Pneumoconiosis differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dushka Riaz, MD

Overview

Pneumoconiosis must be differentiated from other diseases that cause chronic cough and dyspnea.

Differentiating Pneumoconiosis from other Diseases

Pneumoconiosis must be differentiated from other diseases that cause cough and dyspnea.

Differentiating pneumoconiosis from other diseases on the basis of dyspnea and cough

On the basis of cough and chronic dyspnea, pneumoconiosis must be differentiated from lung malignancy, tuberculosis, emphysema, asthma, interstitial lung disease, pneumonia, and sarcoidosis.

Diseases	Clinical manifestations						Para-clinical findings			Gold standard
	Symptoms			Physical examination
							Lab Findings		Imaging
	Chronic Dyspnea	Cough	Fever	Spirometry	Auscultation	Night Sweats	CBC	ABG	Imaging
Pneumoconiosis	+	+	+	↑ FEV1/FVC	Wheezing, rhonchi, crackles	+	↑WBC	↓O2, ↑CO2	Massive fibrosis, hilar adenopathy, reticular opacities, pleural plaques	HRCT
Lung Malignancy	+	+	-	↓Vt, ↑RV	Wheezing, crackles	+	Normal	Normal	Mass lesion, hilar lymphadenopathy	Bronchoscopy
Tuberculosis	+	+	+	Restrictive, obstructive, or mixed	Wheezing, rhonchi, crackles	+	↑WBC	↓O2, ↑CO2	Patchy consolidation, nodular opacities	IFN-y assay and acid fast stain
Emphysema	+	+	-	↓ FEV1/FVC	Wheezing	-	Normal	Respiratory alkalosis, Metabolic acidosis	Flat diaphragm	Physical exam, spirometry
Asthma	+	+	-	↓ FEV1/FVC	Wheezing	-	↑ Eosinophil	Respiratory alkalosis, Metabolic acidosis	Normal	Physical exam, spirometry before and after bronchodilator
Interstitial lung diseases	+	+	-	↑ FEV1/FVC	Wheezing, rhonchi, crackles	+/-	Normal	↓O2, ↑CO2	Peripheral pulmonary infiltrative opacification	HRCT
Sarcoidosis	+	+	-	↑ FEV1/FVC	Crackles	+	Normal	↓O2, ↑CO2	Hilar adenopathy	HRCT
Pneumonia	+	+	+	Normal	Wheezing, rhonchi, crackles	+	↑WBC, neutrophilia	Normal	Lobar consolidation	CXR, CT Scan