Phys Med Rehabil. 86 (1): 37–44. PMID 17304687.
↑ Jancuska JM, Spivak JM, Bendo JA (2015). "A Review of Symptomatic Lumbosacral Transitional Vertebrae: Bertolotti's Syndrome". Int J Spine Surg. 9: 42. doi:10.14444/2042. PMC 4603258. PMID 26484005.

Template:WikiDoc Sources

[pmid21282698-1] Chou R, Qaseem A, Owens DK, Shekelle P (February 2011). "Diagnostic imaging for low back pain: advice for high-value health care from the American College of Physicians". Ann. Intern. Med. 154 (3): 181–9. doi:10.7326/0003-4819-154-3-201102010-00008. PMID 21282698.

[pmid9270576-2] 2.0 ^2.1 Schiff D, O'Neill BP, Suman VJ (August 1997). "Spinal epidural metastasis as the initial manifestation of malignancy: clinical features and diagnostic approach". Neurology. 49 (2): 452–6. PMID 9270576.

[pmid2967893-3] 3.0 ^3.1 Deyo RA, Diehl AK (1988). "Cancer as a cause of back pain: frequency, clinical presentation, and diagnostic strategies". J Gen Intern Med. 3 (3): 230–8. PMID 2967893.

[pmid24150427-4] Sun JC, Xu T, Chen KF, Qian W, Liu K, Shi JG, Yuan W, Jia LS (April 2014). "Assessment of cauda equina syndrome progression pattern to improve diagnosis". Spine. 39 (7): 596–602. doi:10.1097/BRS.0000000000000079. PMID 24150427.

[pmid12353946-5] Jarvik JG, Deyo RA (October 2002). "Diagnostic evaluation of low back pain with emphasis on imaging". Ann. Intern. Med. 137 (7): 586–97. PMID 12353946.

[pmid8542211-6] Underwood MR, Dawes P (November 1995). "Inflammatory back pain in primary care". Br. J. Rheumatol. 34 (11): 1074–7. PMID 8542211.

[pmid7987418-7] "Acute low back problems in adults: assessment and treatment. Agency for Health Care Policy and Research". Clin Pract Guidel Quick Ref Guide Clin (14): iii–iv, 1–25. December 1994. PMID 7987418.

[pmid25806916-8] Ropper AH, Zafonte RD (March 2015). "Sciatica". N. Engl. J. Med. 372 (13): 1240–8. doi:10.1056/NEJMra1410151. PMID 25806916.

[pmid25844995-9] Delitto A, Piva SR, Moore CG, Fritz JM, Wisniewski SR, Josbeno DA, Fye M, Welch WC (April 2015). "Surgery versus nonsurgical treatment of lumbar spinal stenosis: a randomized trial". Ann. Intern. Med. 162 (7): 465–73. doi:10.7326/M14-1420. PMID 25844995.

[pmid15062719-10] Papadopoulos EC, Khan SN (January 2004). "Piriformis syndrome and low back pain: a new classification and review of the literature". Orthop. Clin. North Am. 35 (1): 65–71. doi:10.1016/S0030-5898(03)00105-6. PMID 15062719.

[pmid20596735-11] Hopayian K, Song F, Riera R, Sambandan S (December 2010). "The clinical features of the piriformis syndrome: a systematic review". Eur Spine J. 19 (12): 2095–109. doi:10.1007/s00586-010-1504-9. PMC 2997212. PMID 20596735.

[pmid2932746-12] Potter NA, Rothstein JM (November 1985). "Intertester reliability for selected clinical tests of the sacroiliac joint". Phys Ther. 65 (11): 1671–5. PMID 2932746.

[pmid7326071-13] Russel AS, Maksymowych W, LeClercq S (December 1981). "Clinical examination of the sacroiliac joints: a prospective study". Arthritis Rheum. 24 (12): 1575–7. PMID 7326071.

[pmid10534797-14] Levangie PK (November 1999). "Four clinical tests of sacroiliac joint dysfunction: the association of test results with innominate torsion among patients with and without low back pain". Phys Ther. 79 (11): 1043–57. PMID 10534797.

[pmid12147007-15] Riddle DL, Freburger JK (August 2002). "Evaluation of the presence of sacroiliac joint region dysfunction using a combination of tests: a multicenter intertester reliability study". Phys Ther. 82 (8): 772–81. PMID 12147007.

[pmid17304687-16] Irwin RW, Watson T, Minick RP, Ambrosius WT (January 2007). "Age, body mass index, and gender differences in sacroiliac joint pathology". Am J Phys Med Rehabil. 86 (1): 37–44. PMID 17304687.

[pmid26484005-17] Jancuska JM, Spivak JM, Bendo JA (2015). "A Review of Symptomatic Lumbosacral Transitional Vertebrae: Bertolotti's Syndrome". Int J Spine Surg. 9: 42. doi:10.14444/2042. PMC 4603258. PMID 26484005.

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@@ Line 34: / Line 34: @@
 ===Differential Diagnosis of Back Pain:===
-When a patient presents with back pain, the following differentials mentioned in the table below need to be ruled out to reach the appropriate diagnosis.
+==Differential Diagnosis of Back Pain==
-'''''Abbreviations:''''' '''ABG ('''[[arterial blood gas]]'''); ACE ('''[[Angiotensin-converting enzyme|angiotensin converting enzyme]]'''); BMI ('''[[body mass index]]'''); CBC ('''[[Complete blood counts|complete blood count]]'''); CSF ('''[[cerebrospinal fluid]]'''); CXR ('''[[chest X-ray]]'''); ECG ('''[[electrocardiogram]]'''); FEF ('''[[Spirometry|forced expiratory flow rate]]'''); FEV1 ('''[[forced expiratory volume]]'''); FVC ('''[[forced vital capacity]]'''); JVD ('''[[jugular vein distention]]''');''' '''MCV ('''[[mean corpuscular volume]]'''); Plt ('''[[platelet]]'''); RV ('''[[residual volume]]'''); SIADH ('''[[syndrome of inappropriate antidiuretic hormone]]'''); TSH ('''[[thyroid stimulating hormone]]'''); Vt ('''[[tidal volume]]''');''' '''WBC ('''[[White blood cells|white blood cell]]'''); Coronary CT angiography (CCTA); multidetector row scanners (MDCT); Cardiovascular magnetic resonance — CMRI; Myocardial perfusion imaging (MPI); single-photon emission CT (SPECT); Positron emission tomography (PET) scanning; Magnetic resonance (MR) angiography, Computed tomographic (CT) angiography, and Transesophageal echocardiography (TEE), late gadolinium enhancement (LGE); right ventricular hypertrophy (RVH), right atrial enlargement (RAE), functional tricuspid regurgitation (TR), Pulmonary artery systolic pressure (PASP; adenosine deaminase (ADA); Serum amyloid A (SAA), soluble interleukin-2 receptor (sIL2R); High-resolution CT (HRCT) scanning;'''
+{| class="wikitable"
+! rowspan="2" |Classification of pain in the back based on etiology
+! rowspan="2" |Diease
+! colspan="2" |Clinical Manifestation
+! colspan="2" |Diagnosis
+!Comments
+|-
+|Symptoms
+|Signs
+|Lab findings
+|Imaging
+|
+|-
+| rowspan="2" |Vascular
+|Aortic dissection
+|
+|
+|
+|
+|
+|-
+|Aortic aneurysm
+- Abdominal aneurysm
-{|
+- Thoracic aneurysm
-|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
-! rowspan="3" |Differentials on the basis of Etiology
-! rowspan="3" |Disease
-! colspan="10" |Clinical manifestations
-! colspan="4" |Diagnosis
-|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
-! colspan="8" |Symptoms
-! rowspan="2" |Risk factors
-! rowspan="2" |Physical exam
-! rowspan="2" |Lab Findings
-! rowspan="2" |EKG
-! rowspan="2" |Imaging
-! rowspan="2" |Gold standard
-|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
-!Onset
-!Duration
-!Quality of Pain
-!Cough
-!Fever
-!Dyspnea
-!Weight loss
-!Associated Features
-|- style="background: #DCDCDC; padding: 5px;" |
 |
-!'''[[Stable Angina]]'''
-| style="background: #F5F5F5; padding: 5px;" |Sudden (acute)
-| style="background: #F5F5F5; padding: 5px;" |2-10 minutes
-| style="background: #F5F5F5; padding: 5px;" |
-*Heaviness/pressure/ tightness/squeezing/ burning ([[Levine's sign]])
-*Retrosternal  or left sided chest pain
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +/-
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Nausea and vomiting|Nausea]] and [[vomiting]]
-*[[Diaphoresis]]
-| style="background: #F5F5F5; padding: 5px;" |Dyslipidemia, hypertension, smoking,  family history of premature disease, and diabetes
-| style="background: #F5F5F5; padding: 5px;" |
-*Transient [[third heart sound]] [[S3|(S3]] - [[Ventricular|ventricular filling sound]]) and [[fourth heart sound]] ([[S4]] - [[atrial]] filling sound)
-| style="background: #F5F5F5; padding: 5px;" |
-*Cardiac enzymes normal
-| style="background: #F5F5F5; padding: 5px;" |
-*Exercise EKG: ST-segment depression
-| style="background: #F5F5F5; padding: 5px;" |
-*Exercise Stress Testing: Decreased myocardial perfusion
-*Transthoracic echocardiography: Ejection fraction <50 percent
-| style="background: #F5F5F5; padding: 5px;" |
-*Coronary angiography
-|- style="background: #DCDCDC; padding: 5px;" |
 |
-|'''[[Unstable Angina]]'''
-| style="background: #F5F5F5; padding: 5px;" |Acute
-| style="background: #F5F5F5; padding: 5px;" |10-20 minutes
-| style="background: #F5F5F5; padding: 5px;" |
-*Same as stable angina but often more severe
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Nausea and vomiting]]
-*[[Diaphoresis]]
-*[[Presyncope]]
-*[[Palpitation|Palpitations]]
-| style="background: #F5F5F5; padding: 5px;" |Dyslipidemia, hypertension, smoking,  family history of premature disease, and diabetes
-| style="background: #F5F5F5; padding: 5px;" |
-*Reverse [[Splitting of S2|splitting]] of the [[second heart sound]]
-*[[Rales/Crackles|Rales or crackles]]
-*[[Elevated jugular venous pressure]]
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Cardiac Biomarkers|Cardiac biomarkers [Cardiac troponin I, cardiac troponin T]] and [[CK MB|<nowiki>MB isoenzyme of creatine kinase (CK-MB)]</nowiki>]] normal
-| style="background: #F5F5F5; padding: 5px;" |
-*ST-depression
-*New T wave inversions
-*Transient ST-elevation
-| style="background: #F5F5F5; padding: 5px;" |
-*Echocardiography: Ejection fraction <50 percent
-*Exercise Stress Testing: Decreased myocardial perfusion
-| style="background: #F5F5F5; padding: 5px;" |
-*Invasive coronary angiography
-|- style="background: #DCDCDC; padding: 5px;" |
 |
-|'''[[Myocardial Infarction]]'''<ref name="pmid8704488">{{cite journal |vauthors=Svavarsdóttir AE, Jónasson MR, Gudmundsson GH, Fjeldsted K |title=Chest pain in family practice. Diagnosis and long-term outcome in a community setting |journal=Can Fam Physician |volume=42 |issue= |pages=1122–8 |date=June 1996 |pmid=8704488 |pmc=2146490 |doi= |url=}}</ref><ref name="pmid8163958">{{cite journal |vauthors=Klinkman MS, Stevens D, Gorenflo DW |title=Episodes of care for chest pain: a preliminary report from MIRNET. Michigan Research Network |journal=J Fam Pract |volume=38 |issue=4 |pages=345–52 |date=April 1994 |pmid=8163958 |doi= |url=}}</ref><ref name="pmid19883149">{{cite journal |vauthors=Bösner S, Becker A, Haasenritter J, Abu Hani M, Keller H, Sönnichsen AC, Karatolios K, Schaefer JR, Seitz G, Baum E, Donner-Banzhoff N |title=Chest pain in primary care: epidemiology and pre-work-up probabilities |journal=Eur J Gen Pract |volume=15 |issue=3 |pages=141–6 |date= 2009 |pmid=19883149 |doi=10.3109/13814780903329528 |url=}}</ref><ref name="pmid21391528">{{cite journal |vauthors=Ebell MH |title=Evaluation of chest pain in primary care patients |journal=Am Fam Physician |volume=83 |issue=5 |pages=603–5 |date=March 2011 |pmid=21391528 |doi= |url=}}</ref>
+|
-| style="background: #F5F5F5; padding: 5px;" |Acute
+|
-| style="background: #F5F5F5; padding: 5px;" |Commonly > 20 minutes
+|-
-| style="background: #F5F5F5; padding: 5px;" |
+| rowspan="4" |Neurological
-*Same as stable angina but often more severe
+|Spinal cord compression
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Nausea and vomiting]]
-*[[Diaphoresis]]
-*[[Presyncope]]
-*[[Palpitation|Palpitations]]
-*[[Lateral]] [[displacement]] of the [[apical impulse]]
-| style="background: #F5F5F5; padding: 5px;" |Dyslipidemia, hypertension, smoking,  family history of premature disease, and diabetes
-| style="background: #F5F5F5; padding: 5px;" |
-* Hypotension
-* Tachycardia
-*[[S4]] [[Gallop rhythm|gallop]]
+- Thoracic spine
-*[[Paradoxical splitting of S2]]
-*[[Mitral regurgitation]] [[Heart murmur|murmur]]
-| style="background: #F5F5F5; padding: 5px;" |
-*Elevated [[cardiac enzymes]]
-*↑[[Brain natriuretic peptide|B-Type Natriuretic Peptide]]
-| style="background: #F5F5F5; padding: 5px;" |
-*ST elevation MI (STEMI)
-*Non-ST elevation MI (NSTEMI) or Non Q wave
-| style="background: #F5F5F5; padding: 5px;" |
-*Echocardiography: ↓ EF
-*CCTA: Coronory artery stenosis
-*CMRI: Coronory vessels stenosis
-*MPI on SPECT or PET scanning: Decreased myocardial perfusion.
-| style="background: #F5F5F5; padding: 5px;" |
-*CCTA combined with MPI
-|- style="background: #DCDCDC; padding: 5px;" |
-! rowspan="9" |Cardiac
-|Vasospastic/ Prinzmetal/ Variant Angina
-| style="background: #F5F5F5; padding: 5px;" |Gradual in onset and offset
-| style="background: #F5F5F5; padding: 5px;" |Episodic, gradual in onset and offset.
-| style="background: #F5F5F5; padding: 5px;" |Chest discomfort described as squeezing, tightness, pressure, constriction, strangling, burning, heart burn, fullness in the chest, a band-like sensation, knot in the center of the chest, lump in the throat, ache, and heavy weight on chest
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-* Nausea, sweating, dizziness, dyspnea, and palpitations
-* Associated with other vasospastic disorders, such as Raynaud's phenomenon and migraine headache
-| style="background: #F5F5F5; padding: 5px;" |
-* Multiple drugs (ephedrine-based products, cocaine, marijuana, alcohol, butane, sumatriptan, and amphetamines)
-* Food-born botulism
-* Guide wire or balloon dilatation while doing PCI
-* Magnesium deficiency
-| style="background: #F5F5F5; padding: 5px;" |Tachycardia, hypertension, diaphoresis, and a gallop rhythm
-| style="background: #F5F5F5; padding: 5px;" |
-* Urine drug screen may be positive for cocaine or other drugs
-| style="background: #F5F5F5; padding: 5px;" |
-* Transient (less than 15 minutes) ischemic ST changes in multiple leads
-* A tall and broad R wave,
-* Disappearance of the S wave
-* A taller T wave
-* Negative U waves
-| style="background: #F5F5F5; padding: 5px;" |
-* Stress testing: normal noninvasive stress test, exercise-induced spasm with ST-segment elevation,
-* Stress echocardiography with ergonovine provocation: Vasospasm of coronory vessels
-* Coronary arteriography: Epicardial spasm
-| style="background: #F5F5F5; padding: 5px;" |
-* Coronary arteriography
-|- style="background: #DCDCDC; padding: 5px;" |
-|'''[[Aortic Dissection]]'''
-| style="background: #F5F5F5; padding: 5px;" |Sudden severe progressive pain (common) or chronic (rare)
-| style="background: #F5F5F5; padding: 5px;" |Variable
-| style="background: #F5F5F5; padding: 5px;" |
-* Tearing, ripping sensation, knife like
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Focal neurologic deficit]]
-*[[Hypotension]]
-| style="background: #F5F5F5; padding: 5px;" |
-* Hypertension
-* Genetically mediated collagen disorders
-* Preexisting aortic aneurysm
-* Bicuspid aortic valve
-* Aortic coarctation
-* Turner syndrome
-* Vasculitis (giant cell arteritis, Takayasu arteritis, rheumatoid arthritis, syphilitic aortitis)
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Pulse]] deficit
-*New [[Diastolic murmurs|diastolic murmur]]
-*[[Diastolic]] decrescendo [[Heart murmur|murmur]]
-*[[Focal neurologic deficit]]
-*[[Hypotension]]
-| style="background: #F5F5F5; padding: 5px;" |
-* [[D-dimer]] <500 ng/mL rules out aortic dissection
-* ↑Soluble ST2 (sST2)
-* Measurements of soluble elastin fragments, smooth muscle myosin heavy chain, high-sensitivity [[C-reactive protein (CRP)|C-reactive protein]], [[fibrinogen]], and [[Fibrillin|fibrillin fragments]]
-| style="background: #F5F5F5; padding: 5px;" |
-* Nonspecific ST and T wave changes
-| style="background: #F5F5F5; padding: 5px;" |
-*CXR: Mediastinal and/or aortic widening
-*CTA: A compressed true lumen
-*MRA: Detects differential flow between the true and false lumens, widening of the aorta with a thickened wall
-*TEE: Intimal dissection flaps, true and false lumens, thrombosis in the false lumen
-*Aortography: Distortion of the normal contrast column, Flow reversal or stasis into a false channel, Failure of major branches to fill, and Aortic valvular regurgitation
-| style="background: #F5F5F5; padding: 5px;" |
-*CT angiography
-*Digital subtraction aortography (if high suspicion)
-|- style="background: #DCDCDC; padding: 5px;" |
-|'''[[Pericarditis]]'''
-| style="background: #F5F5F5; padding: 5px;" |Acute or subacute
-| style="background: #F5F5F5; padding: 5px;" |May last for hours to days
-| style="background: #F5F5F5; padding: 5px;" |
-*Sharp & localized retrosternal pain
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Pericardial friction rub]]
-| style="background: #F5F5F5; padding: 5px;" |
-*HIV
-*TB
-*Immunosuppression
-*Acute trauma
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Pericardial friction rub]] heard with the [[diaphragm]] of [[stethoscope]]
-| style="background: #F5F5F5; padding: 5px;" |
-*Leukocytosis
-*↑[[Cardiac troponin I (cTnI) and T (cTnT)|Troponin level]]
-*↑[[Erythrocyte sedimentation rate]]
-*↑[[C-reactive protein|C-reactive protein level]]
-| style="background: #F5F5F5; padding: 5px;" |
-*EKG changes (typically widespread ST segment elevation or PR depressions)
-| style="background: #F5F5F5; padding: 5px;" |
-*Chest x-ray typically normal
-*Echocardiogram: normal or pericardial effusion
-*CT scan: Noncalcified pericardial thickening with pericardial effusion
-*CMR: inflamed pericardium and myocarditis
-| style="background: #F5F5F5; padding: 5px;" |
-*Pericardiocentesis
-*Pericardial biopsy
-|- style="background: #DCDCDC; padding: 5px;" |
-|[[Pericardial Tamponade]]
-| style="background: #F5F5F5; padding: 5px;" |Acute or subacute
-| style="background: #F5F5F5; padding: 5px;" |May last for hours to days
-| style="background: #F5F5F5; padding: 5px;" |
-*Sharp and stabbing retrosternal pain
-| style="background: #F5F5F5; padding: 5px;" | +/-
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Pulsus paradoxus]]
-*[[Pericardial friction rub|Pericardial rub]]
-| style="background: #F5F5F5; padding: 5px;" |
-*HIV
-*TB
-*Immunosuppression
-*Acute trauma
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Kussmaul's sign|Kussmaul sign]]
-*[[Beck's triad (cardiology)|Beck triad]]
-*[[Pulsus paradoxus]]
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Creatine kinase|Creatine kinase and isoenzymes]]
-*Abnormal LFTs
-*[[Antinuclear antibody|Antinuclear antibody assay]], [[erythrocyte sedimentation rate]] and [[rheumatoid factor]]
-*[[HIV testing]]
-| style="background: #F5F5F5; padding: 5px;" |EKG findings:
-* Sinus tachycardia
-* Low QRS voltage
-* Electrical alternans
-| style="background: #F5F5F5; padding: 5px;" |
-*CXR: enlarged cardiac silhouette with clear lung fields
-*Echocardiography: Chamber collapse, Respiratory variation in volumes and flows, IVC plethora
-*Swan-Ganz Catheterization: Equilibration of average intracardiac diastolic pressures (usually between 10 and 30 mmHg)
-| style="background: #F5F5F5; padding: 5px;" |
-*Echocardiography
-|- style="background: #DCDCDC; padding: 5px;" |
-|Myocarditis
-| style="background: #F5F5F5; padding: 5px;" |Acute or subacute
-| style="background: #F5F5F5; padding: 5px;" |Variable
-| style="background: #F5F5F5; padding: 5px;" |
-* Sharp & localized retrosternal pain reflects associated pericarditis
-| style="background: #F5F5F5; padding: 5px;" | +/-
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-* Heart failure
-* Sudden cardiac death
-* Arrythmias
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-* S3 and S4 gallop
-* Cardiac murmurs
-* Pericardial friction rub
-| style="background: #F5F5F5; padding: 5px;" |
-* Serum cardiac troponin levels
-* ↑ BNP or NT-proBNP level
-| style="background: #F5F5F5; padding: 5px;" |Nonspecific ST changes, single atrial or ventricular ectopic beats, complex ventricular arrhythmias
-| style="background: #F5F5F5; padding: 5px;" |
-* CXR: Normal to enlarged with or without pulmonary vascular congestion and pleural effusions
-* Echo: Left ventricular dilation, changes in left ventricular geometry (eg, development of a more spheroid shape), and wall motion abnormalities
-* CMR: T1 and T2 signal intensity consistent with edema, presence of LGE consistent with necrosis or scar
-* Radionuclide ventriculography: ↓ EF
-* Cardiac catheterization: Assessment of hemodynamic status
-| style="background: #F5F5F5; padding: 5px;" |Endomyocardial biopsy
-|- style="background: #DCDCDC; padding: 5px;" |
-|Hypertrophic cardiomyopathy
-| style="background: #F5F5F5; padding: 5px;" |Acute or subacute
-| style="background: #F5F5F5; padding: 5px;" |Variable
-| style="background: #F5F5F5; padding: 5px;" |Typical or atypical chest pain
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-* HF
-* Arrhythmias
-* Syncope
-* Acute hemodynamic collapse
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-* S4
-* Systolic murmurs
-*  LV apical impulse
-* Brisk carotid pulse
-* ↑ JVP
-* A parasternal lift
-| style="background: #F5F5F5; padding: 5px;" |Non-specific
-| style="background: #F5F5F5; padding: 5px;" |
-* Prominent abnormal Q waves
-* P wave abnormalities
-* Left axis deviation
-* Deeply inverted T waves
-| style="background: #F5F5F5; padding: 5px;" | -Echocardiography:
-* LV hypertrophy
-* Systolic anterior motion of the mitral valve,
-* LVOT obstruction
-- Cardiac catheterization
+- Lumbar spine
-* Pressure gradient
+|
-* Augmentation of the gradient
+|
-* Aortic pressure
+|
-* Left ventricular pressure
+|
-* Left atrial or pulmonary capillary wedge pressure
+|
--Coronary angiography
+|-
-* Obstructive epicardial coronary artery disease
+|Cauda equina compression
-- Genetic testing for HCM
+|
+|
-| style="background: #F5F5F5; padding: 5px;" |
+|
-|- style="background: #DCDCDC; padding: 5px;" |
+|
-|[[Stress cardiomyopathy|Stress (takotsubo)]]
+|
-[[Stress cardiomyopathy|Cardiomyopathy]]
+|-
-| style="background: #F5F5F5; padding: 5px;" |Acute
+|Radiculopathy
-| style="background: #F5F5F5; padding: 5px;" |Commonly > 20 minutes
+|
-| style="background: #F5F5F5; padding: 5px;" |
+|
-*Substernal heaviness or tightness
+|
-| style="background: #F5F5F5; padding: 5px;" | -
+|
-| style="background: #F5F5F5; padding: 5px;" | -
+|
-| style="background: #F5F5F5; padding: 5px;" | +
+|-
-| style="background: #F5F5F5; padding: 5px;" | -
+|Epidural abscess
-| style="background: #F5F5F5; padding: 5px;" |
+|
-*Setting of physical or emotional stress or critical illness
+|
-| style="background: #F5F5F5; padding: 5px;" |Stress
+|
-| style="background: #F5F5F5; padding: 5px;" |
+|
-*[[Murmurs]] and [[rales]] may be present on [[auscultation]] in the setting of [[Pulmonary edema|acute pulmonary edema]]
+|
-| style="background: #F5F5F5; padding: 5px;" |
+|-
-*[[Catecholamines|Catecholamines transiently elevated]]
+| rowspan="15" |Bone
-*↑TnT level
+|Discitis
-*↑[[Brain natriuretic peptide|BNP level]]
+|
-| style="background: #F5F5F5; padding: 5px;" |
+|
-*ST segment elevation
+|
-*ST depression
+|
-*QT interval prolongation, T wave inversion, abnormal Q waves
+|
-| style="background: #F5F5F5; padding: 5px;" |
+|-
-*Radionuclide myocardial perfusion imaging: Transient perfusion abnormalities in the left ventricular apex
+|Vertebral osteomyelitis
-| style="background: #F5F5F5; padding: 5px;" |
+|
-*Ventriculography and invasive coronary angiography
+|
-|- style="background: #DCDCDC; padding: 5px;" |
+|
-|'''[[Aortic Stenosis]]'''
+|
-| style="background: #F5F5F5; padding: 5px;" |Acute, recurrent episodes of angina
+|
-| style="background: #F5F5F5; padding: 5px;" |2-10 minutes
+|-
-| style="background: #F5F5F5; padding: 5px;" |
+|Septic sacroilitis
-*Heaviness/pressure/ tightness/squeezing/ burning ([[Levine's sign]])
+|
-*Retrosternal
+|
-| style="background: #F5F5F5; padding: 5px;" | -
+|
-| style="background: #F5F5F5; padding: 5px;" | -
+|
-| style="background: #F5F5F5; padding: 5px;" | +
+|
-| style="background: #F5F5F5; padding: 5px;" | -
+|-
-| style="background: #F5F5F5; padding: 5px;" |
+|Vertebral compression fracture
-*[[Dyspnea]] and decreased exercise tolerance
+|
-*[[Dizziness]] and [[syncope]]
+|
-*[[Angina pectoris]]
+|
-| style="background: #F5F5F5; padding: 5px;" |
+|
-* HTN
+|
-* Old age
+|-
-| style="background: #F5F5F5; padding: 5px;" |
+|Spinal stenosis
-*[[S2]] is soft, single and [[Paradoxical splitting of S2|paradoxically split]]
+|
-*[[A2]] delayed and tends to occur simultaneously with [[P2]]
+|
-*[[Aortic]] [[Ejection murmur|ejection]] click
+|
-*[[Fourth heart sound|Fourth heart sound (S4)]] can also be heard
+|
-*Crescendo–decrescendo [[Heart murmur|murmur]]
+|
-| style="background: #F5F5F5; padding: 5px;" |
+|-
-*Schistiocytes on peripheral blood smear
+|Osteoarthritis
-| style="background: #F5F5F5; padding: 5px;" |
+|
-*Non specific (the voltage of the QRS complex is increased showing the presence of left ventricular hypertrophy)
+|
-| style="background: #F5F5F5; padding: 5px;" |
+|
-*Echocardiography: aortic leaflets thickened and calcified, ↑ pulmonary artery pressure)
+|
-*CMR: Myocardial fibrosis, evaluation of aortic anatomy and size
+|
-*MDCT: Degree of aortic valve calcification
+|-
-*PET: Measures active mineralization which correlates with stenosis severity
+|Ankylosing spondylitis
-| style="background: #F5F5F5; padding: 5px;" |
+|
-**Echocardiography
+|
-|- style="background: #DCDCDC; padding: 5px;" |
+|
-|[[Heart Failure]]
+|
-| style="background: #F5F5F5; padding: 5px;" |Subacute or chronic
+|
-| style="background: #F5F5F5; padding: 5px;" |Variable
+|-
-| style="background: #F5F5F5; padding: 5px;" |
+|Chronic recurrent focal osteomyelitis
-*Dull
+|
-*Left sided chest pain
+|
-| style="background: #F5F5F5; padding: 5px;" | +
+|
-| style="background: #F5F5F5; padding: 5px;" | -
+|
-| style="background: #F5F5F5; padding: 5px;" | +
+|
-| style="background: #F5F5F5; padding: 5px;" | +
+|-
-| style="background: #F5F5F5; padding: 5px;" |
+|Scoliosis
-*[[Orthopnea]]
+|
-*[[Peripheral edema]]
+|
-*[[Hemoptysis]]
+|
-| style="background: #F5F5F5; padding: 5px;" |Dyslipidemia, hypertension, smoking,  family history of premature disease, and diabetes
+|
-| style="background: #F5F5F5; padding: 5px;" |
+|
-*[[S3]]
+|-
-*[[Jugular venous pressure|Elevated JVP]]
+|Hyperkyphosis
-*[[Peripheral edema]]
+|
-| style="background: #F5F5F5; padding: 5px;" |
+|
-** Hyponatremia
+|
-** Hypoalbuminemia
+|
-** ↑ [[Brain natriuretic peptide|Serum brain natriuretic peptide (BNP) or NT-proBNP level]]
+|
-** A mild elevation in serum bilirubin (total bilirubin <3 mg/dL)
+|-
-| style="background: #F5F5F5; padding: 5px;" |
+|Spondylosis
-*EKG findings are specific according to each cause of heart failure
+- Spondylolisthesis
-*Q waves, ST and T wave abnormalities in patients with prior MI
+|
-*New onset arrhythmias (atrial fibrillation and ventricular tachycardia)
+|
-| style="background: #F5F5F5; padding: 5px;" |
+|
-*CXR: Cardiomegaly
+|
-*Echocardiography: ↓ EF
+|
-*Right heart catheterization: Pulmonary capillary wedge pressure >20 mmHg, right atrial pressure ≥12 mmHg) and/or decreased cardiac index (≤2.2 L/min/m2
+|-
-| style="background: #F5F5F5; padding: 5px;" |
+|Scheuermann (juvenile) kyphosis
-*Echocardiography
+|
-|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
+|
-! rowspan="3" |Differentials on the basis of Etiology
+|
-! rowspan="3" |Disease
+|
-! colspan="10" |Clinical manifestations
+|
-! colspan="4" |Diagnosis
+|-
-|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
+|Disc herniation
-| colspan="8" |Symptoms
+|
-| rowspan="2" |Risk factors
+|
-! rowspan="2" |Physical exam
+|
-! rowspan="2" |Lab Findings
+|
-! rowspan="2" |EKG
+|
-! rowspan="2" |Imaging
+|-
-! rowspan="2" |Gold standard
+|Sacroiliac joint dysfunction
-|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
+|
-!Onset
+|
-!Duration
+|
-!Quality of Pain
+|
-!Cough
+|
-!Fever
+|-
-!Dyspnea
+|Bertolotti's syndrome (Lumbosacral transitional vertebrae)
-!Weight loss
+|
-!Associated Features
+|
-|- style="background: #DCDCDC; padding: 5px;" |
+|
-! rowspan="12" |Pulmonary
+|
-|'''[[Pulmonary Embolism]]'''
+|
-| style="background: #F5F5F5; padding: 5px;" |Acute
+|-
-| style="background: #F5F5F5; padding: 5px;" |May last minutes to hours
+| rowspan="11" |Non-spinal infections
-| style="background: #F5F5F5; padding: 5px;" |
+|Pyomyositis
-*Sharp or knifelike or pleuritic pain
+|
-*Localized to side of lesion
+|
-| style="background: #F5F5F5; padding: 5px;" | +
+|
-| style="background: #F5F5F5; padding: 5px;" | +/-
+|
-| style="background: #F5F5F5; padding: 5px;" | +
+|
-| style="background: #F5F5F5; padding: 5px;" | -
+|-
-| style="background: #F5F5F5; padding: 5px;" |
+|Pyelonephritis
-*[[Hemoptysis]]
+|
-*History of [[venous thromboembolism]] or [[coagulation]] abnormalities.
+|
-| style="background: #F5F5F5; padding: 5px;" | [[Hormone replacement therapy]]
+|
+|
- [[Cancer]]
+|
+|-
- [[Oral contraceptive pills]]
+|Nephrolithiasis
+|
-  [[Stroke]]
+|
+|
-[[Pregnancy]]
+|
+|
-  [[Postpartum]]
+|-
+|Pelvic inflammatory disease
-Prior history of [[VTE]]
+|
+|
-  [[Thrombophilia]]
+|
-| style="background: #F5F5F5; padding: 5px;" |
+|
-*[[S3]] or [[S4]] [[Gallop rhythm|gallop]]
+|
-*Low grade fever
+|-
-*[[Tachycardia]]
+|Pneumonia
-*[[Tachypnea]]
+|
-*[[Hypoxia]]
+|
-| style="background: #F5F5F5; padding: 5px;" |
+|
-*↑[[D-dimer]] ≥500 ng/mL
+|
-*[[Arterial blood gas|Arterial blood gases]] (Respiratory alkalosis)
+|
-*↑[[Troponin|Troponin levels]]
+|-
-*Hypercoagulation workup
+|Endocarditis
-| style="background: #F5F5F5; padding: 5px;" |
+|
-*Tachycardia and nonspecific ST-segment and T-wave changes (70 percent)
+|
-*S1Q3T3 pattern
+|
-*New right bundle branch block
+|
-*Inferior Q-waves (leads II, III, and aVF)
+|
-| style="background: #F5F5F5; padding: 5px;" |
+|-
-*Duplex Ultrasonography: DVT
+|Myalgia
-*CXR: [[Westermark sign]], [[Hampton hump]], [[Palla's sign]]
+|
-*Echocardiography:
+|
-** [[RV]] dilation (ratio of apical 4-chamber [[RV]] diameter to [[LV|left ventricle (LV)]] diameter > 0.9)
+|
-** [[RV]] systolic dysfunction
+|
-*Ventilation-Perfusion Scanning: High probability
+|
-| style="background: #F5F5F5; padding: 5px;" |
+|-
-*CT pulmonary angiography
+|Cystitis
-|- style="background: #DCDCDC; padding: 5px;" |
+|
-|'''[[Pneumothorax|Spontaneous Pneumothorax]]'''
+|
-| style="background: #F5F5F5; padding: 5px;" |Acute
+|
-| style="background: #F5F5F5; padding: 5px;" |May last minutes to hours
+|
-| style="background: #F5F5F5; padding: 5px;" |
+|
-*Sharp
+|-
-*Localized pleuritic
+|Cholelithiasis
-| style="background: #F5F5F5; padding: 5px;" | -
+|
-| style="background: #F5F5F5; padding: 5px;" | -
+|
-| style="background: #F5F5F5; padding: 5px;" | +
+|
-| style="background: #F5F5F5; padding: 5px;" | -
+|
-| style="background: #F5F5F5; padding: 5px;" |
+|
-*[[Respiratory distress]]
+|-
-*[[Tachypnea]]
+|Appendicitis
-*Asymmetric lung expansion
+|
-*Hyperresonance on [[percussion]]
+|
-*Decreased [[tactile fremitus]]
+|
-*[[Tachycardia]]
+|
-*Cardiac apical displacement
+|
-| style="background: #F5F5F5; padding: 5px;" |
+|-
-* Smoking
+|Inflammatory arthritis
-* Positive family history
+|
-* Marfan syndrome
+|
-* Homocystinuria
+|
-* Thoracic endometriosis.
+|
-| style="background: #F5F5F5; padding: 5px;" |
+|
-*[[Decreased breath sounds]] on involved side
+|-
-*[[Respiratory sounds|Lung sounds]] transmitted from the unaffected hemithorax are minimal with [[auscultation]] at the midaxillary line
+| rowspan="9" |Tumors
-*Adventitious lung sounds ([[crackles]], [[wheeze]]; an ipsilateral finding)
+|Osteoid osteoma
-*[[Pulsus paradoxus]]
+|
-| style="background: #F5F5F5; padding: 5px;" |
+|
-*Respiratory alkalosis on [[Arterial blood gases|ABGs]]
+|
-| style="background: #F5F5F5; padding: 5px;" |
+|
-*Rightward shift in the mean electrical axis
+|
-*Loss of precordial R waves
+|-
-*Diminution of the QRS voltage
+|Osteoblastoma
-*Precordial T wave inversions
+|
-| style="background: #F5F5F5; padding: 5px;" |
+|
-*CXR: White visceral pleural line on the chest radiograph
+|
-*CT: small amounts of intrapleural gas, atypical collections of pleural gas, and loculated pneumothoraces
+|
-| style="background: #F5F5F5; padding: 5px;" |
+|
-*CT scan
+|-
+|Ewing sarcoma
+|
+|
+|
+|
+|
+|-
+|Osteosarcoma
+|
+|
+|
+|
+|
+|-
+|Lymphoma
+|
+|
+|
+|
+|
+|-
+|Prostate cancer
+|
+|
+|
+|
+|
+|-
+|Neurofibroma
+|
+|
+|
+|
+|
+|-
+|Leukemia
+|
+|
+|
+|
+|
+|-
+|Langerhan cell histocytosis (eosinophilic granulomas)
+|
+|
+|
+|
+|
+|-
+|Muscle-related
+|Pyriformis syndrome
+|
+|
+|
+|
+|
+|-
+| rowspan="6" |Miscellaneous
+|Herpes zoster
+|
+|
+|
+|
+|
+|-
+|Sickle cell anemia
+|
+|
+|
+|
+|
+|-
+|Syringomyelia
+|
+|
+|
+|
+|
+|-
+|Ureteropelvic junction obstruction
+|
+|
+|
+|
+|
+|-
+|Chronic pain syndrome
+|
+|
+|
+|
+|
 |-
-| style="background: #DCDCDC; padding: 5px;" |[[Tension Pneumothorax]]
+|Psychologic distress
-| style="background: #F5F5F5; padding: 5px;" |Acute
+|
-| style="background: #F5F5F5; padding: 5px;" |May last minutes to hours
+|
-| style="background: #F5F5F5; padding: 5px;" |
+|
-*Sharp
+|
-*Pleuritic
+|
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Hypotension]]
-*[[Jugular venous distention]]
-*[[Respiratory distress]]
-| style="background: #F5F5F5; padding: 5px;" |Trauma
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Decreased breath sounds]] on involved side
-*[[Respiratory sounds|Lung sounds]] transmitted from the unaffected hemithorax are minimal with [[auscultation]] at the midaxillary line
-*Adventitious [[Respiratory sounds|lung sounds]] ([[crackles]], [[wheeze]]; an ipsilateral finding)
-*[[Pulsus paradoxus]]
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Arterial blood gases|Respiratory alkalosis on ABGs]]
-| style="background: #F5F5F5; padding: 5px;" |
-*Significant elevation of the ST-T segment from leads V1 to V4
-| style="background: #F5F5F5; padding: 5px;" |
-*CXR: A distinct shift of the mediastinum to the contralateral side, collapse of the ipsilateral lung, and flattening or inversion of the ipsilateral hemidiaphragm
-| style="background: #F5F5F5; padding: 5px;" |
-*CT scan
-|- style="background: #DCDCDC; padding: 5px;" |
-|[[Pneumonia]]
-| style="background: #F5F5F5; padding: 5px;" |Acute or chronic
-| style="background: #F5F5F5; padding: 5px;" |Variable
-| style="background: #F5F5F5; padding: 5px;" |
-*Dull
-*Localized to side of lesion
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | +/-
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Altered mental status]]
-*[[Tachycardia]]
-*Rust-colored [[sputum]]
-*Green [[sputum]]
-*Red currant-jelly [[sputum]]
-*[[Central cyanosis]]
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Wheezing]]
-*[[Rhonchi]]
-*[[Rales]]
-*[[Decreased breath sounds]]
-*[[Pleural friction rub]]
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Arterial blood gases|Arterial blood gas]] : Hypoxia, hypoxemia
-*↑ Procalcitonin
-*Leukocytosis
-*[[Sputum culture|Sputum evaluation]]
-*Positive blood cultures
-| style="background: #F5F5F5; padding: 5px;" |
-*Sinus tachycardia
-*Nonspecific ST-segment or T-wave changes
-| style="background: #F5F5F5; padding: 5px;" |
-*CXR: Interstitial infiltrates, lobar consolidation, cavitation
-| style="background: #F5F5F5; padding: 5px;" |
-*CXR
-|- style="background: #DCDCDC; padding: 5px;" |
-|[[Tracheitis]]/ [[Bronchitis]]
-| style="background: #F5F5F5; padding: 5px;" |Acute
-| style="background: #F5F5F5; padding: 5px;" |Variable
-| style="background: #F5F5F5; padding: 5px;" |
-*Dull
-*Substernal
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Tachypnea]]
-*[[Respiratory distress]]
-*[[Hoarseness]]
-*[[Dyspnea]]
-*[[Cyanosis]]
-*[[Sore throat]]
-*[[Odynophagia]]
-*[[Dysphonia]]
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-*Inspiratory [[stridor]] (with or without expiratory [[Stridor|stridor)]]
-*Nasal flaring
-*Wheezing
-| style="background: #F5F5F5; padding: 5px;" |
-*Gram stain of exudates: Neutrophils
-| style="background: #F5F5F5; padding: 5px;" |
-*Peaked P-wave
-| style="background: #F5F5F5; padding: 5px;" |
-*Radiography of the neck: Steeple sign
-*Laryngotracheobronchoscopy: a normal epiglottis with subglottic narrowing, thick and purulent secretions in the trachea, pseudomembranes
-| style="background: #F5F5F5; padding: 5px;" |
-*Endoscopy
-|- style="background: #DCDCDC; padding: 5px;" |
-|'''[[Pleuritis]]'''
-| style="background: #F5F5F5; padding: 5px;" |Acute or subacute or chronic
-| style="background: #F5F5F5; padding: 5px;" |May last minutes to hours
-| style="background: #F5F5F5; padding: 5px;" |
-*Sharp
-*Localized pleuritic
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*Sharp [[chest pain]] with breathing
-*[[Itching]] in sites on the back
-*[[Dizziness]]
-| style="background: #F5F5F5; padding: 5px;" |
-* Autoimmune conditions
-* Infections
-| style="background: #F5F5F5; padding: 5px;" |
-* Tachypnea
-* Tachycardia
-*[[Pleural friction rub|Pleural Rubs]]
-*Decreased breath sounds
-| style="background: #F5F5F5; padding: 5px;" |
-*Leukocytosis
-*[[Arterial blood gases|Arterial blood gas (ABG)]]: Hypoxia
-*[[Thoracentesis|Thoracocentesis]]
-| style="background: #F5F5F5; padding: 5px;" |
-*EKG done to rule out other causes in differential diagnoses
-| style="background: #F5F5F5; padding: 5px;" |
-*Chest X Ray: Pleural fluid on one or both sides
-*Computerized tomography (CT) scan: Pleural effusions
-| style="background: #F5F5F5; padding: 5px;" |
-*CXR
-|- style="background: #DCDCDC; padding: 5px;" |
-|'''[[Pulmonary Hypertension]]'''
-| style="background: #F5F5F5; padding: 5px;" |Acute or subacute or chronic
-| style="background: #F5F5F5; padding: 5px;" |Variable
-| style="background: #F5F5F5; padding: 5px;" |
-*Substernal pressure like
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Dyspnea]]
-*Symptoms of [[right heart failure]] ([[edema]])
-*Past history of [[heart murmur]]
-*[[Deep venous thrombosis|Deep venous thrombosis (DVT)]]
-*[[Arthritis]] or [[Arthralgia|arthralgias]]
-*[[Rash]]
-| style="background: #F5F5F5; padding: 5px;" |
-* Smoking
-* HF
-* Heavy [[snoring]]
-* [[Morbid obesity]]
-| style="background: #F5F5F5; padding: 5px;" |
-*The intensity of the [[P2|pulmonic component of the second heart sound (P2]]) may be increased and the [[P2]] may demonstrate fixed or paradoxical [[splitting]].
-*[[Systolic ejection murmur]]
-*A [[S4|right-sided fourth heart sound (S4)]] with a left [[parasternal heave]]
-| style="background: #F5F5F5; padding: 5px;" |
-*Abnormal [[Arterial blood gases|Arterial blood gas]]
-*[[Antinuclear antibody|Antinuclear antibody (ANA) levels]]
-*[[Anti-neutrophil cytoplasmic antibody|Antineutrophil cytoplasmic antibody (ANCA)]]
-*[[Brain natriuretic peptide|Brain natriuretic peptide (BNP of NT-proBNP)]]
-*[[HIV testing]]
-*[[Iron deficiency]]
-*[[PFTs|Pulmonary Function Testing]]
-*[[Polysomnography]]
-| style="background: #F5F5F5; padding: 5px;" |
-*Right axis deviation
-*An R wave/S wave ratio greater than one in lead V1
-*Incomplete or complete right bundle branch block
-*Increased P wave amplitude in lead II (P pulmonale) due to right atrial enlargement
-| style="background: #F5F5F5; padding: 5px;" |
-*Chest Radiography: Oligemic lung fields
-*Echocardiography:  PASP is >50 and the TRV is >3.4
-*Ventilation-Perfusion (V/Q) Lung Scanning: Abnormal
-*Right-sided cardiac catheterization: Mean PCWP >15 mmHg,
-| style="background: #F5F5F5; padding: 5px;" |
-*Cardiac catheterization
-|- style="background: #DCDCDC; padding: 5px;" |
-|[[Pleural Effusion]]
-| style="background: #F5F5F5; padding: 5px;" |Acute or subacute or chronic
-| style="background: #F5F5F5; padding: 5px;" |Variable
-| style="background: #F5F5F5; padding: 5px;" |
-*Dull
-*Pleuritic pain
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | +/-
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | +/-
-| style="background: #F5F5F5; padding: 5px;" |
-*Increasing lower extremity edema
-*[[Orthopnea]]
-*[[Paroxysmal nocturnal dyspnea]]
-*[[Night sweats]]
-*[[Hemoptysis]]
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-*Diminished or inaudible [[breath sounds]]
-*[[Pleural friction rub]]
-*[[Egophony]] (known as "E-to-A" changes)
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Pleural fluid|Pleural fluid LDH levels above 1000 IU/L]]  [[Complete blood count|Nucleated cells]]
-** [[Complete blood count|- Lymphocytosis]]
-** [[Complete blood count|- Eosinophilia]]
-** [[Complete blood count|- Mesothelial cells]]
-*[[Pleural fluid]] culture and [[cytology]]
-*[[Pleural fluid]] [[Anti-nuclear antibody|antinuclear antibody]] and [[rheumatoid factor]]
-| style="background: #F5F5F5; padding: 5px;" |
-*Typically not indicated
-| style="background: #F5F5F5; padding: 5px;" |
-*Chest X Ray: Pleural fluid on one or both sides
-*Computerized tomography (CT) scan: Detects small pleural effusions, ie, less than 10 mL and possibly as little as 2 mL of liquid in the pleural space, Thickening of the visceral and parietal pleura
-*MRI: Characterize the content of pleural effusions
-| style="background: #F5F5F5; padding: 5px;" |
-*Computed tomography
-|- style="background: #DCDCDC; padding: 5px;" |
-|[[Asthma]] & [[COPD]]
-| style="background: #F5F5F5; padding: 5px;" |Acute or subacute or chronic
-| style="background: #F5F5F5; padding: 5px;" |Variable
-| style="background: #F5F5F5; padding: 5px;" |
-*Tightness
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | +/-
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | +/-
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Cyanosis]]
-| style="background: #F5F5F5; padding: 5px;" |
-* Smoking
-* HF
-* HTN
-| style="background: #F5F5F5; padding: 5px;" |
-* [[Elevated jugular venous pressure|Elevated jugular venous pulse (JVP]])
-* Hyperinflation ([[barrel chest]])
-* [[Peripheral edema]]
-* Clubbing
-*[[Wheezing]]
-*Rhonchi
-*Diffusely decreased [[breath sounds]]
-*Coarse [[crackles]] beginning with [[inspiration]]
-| style="background: #F5F5F5; padding: 5px;" |
-*Leukocytosis
-*Eosinophilia
-*Respiratory alkalosis
-| style="background: #F5F5F5; padding: 5px;" |
-*Peaked P-wave
-*Reduced amplitude of the QRS complexes
-*Multifocal atrial tachycardia (MAT)
-| style="background: #F5F5F5; padding: 5px;" |
-*CXR: Hyperinflation
-*Spirometry: ↓ [[FEV1]], [[Peak expiratory flow|PEF]], ↓ [[FEV1]]/[[FVC]]
-| style="background: #F5F5F5; padding: 5px;" |
-*Spirometry
-|- style="background: #DCDCDC; padding: 5px;" |
-|[[Lung Cancer|Pulmonary Malignancy]]
-| style="background: #F5F5F5; padding: 5px;" |Chronic
-| style="background: #F5F5F5; padding: 5px;" |Variable
-| style="background: #F5F5F5; padding: 5px;" |
-*Dull aching
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | +/-
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Bone pain]]
-*[[Fatigue]]
-*Neurologic dysfunction
-*[[Superior vena cava syndrome|Superior vena cava (SVC) obstruction]]
-*[[Hoarseness]]
-*Hemidiaphragm [[paralysis]]
-*[[Dysphagia]]
-*[[Paraneoplastic syndrome|Paraneoplastic syndromes]]
-*[[Hypercalcemia]]
-| style="background: #F5F5F5; padding: 5px;" |
-* Smoking
-* Metastasis
-| style="background: #F5F5F5; padding: 5px;" |
-*Wheeze
-*Crackles
-*Depending upon [[complications]] caused by the spread of [[cancer]]
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Hypercalcemia]]
-| style="background: #F5F5F5; padding: 5px;" |
-*EKG may be performed before cancer treatment to identify any pre-existing conditions, or during treatment to check for possible heart damage
-| style="background: #F5F5F5; padding: 5px;" |
-*CXR and CT ccan: Mass lesion, [[hilar lymphadenopathy]]
-*Spirometry: ↓[[Tidal volume|Vt]], ↑[[Residual volume|RV]]
-*Bronchoscopy: Biopsy
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Bronchoscopy]]
-|- style="background: #DCDCDC; padding: 5px;" |
-|[[Sarcoidosis]]
-| style="background: #F5F5F5; padding: 5px;" |Chronic
-| style="background: #F5F5F5; padding: 5px;" |Days to week
-| style="background: #F5F5F5; padding: 5px;" |
-*Chest fullness
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Löfgren syndrome]] ([[fever]], bilateral hilar [[lymphadenopathy]] (BHL), and [[Polyarthralgia|polyarthralgias]])
-*[[Uveitis]]
-*[[Heart block]]
-*[[Lymphocytic]] [[meningitis]]
-*[[Diabetes insipidus]]
-*[[Fatigue]]
-*[[Hypercalciuria]]
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-*Diminished respiratory sounds
-| style="background: #F5F5F5; padding: 5px;" |
-*↑ ACE level, adenosine deaminase, SAA, sIL2R
-*[[Hypercalciuria]]
-*Elevated 1,25-dihydroxyvitamin D levels
-| style="background: #F5F5F5; padding: 5px;" |
-*AV block
-*Prolongation of the PR interval (first-degree AV block)
-*Ventricular arrhythmias (sustained or nonsustained ventricular tachycardia and ventricular premature beats [VPBs])
-*Supraventricular arrhythmias
-| style="background: #F5F5F5; padding: 5px;" |
-*Chest radiograph: Bilateral hilar adenopathy,
-*High-resolution CT (HRCT) scanning of the chest: Ground glass opacification, Hilar and mediastinal lymphadenopathy,    Bronchial wall thickening
-| style="background: #F5F5F5; padding: 5px;" |
-*Lung Biopsy
-|- style="background: #DCDCDC; padding: 5px;" |
-|[[Acute chest syndrome]] ([[Sickle cell anemia|Sickle cell anemia)]]
-| style="background: #F5F5F5; padding: 5px;" |Acute
-| style="background: #F5F5F5; padding: 5px;" |May last minutes to hours
-| style="background: #F5F5F5; padding: 5px;" |
-*Chest tightness
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | +/-
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Sickle-cell disease|Sickle cell anemia]]
-*Vaso-occlusive [[Crisis (charity)|crisis]]
-*[[Pain]] crises
-| style="background: #F5F5F5; padding: 5px;" |
-* ↑ WBC
-* ↑ Hb levels
-* ↓ fetal hemoglobin levels
-* Smoking
-* Vaso-occlusive pain events
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Systolic murmurs|Systolic murmur]] may be heard over the entire [[precordium]]
-| style="background: #F5F5F5; padding: 5px;" |
-*↑[[Erythrocyte sedimentation rate]]
-*[[Peripheral blood smear|Peripheral blood smears]]: Schistiocytes
-*↑ [[Reticulocyte count|Reticulocyte count]]
-| style="background: #F5F5F5; padding: 5px;" |
-*EKG typically not indicated
-| style="background: #F5F5F5; padding: 5px;" |
-*Plain radiography of the extremities: Avascular necrosis
-| style="background: #F5F5F5; padding: 5px;" | ---
-|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
-! rowspan="3" |Differentials on the basis of Etiology
-! rowspan="3" |Disease
-! colspan="10" |Clinical manifestations
-! colspan="4" |Diagnosis
-|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
-| colspan="8" |Symptoms
-| rowspan="2" |Risk factors
-! rowspan="2" |Physical exam
-! rowspan="2" |Lab Findings
-! rowspan="2" |EKG
-! rowspan="2" |Imaging
-! rowspan="2" |Gold standard
-|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
-!Onset
-!Duration
-!Quality of Pain
-!Cough
-!Fever
-!Dyspnea
-!Weight loss
-!Associated Features
-|- style="background: #DCDCDC; padding: 5px;" |
-| rowspan="9" |Gastrointestinal
-|'''[[GERD]], [[Peptic Ulcer]]'''
-| style="background: #F5F5F5; padding: 5px;" |[[Acute (medicine)|Acute]]
-| style="background: #F5F5F5; padding: 5px;" |
-*Minutes to hours ([[Gastroesophageal reflux disease|gastroesophageal reflux]])
-*Prolonged ([[peptic ulcer]])
-*5 to 60 minutes
-| style="background: #F5F5F5; padding: 5px;" |
-*Burning
-*Substernal
-*[[Epigastric]]
-| style="background: #F5F5F5; padding: 5px;" | +/-
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +/-
-| style="background: #F5F5F5; padding: 5px;" |
-*Visceral, substernal, worse with recumbency, no radiation, relief with food, antacids
-*[[Hematemesis]] or [[melena]] resulting from [[gastrointestinal bleeding]]
-*[[Dyspepsia]]
-| style="background: #F5F5F5; padding: 5px;" |
-* Prolonged NSAIDs intake
-* Smoking
-* Alcohol abuse
-* Spicy foods
-* H-pylori
-| style="background: #F5F5F5; padding: 5px;" |
-*Not any auscultatory findings associated with this disease
-*[[Enamel]] [[Erosion (dental)|erosion]] or other dental manifestations
-| style="background: #F5F5F5; padding: 5px;" |
-*↑Serum [[Gastrin]] Level
-*Secretin Stimulation Test
-*H-Pylori testing
-| style="background: #F5F5F5; padding: 5px;" |
-* EKG usually normal but may show T wave inversions in leads V2 through V4 consistent with myocardial ischemia in patients with peptic ulcer perforation
-| style="background: #F5F5F5; padding: 5px;" |
-*Upper Gastrointestinal Endoscopy: Biopsy
-*Esophageal Manometry: To exclude an esophageal motility disorder
-*Esophageal impedance pH testing: Monitors esophageal pH
-| style="background: #F5F5F5; padding: 5px;" |
-*Upper Gastrointestinal Endoscopy
-|- style="background: #DCDCDC; padding: 5px;" |
-|'''Diffuse Esophageal Spasm'''
-| style="background: #F5F5F5; padding: 5px;" |[[Acute (medicine)|Acute]]
-| style="background: #F5F5F5; padding: 5px;" |
-*Minutes to hours
-*5 to 60 minutes
-| style="background: #F5F5F5; padding: 5px;" |
-*Burning
-*Pressure
-*Visceral, spontaneous, substernal,
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +/-
-| style="background: #F5F5F5; padding: 5px;" | +/-
-| style="background: #F5F5F5; padding: 5px;" |
-*Associated with cold liquids
-*Relief with nitroglycerin
-| style="background: #F5F5F5; padding: 5px;" | ---
-| style="background: #F5F5F5; padding: 5px;" | ---
-| style="background: #F5F5F5; padding: 5px;" |
-*Barium swallow: Multiple areas of spasm  throughout the length of the esophagus
-*Impedance testing: Higher amplitudes and better transit of swallowed boluses
-| style="background: #F5F5F5; padding: 5px;" |
-*No ECG findings associated with DES, but ECG is done to exclude variant angina due to higher concurrent association of variant angina with DES
-| style="background: #F5F5F5; padding: 5px;" |
-*Esophageal [[Esophageal motility study|manometry]] : ≥20 percent premature contractions (distal latency <4.5 seconds)
-| style="background: #F5F5F5; padding: 5px;" |
-* Esophageal manometry
-|- style="background: #DCDCDC; padding: 5px;" |
-|[[Esophagitis]]
-| style="background: #F5F5F5; padding: 5px;" |[[Acute (medicine)|Acute]]
-| style="background: #F5F5F5; padding: 5px;" |Variable
-| style="background: #F5F5F5; padding: 5px;" |
-*Burning
-*[[Epigastric]]
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +/-
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Heartburn]]
-*[[Abdominal pain]]
-| style="background: #F5F5F5; padding: 5px;" |
-* HIV
-* Immunosuppression
-| style="background: #F5F5F5; padding: 5px;" |
-*No auscultatory finding
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Cardiac troponin I (cTnI) and T (cTnT)|Troponin or other cardiac markers]]
-*Leukopenia
-*↓[[CD4|CD4 count]]
-*[[Human Immunodeficiency Virus (HIV)|Human immunodeficiency virus (HIV) test]]
-| style="background: #F5F5F5; padding: 5px;" |
-*ECG is done to rule out acute coronary syndrome
-| style="background: #F5F5F5; padding: 5px;" |
-*Double-contrast esophageal barium study (esophagography)
-*Endoscopy: Biopsy
-| style="background: #F5F5F5; padding: 5px;" |
-*Endoscopy
-|- style="background: #DCDCDC; padding: 5px;" |
-|[[Eosinophilic esophagitis|Eosinophilic Esophagitis]]
-| style="background: #F5F5F5; padding: 5px;" |[[Chronic (medical)|Chronic]]
-| style="background: #F5F5F5; padding: 5px;" |Variable
-| style="background: #F5F5F5; padding: 5px;" |
-*Burning
-*Retrosternal
-*Abdominal
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-* Dysphagia
-* Food impaction
-* GERD
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Allergy|Allergic]] [[Disease|diseases]]
-*[[Asthma]]
-*[[Rinitis]]
-*[[Eczema]]
-| style="background: #F5F5F5; padding: 5px;" |
-*No auscultatory finding in the this [[disease]]
-| style="background: #F5F5F5; padding: 5px;" |
-*Elevated IgE (>114,000 units/L)
-*Elevated peripheral eosinophils
-| style="background: #F5F5F5; padding: 5px;" |
-*Typically no finding on EKG
-| style="background: #F5F5F5; padding: 5px;" |
-*Barium studies: Strictures and a ringed esophagus
-*Endoscopy: Stacked circular rings ("feline" esophagus)  ●Strictures   ●Linear furrows   ●Whitish papules
-*Esophageal biopsy: More than 15 [[Eosinophil granulocyte|eosinophils]] per high-power field
-| style="background: #F5F5F5; padding: 5px;" |
-*Esophageal biopsy
-|- style="background: #DCDCDC; padding: 5px;" |
-|[[Esophageal perforation|Esophageal Perforation]]<ref name="pmid2730190">{{cite journal |vauthors=Pate JW, Walker WA, Cole FH, Owen EW, Johnson WH |title=Spontaneous rupture of the esophagus: a 30-year experience |journal=Ann. Thorac. Surg. |volume=47 |issue=5 |pages=689–92 |date=May 1989 |pmid=2730190 |doi= |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |[[Acute (medicine)|Acute]]
-| style="background: #F5F5F5; padding: 5px;" |Minutes to hours
-| style="background: #F5F5F5; padding: 5px;" |
-*Burning
-*Upper abdominal
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +/-
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Eating disorder|Eating disorders]] such as [[Bulimia nervosa|bulimia]]
-*Repeated episodes of [[retching]] and [[vomiting]] with either recent excessive [[dietary]] or [[Alcohol|alcoho]]<nowiki/>l intake
-*[[Subcutaneous emphysema]]
-| style="background: #F5F5F5; padding: 5px;" |
-* Instrumentation/surgery
-* Penetrating or blunt trauma
-* Medications, other ingestions, foreign body
-* Violent retching/vomiting
-* Hernia/intestinal volvulus/obstruction
-* Inflammatory bowel disease
-* Appendicitis
-* Peptic ulcer disease
-| style="background: #F5F5F5; padding: 5px;" |
-*Mild tachycardia or hypothermia
-*[[Hamman's crunch|Hamman crunch (crackling sound upon chest auscultation occurs due to pneumomediastinum)]]
-| style="background: #F5F5F5; padding: 5px;" |
-*↑Serum amylase
-*↑C-reactive protein levels
-| style="background: #F5F5F5; padding: 5px;" |
-*EKG may be indicated to assess for [[myocardial ischemia]] due to [[Gastrointestinal bleeding|acute gastrointestinal bleeding]], especially if there is coexisting:Cardiovascular disease, significant anemia and advanced age
-| style="background: #F5F5F5; padding: 5px;" |
-*Plain chest films or chest CT: Pneumomediastinum, Free air under the diaphragm,  •Pleural effusion   •Pneumothorax  (Macklin effect).    •Subcutaneous emphysema
-*Plain abdominal films (or abdominal CT scout film):The appearance of pneumoperitoneum   -Free air under the diaphragm   -Cupola sign (inverted cup)   -Rigler sign (double-wall sign)   -Psoas sign  -Urachus sign
-| style="background: #F5F5F5; padding: 5px;" |
-** Confirmed by water-soluble contrast esophagram
-|- style="background: #DCDCDC; padding: 5px;" |
-|[[Mediastinitis]]
-| style="background: #F5F5F5; padding: 5px;" |[[Acute (medicine)|Acute]], [[Chronic (medical)|Chronic]]
-| style="background: #F5F5F5; padding: 5px;" |Variable
-| style="background: #F5F5F5; padding: 5px;" |
-*Retrosternal irritation
-| style="background: #F5F5F5; padding: 5px;" | +/-
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*Nonspecific
-| style="background: #F5F5F5; padding: 5px;" |
-* Infection
-* Esophageal perforation
-* Post operative complication
-| style="background: #F5F5F5; padding: 5px;" |
-*Dysphagia
-*Dysphonia
-*Stridor
-*[[Hamman's sign|Hamman sign]]
-| style="background: #F5F5F5; padding: 5px;" |
-*Positive organisms in sternal [[Culture collection|culture]]
-*Leukocytosis
-*Positive blood cultures
-| style="background: #F5F5F5; padding: 5px;" |
-*Diffuse ST elevation
-| style="background: #F5F5F5; padding: 5px;" |
-*CT: Localize the infection and extent of spread
-*MRI: Assesses vascular  involvement and complications
-| style="background: #F5F5F5; padding: 5px;" | CT scan
-|- style="background: #DCDCDC; padding: 5px;" |
-|'''[[Gallstone disease| Cholelithiasis]]'''
-| style="background: #F5F5F5; padding: 5px;" |[[Acute (medicine)|Acute]], [[subacute]]
-| style="background: #F5F5F5; padding: 5px;" |Minutes to hours
-| style="background: #F5F5F5; padding: 5px;" |
-*Burning
-*Colicky
-*Right upper [[abdomen]]
-*Substernal
-*[[epigastric]]
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +/-
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Obesity]]
-*Fertile females in 40's
-| style="background: #F5F5F5; padding: 5px;" |The presence of a common bile duct stone on transabdominal ultrasound
-•Clinical acute cholangitis
-•A serum bilirubin greater than 4 mg/dL (68 micromol/L)
-| style="background: #F5F5F5; padding: 5px;" |
-*Murphy sign negative
-*Jaundice
-| style="background: #F5F5F5; padding: 5px;" |
-*↑ALT
-*↑AST
-*↑[[Amylase]] levels
-*↑ALP
-| style="background: #F5F5F5; padding: 5px;" |
-*Typically not indicated
-| style="background: #F5F5F5; padding: 5px;" |
-*Transabdominal [[ultrasound]] (TAUS): shows gallstones
-*EUS: Detects biliary sludge
-*MRCP: Detects stones >6mm
-*Endoscopic Retrograde Cholangiopancreatography (ERCP): Diagnostic and therapeutic removal of stones
-|Endoscopic ultrasound and MECP
-|- style="background: #DCDCDC; padding: 5px;" |
-|[[Pancreatitis]]
-| style="background: #F5F5F5; padding: 5px;" |[[Acute (medicine)|Acute]], [[Chronic (medical)|Chronic]]
-| style="background: #F5F5F5; padding: 5px;" |Variable
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Epigastric]]
-*Upper left side of the [[abdomen]]
-*Pressure like
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | +/-
-| style="background: #F5F5F5; padding: 5px;" |
-*Primary [[cirrhosis]]
-*[[Primary sclerosing cholangitis]]
-*Cystic fibrosis
-*Autoimmune diseases
-| style="background: #F5F5F5; padding: 5px;" |
-* Alcohol abuse
-* Smoking
-* Genetic predisposition
-| style="background: #F5F5F5; padding: 5px;" |
-* Tachypnea
-*Hypoxemia
-*Hypotension
-*Cullen's sign
-*Grey Turner sign
-| style="background: #F5F5F5; padding: 5px;" |
-*↑[[Amylase]] levels
-*↑[[Lipase]] levels
-*↑ALT
-*↑ALP
-*Leukocytosis
-| style="background: #F5F5F5; padding: 5px;" |
-* T-wave inversion
-* ST-segment depression
-*  ST-segment elevation rarely
-* Q-waves
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Computed tomography|CT]]: focal or diffuse enlargement of the pancreas
-*[[Magnetic resonance imaging|MRI]]: Pancreatic enlargement
-| style="background: #F5F5F5; padding: 5px;" |
-*CT Scan
-|- style="background: #DCDCDC; padding: 5px;" |
-|[[Hiatal Hernia|Sliding Hiatal Hernia]]
-| style="background: #F5F5F5; padding: 5px;" |[[Acute (medicine)|Acute]]
-| style="background: #F5F5F5; padding: 5px;" |Variable
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Epigastric]]
-*Burning
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Obstruction]]
-*Cameron [[Ulcer|ulcers]]
-*GERD
-*Dysphagia
-| style="background: #F5F5F5; padding: 5px;" |
-* Trauma
-* Iatrogenic
-* Congenital malformation
-| style="background: #F5F5F5; padding: 5px;" |
-*Bowel sounds may be heard in the chest
-| style="background: #F5F5F5; padding: 5px;" |
-*Non specific
-| style="background: #F5F5F5; padding: 5px;" |
-*T wave inversion in anterior lead.
-| style="background: #F5F5F5; padding: 5px;" |
-*Barium swallow: At least three rugal folds traversing the diaphragm
-*Upper endoscopy: A greater than 2-cm separation between the squamocolumnar junction and the diaphragmatic impression
-*High resolution manometry: The separation of the crural diaphragm from the lower esophageal sphincter (LES) by a pressure trough
-| style="background: #F5F5F5; padding: 5px;" |
-*Upper endoscopy
-*High resolution manometry (for smaller hernias)
-|- style="background: #DCDCDC; padding: 5px;" |
-| rowspan="6" |Musculoskeletal
-|[[Costochondritis|Costosternal syndromes (costochondritis)]]
-| style="background: #F5F5F5; padding: 5px;" |Acute, subacute
-| style="background: #F5F5F5; padding: 5px;" |Days to weeks
-| style="background: #F5F5F5; padding: 5px;" |
-*Pressure like on anterior part of chest wall
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*History of repeated minor trauma or unaccustomed activity (eg, painting, moving furniture)
-| style="background: #F5F5F5; padding: 5px;" |
-* Trauma
-| style="background: #F5F5F5; padding: 5px;" |
-*Pain by palpation of tender areas
-*Maneuvers, such as the "crowing rooster" and horizontal arm flexion maneuver
-| style="background: #F5F5F5; padding: 5px;" |
-*Non specific
-| style="background: #F5F5F5; padding: 5px;" |
-*EKG is done to rule out other cardiovascular causes
-| style="background: #F5F5F5; padding: 5px;" |
-*CXR: To rule out fracture
-|Pain by palpation of tender areas
-|- style="background: #DCDCDC; padding: 5px;" |
-|Lower rib pain syndromes
-| style="background: #F5F5F5; padding: 5px;" |Chronic
-| style="background: #F5F5F5; padding: 5px;" |Variable
-| style="background: #F5F5F5; padding: 5px;" |
-*Aching
-*Lower chest
-*Upper abdomen
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*Common in women with a mean age in the mid-40s
-| style="background: #F5F5F5; padding: 5px;" | ---
-| style="background: #F5F5F5; padding: 5px;" |
-*Hooking maneuver
-*Reproduces pain by pressing a tender spot on the costal margin
-| style="background: #F5F5F5; padding: 5px;" |
-*Non specific
-*The workup is done for excluding cardiac disorders and other causes of chest pain
-| style="background: #F5F5F5; padding: 5px;" |
-*EKG is done to rule out other cardiovascular causes
-| style="background: #F5F5F5; padding: 5px;" |
-*CXR: To rule out fracture
-| style="background: #F5F5F5; padding: 5px;" | ---
-|- style="background: #DCDCDC; padding: 5px;" |
-|Sternalis syndrome
-| style="background: #F5F5F5; padding: 5px;" |Chronic
-| style="background: #F5F5F5; padding: 5px;" |Variable
-| style="background: #F5F5F5; padding: 5px;" |Pressure like pain
-*Over the body of sternum
-*Sternalis muscle
-*Left or middle side of the chest wall
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Heart|Cardiac]] diseases
-| style="background: #F5F5F5; padding: 5px;" |
-* Daily activities
-* Emotional [[distress]]
-* [[Anxiety]]
-| style="background: #F5F5F5; padding: 5px;" |
-*Localized [[tenderness]] is found directly over the body of the sternum or overlying sternalis muscle
-| style="background: #F5F5F5; padding: 5px;" |
-*No specific diagnostic test for this disease
-*The workup is done for excluding cardiac disorders and other causes of chest pain
-| style="background: #F5F5F5; padding: 5px;" |
-*EKG is done to rule out other cardiovascular causes
-| style="background: #F5F5F5; padding: 5px;" |
-*[[X-rays|X-ray]] : To rule out fracture
-| style="background: #F5F5F5; padding: 5px;" |Physical exam
-|- style="background: #DCDCDC; padding: 5px;" |
-|[[Tietze's syndrome]]
-| style="background: #F5F5F5; padding: 5px;" |Acute
-| style="background: #F5F5F5; padding: 5px;" |Weeks
-| style="background: #F5F5F5; padding: 5px;" |Pressure like pain over
-*Costosternal joint
-*[[Sternoclavicular articulation|Sternoclavicular]] joint
-*[[Costochondral joint|Costochondral]] joint
-*Second and third ribs
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*Most often involve the areas of 2nd and 3rd ribs
-*More common in young adults
-*Sternocostoclavicular hyperostosis
-*Ankylosing spondylitis
-| style="background: #F5F5F5; padding: 5px;" |
-* Upper respiratory infections
-* Excessive coughing
-| style="background: #F5F5F5; padding: 5px;" |
-*Painful and localized swelling of the costosternal, [[Sternoclavicular articulation|sternoclavicular]], or [[Costochondral joint|costochondral joints]] most often involving 2nd and 3rd [[ribs]]
-| style="background: #F5F5F5; padding: 5px;" |
-*No specific diagnostic test for this disease
-*The workup is done for excluding cardiac disorders and other causes of chest pain
-| style="background: #F5F5F5; padding: 5px;" |
-*EKG is done to rule out other cardiovascular causes
-| style="background: #F5F5F5; padding: 5px;" |
-*[[X-rays|X-ray]]: To rule out fracture
-| style="background: #F5F5F5; padding: 5px;" |
-*Tests are done to rule out other diseases
-|- style="background: #DCDCDC; padding: 5px;" |
-|[[Xiphoidalgia]]
-| style="background: #F5F5F5; padding: 5px;" |Acute
-| style="background: #F5F5F5; padding: 5px;" |Variable
-| style="background: #F5F5F5; padding: 5px;" |Pressure like pain over
-*Over the xiphoid process
-*Sternum
-*Xiphisternal joint
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*Symptoms are aggravated by twisting and bending movements
-| style="background: #F5F5F5; padding: 5px;" |
-* Cough
-* Heavy work
-| style="background: #F5F5F5; padding: 5px;" |
-*Provocative test
-| style="background: #F5F5F5; padding: 5px;" |
-*No specific diagnostic test for this disease
-*The workup is done for excluding cardiac disorders and other causes of chest pain
-| style="background: #F5F5F5; padding: 5px;" |
-*EKG is done to rule out other cardiovascular causes
-| style="background: #F5F5F5; padding: 5px;" |
-*X-ray: To rule out fracture
-| style="background: #F5F5F5; padding: 5px;" |
-*Tests are done to rule out other diseases
-|- style="background: #DCDCDC; padding: 5px;" |
-|Spontaneous [[sternoclavicular]] [[subluxation]]
-| style="background: #F5F5F5; padding: 5px;" |Acute, Chronic
-| style="background: #F5F5F5; padding: 5px;" |Variable
-| style="background: #F5F5F5; padding: 5px;" |Aching pain over [[Sternoclavicular articulation|Sternoclavicular joint]]
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*More common in middle age [[women]]
-*Occurs in dominant hands with repetitive tasks of heavy or moderate quality
-| style="background: #F5F5F5; padding: 5px;" |
-* Trauma
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Palpation]] of tender areas
-| style="background: #F5F5F5; padding: 5px;" |
-*No specific diagnostic test for this disease
-*The workup is done for excluding cardiac disorders and other causes of chest pain
-| style="background: #F5F5F5; padding: 5px;" |
-*EKG is done to rule out other cardiovascular causes
-| style="background: #F5F5F5; padding: 5px;" |
-*[[X-rays|X-ray]]: Sclerosis of the medial clavicle
-| style="background: #F5F5F5; padding: 5px;" |
-*X-ray
-|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
-! rowspan="3" |Differentials on the basis of Etiology
-! rowspan="3" |Disease
-! colspan="10" |Clinical manifestations
-! colspan="4" |Diagnosis
-|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
-| colspan="8" |Symptoms
-| rowspan="2" |Risk factors
-! rowspan="2" |Physical exam
-! rowspan="2" |Lab workup
-! rowspan="2" |EKG
-! rowspan="2" |Imaging
-! rowspan="2" |Gold standard
-|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
-!Onset
-!Duration
-!Quality of Pain
-!Cough
-!Fever
-!Dyspnea
-!Weight loss
-!Associated Features
-|- style="background: #DCDCDC; padding: 5px;" |
-| rowspan="7" |Rheumatic
-|[[Fibromyalgia]]
-| style="background: #F5F5F5; padding: 5px;" |[[Chronic (medical)|Chronic]]
-| style="background: #F5F5F5; padding: 5px;" |Variable
-| style="background: #F5F5F5; padding: 5px;" |
-*Raynaud phenomenon (RP)
-*Deep [[Pain|ache]] and burning pain on
-**[[Shoulder|Shoulders]]
-**Back of the [[Neck]]
-**[[Chest]]
-**Lower [[Human back|Back]]
-**[[Elbow|Elbows]]
-**[[Hip (anatomy)|Hips]]
-**Shin
-**[[Knee|Knees]]
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Somatization]]
-*[[Depression]]
-*IBS
-| style="background: #F5F5F5; padding: 5px;" |---
-| style="background: #F5F5F5; padding: 5px;" |
-*Presence of [[tenderness]] in soft-tissue anatomic locations
-| style="background: #F5F5F5; padding: 5px;" |
-*Non specific
-*Normal [[Blood, Sweat & Tea|Blood]] and [[Urine|urine test]] (mandatory to rule out other diseases)
-| style="background: #F5F5F5; padding: 5px;" |
-*P-wave dispersions (Pd)
-| style="background: #F5F5F5; padding: 5px;" |---
-| style="background: #F5F5F5; padding: 5px;" |---
-|- style="background: #DCDCDC; padding: 5px;" |
-|[[Rheumatoid arthritis]]
-| style="background: #F5F5F5; padding: 5px;" |[[Chronic (medical)|Chronic]]
-| style="background: #F5F5F5; padding: 5px;" |Years
-| style="background: #F5F5F5; padding: 5px;" |Symmetrical joint pain in
-*Wrist
-*Fingers
-*[[Knee|Knees]]
-*Feet
-*Ankles
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" |
-*Extra-articular involvement of other organ systems
-*[[Carpal tunnel syndrome]]
-*[[Tarsal tunnel syndrome]]
-| style="background: #F5F5F5; padding: 5px;" |
-* Old age
-* Smoking
-* Autoimmune conditions
-| style="background: #F5F5F5; padding: 5px;" |
-*Reduced grip strength
-*[[Rheumatoid nodules]]
-| style="background: #F5F5F5; padding: 5px;" |
-*Positive Rheumatic Factor
-*Anti-CCP body
-*Synovial fluid analysis: WBC between 1500 and 25,000/cubicmm, low glucose, low C3 and C4 complement level.
-*Thrombocytosis
-*Anemia
-*Mild leukocytosis
-| style="background: #F5F5F5; padding: 5px;" |
-*ECG is done rule out the heart failure as RA is one of the causes of heart failure
-| style="background: #F5F5F5; padding: 5px;" |
-*Plain film radiography: periarticular osteopenia, joint space narrowing, and bone erosions
-*MRI: Bone erosions
-*Ultrasonography: Degree of inflammation and the volume of inflamed tissue
-| style="background: #F5F5F5; padding: 5px;" |---
-|- style="background: #DCDCDC; padding: 5px;" |
-|[[Ankylosing spondylitis]]
-| style="background: #F5F5F5; padding: 5px;" |[[Chronic (medical)|Chronic]]
-| style="background: #F5F5F5; padding: 5px;" |Years
-| style="background: #F5F5F5; padding: 5px;" |Intermittent pain in
-*[[Vertebral column|Spine]] joint
-*[[Sacroiliac joint|Sacroiliac]] joint
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*Patients with [[Human leukocyte antigen|HLA]]-27 variant
-*Extra-articular joint involvements
-*[[Restrictive lung disease|Restrictive pulmonary disease]]
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Tenderness]] of the SI
-*Limited spinal [[Range of motion|ROM]]
-*[[Schober's test|Schober test]]
-| style="background: #F5F5F5; padding: 5px;" |
-*Complete blood count ([[Complete blood count|CBC]])
-*[[Erythrocyte sedimentation rate|Erythrocyte]] sedimetation rate ([[Erythrocyte sedimentation rate|ESR]])
-*[[Antigen]] HLA-27
-*Negative Rheumatic Factor
-| style="background: #F5F5F5; padding: 5px;" |
-*ECG is done to rule out conductions defects and aortic insufficiency
-| style="background: #F5F5F5; padding: 5px;" |
-*Computed tomography (CT)
-*Magnetic resonance imaging (MRI)
-*Power Doppler ultrasonography
-| style="background: #F5F5F5; padding: 5px;" |
-*Plain films of the sacroiliac joints
-|- style="background: #DCDCDC; padding: 5px;" |
-|[[Psoriatic arthritis]]
-| style="background: #F5F5F5; padding: 5px;" |[[Chronic (medical)|Chronic]]
-| style="background: #F5F5F5; padding: 5px;" |Years
-| style="background: #F5F5F5; padding: 5px;" |Asymmetrical intermittent pain in
-*[[Interphalangeal articulations of hand|Interphalangeal joints]]
-*Nails
-*Wrist
-*[[Knee|Knees]]
-*Ankles
-*Lower [[Human back|Back]]
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Psoriasis]]
-*[[Enthesitis]]
-*[[Tenosynovitis]]
-*[[Dactylitis]]
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Dactylitis]] with sausage [[digits]]
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Serum]] complement
-*Levels of Long Prentaxin 3 protein ([[PTX3]])
-*Increased levels of [[C-reactive protein|CRP]]
-*Erythrocyte sedimentation rate
-*Rheumatoid factor
-*Immunoglobulin
-| style="background: #F5F5F5; padding: 5px;" |
-*Longer PR interval
-| style="background: #F5F5F5; padding: 5px;" |
-*X-ray of the involved joints
-*CT scanning
-*MRI
-*Ultrasonography
-| style="background: #F5F5F5; padding: 5px;" |
-*No any gold standard test is available for this test
-|- style="background: #DCDCDC; padding: 5px;" |
-|Sternocostoclavicular [[hyperostosis]] (SAPHO syndrome)
-| style="background: #F5F5F5; padding: 5px;" |[[Chronic (medical)|Chronic]]
-| style="background: #F5F5F5; padding: 5px;" |Years
-| style="background: #F5F5F5; padding: 5px;" |Recurrent and multifocal pain in
-[[Sternoclavicular articulation|Sternoclavicular]] joint
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*Palmoplantar [[pustulosis]] (PPP)
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-*Depending on the type of [[joint]] affected
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Serology|Serologic]] testing to exclude other diseases
-*High levels of alkaline [[phosphatase]]
-| style="background: #F5F5F5; padding: 5px;" |
-*ECG is done to rule out conductions defects and aortic insufficiency
-| style="background: #F5F5F5; padding: 5px;" |
-*Plain radiography
-*Computed tomography
-*Bone scan
-*Magnetic resonance imaging
-*Positron emission tomography
-| style="background: #F5F5F5; padding: 5px;" |
-*No any gold standard test is available for this disease
-|- style="background: #DCDCDC; padding: 5px;" |
-|[[Systemic lupus erythematosus]]
-| style="background: #F5F5F5; padding: 5px;" |[[Chronic (medical)|Chronic]]
-| style="background: #F5F5F5; padding: 5px;" |Years
-| style="background: #F5F5F5; padding: 5px;" |
-*Skin
-*[[Joint|Joints]] (fingers, wrist, knees)
-*[[Kidney|Kidneys]]
-*SLE can affect any organ of the body
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Human leukocyte antigen|HLA]]-genetic mutations
-*[[Female]] gender
-*Being younger than 50
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Malar rash]]
-*[[Photosensitive]] [[rash]]
-*[[Discoid lupus|Discoid rash]]
-*[[Arthritis]] of the [[Proximal interphalangeal joints|proximal interphalangeal (PIP)]] and [[Metacarpophalangeal joint|metacarpophalangeal (MCP) joints]] of the [[hands]]
-*[[Pleural friction rub|Pleuro-pericardial friction rubs]]
-*[[Systolic murmurs]]
-| style="background: #F5F5F5; padding: 5px;" |
-*Elevation of [[Autoantibody|autoantibodies]] ([[Antinuclear antibodies|ANA]], [[Anti-dsDNA antibody|anti-dsDNA]], [[Anti-SM antibody|anti-SM]], [[Antiphospholipid antibodies|antiphospholipid]])
-*[[Complement]] levels decreased
-*Serum creatinine
-*Urinalysis with microscopy
-*Erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP)
-*Liver function tests
-*Creatine kinase assay
-*Spot protein/spot creatinine ratio
-| style="background: #F5F5F5; padding: 5px;" |
-* [[Sinus tachycardia]], [[ST segment changes]], and [[Ventricular arrhythmias|ventricular conduction disturbances]]
-| style="background: #F5F5F5; padding: 5px;" |
-*Joint radiography
-*Chest X-ray
-*CT Scan
-*MRI
-*Echocardiography
-*Arthrocentesis
-*Lumbar puncture
-| style="background: #F5F5F5; padding: 5px;" |
-*Anti-dsDNA antibody test
-|- style="background: #DCDCDC; padding: 5px;" |
-|[[Relapsing polychondritis]]
-| style="background: #F5F5F5; padding: 5px;" |[[Chronic (medical)|Chronic]]
-| style="background: #F5F5F5; padding: 5px;" |Years
-| style="background: #F5F5F5; padding: 5px;" |Intermittent pain in
-*[[Tissue (biology)|Tissues]] that cover the end of the [[Joint|joints]]
-*[[Cartilage]] of costal rib
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Hodgkin's lymphoma|Hodkin's lymphoma]]
-*[[Myelodysplastic syndrome|Myelodysplastic]] syndromes
-*[[Digestive disease|Gastrointestinal disorders]]
-*Type 1 [[Diabetes mellitus]]
-*[[Auricular appendage|Auricular]] [[chondritis]]
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Physical examination|Physical examinations]] findings are seen related to [[nasal]] [[chondritis]], [[ocular]] [[inflammation]], [[cardiovascular disease]], [[skin disease]], [[CNS]] and [[Pulmonary|pulmonary system]]
-| style="background: #F5F5F5; padding: 5px;" |
-*Negative [[Rheumatoid factor|rheumatoid]] factor
-*[[Biopsy]]
-*Complete blood cell count (CBC) with differential
-*Metabolic panel
-*Serum creatinine
-*Liver transaminase and serum alkaline phosphatase studies
-*Urinalysis dipstick and microscopic evaluation of sediment
-*Cryoglobulins
-*Viral hepatitis panel
-*Antinuclear antibody (ANA)
-*Antineutrophil cytoplasmic antibody (ANCA)
-| style="background: #F5F5F5; padding: 5px;" |
-* ECG is done to rule out the cardiovascular complications of this disease
-| style="background: #F5F5F5; padding: 5px;" |
-*Chest radiography
-*Spiral CT scanning
-*FDG-PET/CT
-*MRI
-*Posteroanterior and lateral dye contrast pharyngotracheogram
-*Scintigraphy
-| style="background: #F5F5F5; padding: 5px;" |
-*No gold standard test for this disease
-|- style="background: #DCDCDC; padding: 5px;" |
-|Psychiatric
-|[[Panic attack]]/ Disorder
-| style="background: #F5F5F5; padding: 5px;" |Acute or subacute or chronic
-| style="background: #F5F5F5; padding: 5px;" |Variable
-| style="background: #F5F5F5; padding: 5px;" |Variable
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*History of [[Depression]]
-*[[Panic attack|Panic attacks]]
-*[[Agoraphobia]]
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-*Anxious
-*Tachypneic
-| style="background: #F5F5F5; padding: 5px;" |
-*Thyroid function tests
-*Complete blood count
-*Chemistry panel
-| style="background: #F5F5F5; padding: 5px;" |
-*Sinus Tachycardia
-| style="background: #F5F5F5; padding: 5px;" |
-*No any specific radiographic test is done
-| style="background: #F5F5F5; padding: 5px;" |
-*No gold standard test for panic attack
-|- style="background: #DCDCDC; padding: 5px;" |
-| rowspan="2" |Others
-|Substance abuse
-([[Cocaine abuse|Cocaine]])
-| style="background: #F5F5F5; padding: 5px;" |Acute (hours)
-| style="background: #F5F5F5; padding: 5px;" |Minutes to hours
-| style="background: #F5F5F5; padding: 5px;" |Pressure like pain in the center of chest
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Anxiety]]
-*[[Dyspnea]]
-*[[Nausea and vomiting|Nausea]]
-*[[Palpitation|Palpitations]]
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Signs]] of [[injection]] [[drug use]]
-*[[Signs]] of [[drug]] [[inhalation]]
-*Poor [[personal hygiene]]
-| style="background: #F5F5F5; padding: 5px;" |
-*Serum [[Cardiac biomarkers|biomarkers]] ([[Troponin I]], [[Troponin T]])
-*Toxicologic tests or drug screens of bodily fluids (blood, urine, saliva) and hairs
-| style="background: #F5F5F5; padding: 5px;" |
-**QT prolongation
-**Sinus Tachycardia
-**Arrhythmias
-**Cardiac conduction abnormalities
-| style="background: #F5F5F5; padding: 5px;" |
-*Brain CT scan
-| style="background: #F5F5F5; padding: 5px;" |
-*Gold standard test depends on the type of substance is abuse
-|- style="background: #DCDCDC; padding: 5px;" |
-|[[Herpes Zoster]]
-| style="background: #F5F5F5; padding: 5px;" |Acute or Chronic
-| style="background: #F5F5F5; padding: 5px;" |Variable
-| style="background: #F5F5F5; padding: 5px;" |Burning pain on
-*Chest
-*Upper back
-*Lower back
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |
-*People who had [[chickenpox]]
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-*[[Painful]] grouped herpetiform [[vesicles]] on an [[Erythematous|erythematous base]] distributed in a single [[dermatome]]
-| style="background: #F5F5F5; padding: 5px;" |
-*Nerve test
-*[[Blood test]]
-| style="background: #F5F5F5; padding: 5px;" |
-*ECG is done to rule out other cardiovascular causes of chest pain
-| style="background: #F5F5F5; padding: 5px;" |
-*Magnetic resonance imaging (MRI)
-| style="background: #F5F5F5; padding: 5px;" |
-*Viral tissue culture
 |}
 ==References==
 {{Reflist|2}}