Bornholm disease differential diagnosis: Difference between revisions
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{{CMG}}; '''Associate Editor(s)-in-Chief:''' Arooj Naz | {{CMG}}; '''Associate Editor(s)-in-Chief:''' [[User:AroojNaz|Arooj Naz]] | ||
==Overview== | ==Overview== | ||
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Symptoms include: | Symptoms include: | ||
* [[Chest pain]] that radiates to the extremities, back or jaw | *[[Chest pain]] that radiates to the extremities, back or jaw | ||
* [[Nausea and vomiting|Nausea]], [[Nausea and vomiting|vomiting]], [[epigastric pain]] | *[[Nausea and vomiting|Nausea]], [[Nausea and vomiting|vomiting]], [[epigastric pain]] | ||
* [[Dyspnea]] | *[[Dyspnea]] | ||
* [[Palpitations]] and [[sweating]] | *[[Palpitations]] and [[sweating]] | ||
| | | | ||
* Useful tests to rule out [[ACS]] include [[ECG]] and [[cardiac biomarkers]] | *Useful tests to rule out [[ACS]] include [[ECG]] and [[cardiac biomarkers]] | ||
* A personal history of significant medical conditions such as [[hypertension]], [[hyperlipidemia]] and [[diabetes]] may also assist in diagnosing the disease | *A personal history of significant medical conditions such as [[hypertension]], [[hyperlipidemia]] and [[diabetes]] may also assist in diagnosing the disease | ||
|- | |- | ||
|[[Aortic dissection]]/ [[Aortic aneurysm|Ruptured aortic aneurysm]] | |[[Aortic dissection]]/ [[Aortic aneurysm|Ruptured aortic aneurysm]] | ||
|<br /> | |<br /> | ||
* Severe and sudden [[chest pain]] that radiates to the extremities, back or jaw | *Severe and sudden [[chest pain]] that radiates to the extremities, back or jaw | ||
* [[Dyspnea]] | *[[Dyspnea]] | ||
* [[Syncope]] | *[[Syncope]] | ||
* Upon examination, unequal [[blood pressure]] in the arms may be noticed as well as [[aortic regurgitation]] | *Upon examination, unequal [[blood pressure]] in the arms may be noticed as well as [[aortic regurgitation]] | ||
| | | | ||
* [[Chest X-ray]] can be used to rule out aortic dissections | *[[Chest X-ray]] can be used to rule out aortic dissections | ||
|- | |- | ||
|[[Pulmonary embolism]] (PE) | |[[Pulmonary embolism]] (PE) | ||
| | | | ||
* [[Chest pain]] | *[[Chest pain]] | ||
* [[Dyspnea]] | *[[Dyspnea]] | ||
* Upon examination, [[tachycardia]] is a common finding | *Upon examination, [[tachycardia]] is a common finding | ||
| | | | ||
* PE can be confirmed using a [[Chest X-ray|chest x-ray]]. In cases of high suspicion despite an inadequate [[Wells score for PE (original)|Wells score]], [[D-dimer]] can be done | *PE can be confirmed using a [[Chest X-ray|chest x-ray]]. In cases of high suspicion despite an inadequate [[Wells score for PE (original)|Wells score]], [[D-dimer]] can be done | ||
* Conditions such as [[pregnancy]], ongoing [[malignancy]], a recent history of [[surgery]] or inability to ambulate may increase the risk of PE | *Conditions such as [[pregnancy]], ongoing [[malignancy]], a recent history of [[surgery]] or inability to ambulate may increase the risk of PE | ||
|- | |- | ||
|[[Tension pneumothorax]] | |[[Tension pneumothorax]] | ||
| | | | ||
* Sharp [[chest pain]] | *Sharp [[chest pain]] | ||
* Difficulty [[breathing]] | *Difficulty [[breathing]] | ||
* Increased work of [[breathing]] | *Increased work of [[breathing]] | ||
* [[Anxiety]] | *[[Anxiety]] | ||
| | | | ||
* A [[Chest X-ray|chest x-ray]] shows absent [[lung]] markings, white [[Pleural cavity|pleural]] lines, and [[Mediastinum|mediastinal]] shift to the opposite side | *A [[Chest X-ray|chest x-ray]] shows absent [[lung]] markings, white [[Pleural cavity|pleural]] lines, and [[Mediastinum|mediastinal]] shift to the opposite side | ||
|- | |- | ||
|[[Pneumonia]] | |[[Pneumonia]] | ||
| | | | ||
* [[Chest pain]] | *[[Chest pain]] | ||
* [[Dyspnea]] | *[[Dyspnea]] | ||
* Accompanying [[fever]] | *Accompanying [[fever]] | ||
| | | | ||
* Requires a [[Chest X-ray|chest x-ray]] to rule out [[pneumonia]] | *Requires a [[Chest X-ray|chest x-ray]] to rule out [[pneumonia]] | ||
* CBC findings: [[leukocytosis]] | *CBC findings: [[leukocytosis]] | ||
|- | |- | ||
|[[Pleurisy]]/ [[Pleuritis]] | |[[Pleurisy]]/ [[Pleuritis]] | ||
| | | | ||
* [[Chest pain]] worse on palpation and inspiration. OFten radiates to the arm and or back | *[[Chest pain]] worse on palpation and inspiration. OFten radiates to the arm and or back | ||
* [[Dyspnea]] | *[[Dyspnea]] | ||
| | | | ||
* [[Chest X-ray]] can be used to rule out [[pleuritis]] | *[[Chest X-ray]] can be used to rule out [[pleuritis]] | ||
* [[ESR]] may also be elevated | *[[ESR]] may also be elevated | ||
|- | |- | ||
|[[Acute appendicitis]] | |[[Acute appendicitis]] | ||
| | | | ||
* Periumibilical that eventually radiates to the [[right iliac fossa]] ([[McBurney's point|McBurney's]] point) | *Periumibilical that eventually radiates to the [[right iliac fossa]] ([[McBurney's point|McBurney's]] point) | ||
* Loss of appetite | *Loss of appetite | ||
* [[Fever]] | *[[Fever]] | ||
* [[Nausea]] or [[vomiting]] | *[[Nausea]] or [[vomiting]] | ||
| | | | ||
* Elevated [[Leukocytosis|leukocyte]] count | *Elevated [[Leukocytosis|leukocyte]] count | ||
* [[CT scan]] | *[[CT scan]] | ||
* [[MRI]] for [[pregnant]] patients | *[[MRI]] for [[pregnant]] patients | ||
|- | |- | ||
|[[Pancreatitis]] | |[[Pancreatitis]] | ||
| | | | ||
* Severe upper [[abdominal pain]] that may be worse after meals, especially those with a high-fat content, exacerbated by lying [[supine]], radiation to the [[back]] or [[shoulder]] | *Severe upper [[abdominal pain]] that may be worse after meals, especially those with a high-fat content, exacerbated by lying [[supine]], radiation to the [[back]] or [[shoulder]] | ||
* [[Nausea]], [[vomiting]], [[diarrhea]] and [[loss of appetite]] | *[[Nausea]], [[vomiting]], [[diarrhea]] and [[loss of appetite]] | ||
* [[Fever]] / [[Chills]] | *[[Fever]] / [[Chills]] | ||
| | | | ||
* [[Amylase]]/ [[Lipase]] levels will be elevated | *[[Amylase]]/ [[Lipase]] levels will be elevated | ||
* [[Ultrasonography]] and [[CT scan]] can be helpful in diagnosis, although their use in acute conditions has been debated | *[[Ultrasonography]] and [[CT scan]] can be helpful in diagnosis, although their use in acute conditions has been debated | ||
|- | |- | ||
|[[Cholecystitis]] | |[[Cholecystitis]] | ||
| | | | ||
* Episodes of upper [[abdominal pain]] | *Episodes of upper [[abdominal pain]] | ||
* [[Nausea and vomiting]] | *[[Nausea and vomiting]] | ||
* [[Diarrhea]] | *[[Diarrhea]] | ||
| | | | ||
* [[Leukocytosis]] | *[[Leukocytosis]] | ||
* Elevated [[CRP]] | *Elevated [[CRP]] | ||
* Elevated [[Alkaline Phosphatase|alkaline phosphate]] | *Elevated [[Alkaline Phosphatase|alkaline phosphate]] | ||
* [[Hyperbilirubinemia]] | *[[Hyperbilirubinemia]] | ||
* The definitive diagnosis is with [[Ultrasonography]]. If negative, [[HIDA scan]] is done | *The definitive diagnosis is with [[Ultrasonography]]. If negative, [[HIDA scan]] is done | ||
|- | |- | ||
|[[Costochondritis]] | |[[Costochondritis]] | ||
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* [[Chest pain]] worsened upon palpation and with movement | *[[Chest pain]] worsened upon palpation and with movement | ||
* [[Dyspnea]] | *[[Dyspnea]] | ||
| | | | ||
* [[Chest X-ray]] | *[[Chest X-ray]] | ||
* [[ESR]] may also be elevated | *[[ESR]] may also be elevated | ||
|- | |- | ||
|[[Guillain-Barré syndrome|Guillain-Barré Syndrome]]<ref name="pmid322960052">{{cite journal| author=Orimo K, Hatano K, Sato N, Okabe S, Suzuki A, Mori K | display-authors=etal| title=Clinical Characteristics of Epidemic Myalgia Associated with Human Parechovirus Type 3 during the Summer of 2019. | journal=Intern Med | year= 2020 | volume= 59 | issue= 14 | pages= 1721-1726 | pmid=32296005 | doi=10.2169/internalmedicine.4416-20 | pmc=7434534 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32296005 }}</ref> | |[[Guillain-Barré syndrome|Guillain-Barré Syndrome]]<ref name="pmid322960052">{{cite journal| author=Orimo K, Hatano K, Sato N, Okabe S, Suzuki A, Mori K | display-authors=etal| title=Clinical Characteristics of Epidemic Myalgia Associated with Human Parechovirus Type 3 during the Summer of 2019. | journal=Intern Med | year= 2020 | volume= 59 | issue= 14 | pages= 1721-1726 | pmid=32296005 | doi=10.2169/internalmedicine.4416-20 | pmc=7434534 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32296005 }}</ref> | ||
| | | | ||
* Symmetrical ascending weakness and [[paralysis]] | *Symmetrical ascending weakness and [[paralysis]] | ||
* [[Paresthesia]] | *[[Paresthesia]] | ||
* [[Areflexia]] | *[[Areflexia]] | ||
| | | | ||
* [[Nerve conduction studies]]: Axonal or demyelinating neuropathy seen in GBS; results are normal in Bornholm | *[[Nerve conduction studies]]: Axonal or demyelinating neuropathy seen in GBS; results are normal in Bornholm | ||
|} | |} | ||
Revision as of 06:02, 2 March 2022
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Bornholm disease Microchapters |
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Bornholm disease differential diagnosis On the Web |
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American Roentgen Ray Society Images of Bornholm disease differential diagnosis |
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Risk calculators and risk factors for Bornholm disease differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Arooj Naz
Overview
Bornholm Disease has been referred to by various different names, some of which include Devil's Grip, epidemic pleurodynia and epidemic myalgia, to name a few. Apart from the plethora of names presenting possible difficulty in its recognition, it is often a diagnosis that is not part of the initial differential diagnosis' when a patient presents with chest pain. Because of the possibility of life-threatening conditions presenting with similar pain, it often requires extensive workup to exclude other diseases in medical settings.
Differential Diagnosis
Bornholm disease presents with acute chest and or abdominal pain and requires a high degree of suspicion for diagnosis. The disease presents with a. clinical syndrome that can appear to mimic inflammation or injury of any organ within the thorax or abdomen and thus requires differentiation.[1]
| Condition | Common Presenting Symptoms | Workup to differentiate conditions from Bornholm Disease |
|---|---|---|
| Acute Coronary syndromes (ACS) | ACS is a spectrum of cardiac conditions that include angina, STEMI and NSTEMI.
Symptoms include:
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| Aortic dissection/ Ruptured aortic aneurysm |
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| Pulmonary embolism (PE) |
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| Tension pneumothorax |
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| Pneumonia |
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| Pleurisy/ Pleuritis |
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| Acute appendicitis |
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| Pancreatitis |
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| Cholecystitis |
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| Costochondritis |
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| Guillain-Barré Syndrome[2] |
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References
- ↑ 1.0 1.1 Lal A, Akhtar J, Isaac S, Mishra AK, Khan MS, Noreldin M; et al. (2018). "Unusual cause of chest pain, Bornholm disease, a forgotten entity; case report and review of literature". Respir Med Case Rep. 25 ( ): 270–273. doi:10.1016/j.rmcr.2018.10.005. PMC 6197799. PMID 30364740.
- ↑ Orimo K, Hatano K, Sato N, Okabe S, Suzuki A, Mori K; et al. (2020). "Clinical Characteristics of Epidemic Myalgia Associated with Human Parechovirus Type 3 during the Summer of 2019". Intern Med. 59 (14): 1721–1726. doi:10.2169/internalmedicine.4416-20. PMC 7434534 Check
|pmc=value (help). PMID 32296005 Check|pmid=value (help).