Wheeze differential diagnosis

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Etiology on the basis of anatomy	Diseases	Clinical manifestations								Diagnosis					Other features
		Symptoms					Physical exam					Imaging
		Onset	Cough	Dyspnea	Fever	Slurred speech	Cyanosis	Clubbing	Auscultation	Labs	Pulmonary function testing	Chest imaging	Other	Gold standard
Extrathoracic upper airway diseases	Laryngeal edema (Anaphylaxis)	Acute	-	✔	-	✔	✔	-	Hoarseness Stridor	High levels of serum tryptase Incrieased levels of plasma histamine Sking test	Not specific	Not required	Not required	Acute onset with one of them: Respiratory compromised Reduced blood pressure (BP) Two or more after the exposure to a likely allergern Respiratory compromised Reduced BP Gastrointestinalsymptoms Skin-mucosal involment BP reduced after exposure of a known allergen Adult BP systolic<90 mmHg Children: Low systolic BP	Nasal discharge, altered mental status, redness and hives of the skin Common allergens: food, insect stings, biologic materials, natural rubber latex, etc
	Cricoarytenoid arthritis	Acute	✔	✔	-	✔	-	-	Hoarseness Stridor	Test for Rheumatoid arthritis	Forced inspiratory flowdecreased Forced expiratory flowdecreased	Clear chest	Hyperdense intra-articular sclerotic cricoid and arytenoid cartilages in CT ^[1]	Direct laryngoscopy	Cartilageerosion can lead on joint luxation and inmovilization of the cord^[1]
	Vocal fold edema/Hematoma/Paralysis^[2]	Acute	✔	✔	-	✔	-	-	Hoarseness Short breathing	Not specific	Variable	Clear chest	Not required	Laryngoscopy	Associated to neck surgery
	Paradoxical vocal fold motion	Acute	✔	✔	-	✔	-	-	Inspiratory stridor	Hypercapnia in Arterial blood gaseswhen distress is severe	Forced insiparatory flowdecrease but normal between episodes^[3]	Clear chest	CT and Color flow Dopplerto rule out other diseases^[4]	Abnormal adduction of vocal fold visualized inLaryngoscopy	Throat tightness, choking sensation Associated to exercise, asthma, postextubation, etc^[5]
	Laryngeal stenosis^[6]	Acute, Chronic	✔	✔	-	✔	✔	-	Glottic or supraglottic: Inspiratory stridor Glottisthrough trachea: Biphasic stridor	Not specific	FV loop variable	Clear chest	Stenosis visualized in neck x-ray	Palpation of arytenoidfor passive mobility and laryngoscopy^[7]	History of neck trauma or intubation
	Laryngocele	Chronic	✔	✔	-	-	-	-	Inspiratory stridor Hoarseness	Not specific	Normal function	Clear chest	Cyst wiht liquid or air content in ultrasound, radiography or CT	Smooth swelling visualized in laryngoscopy ^[8]	Dysphagia, laryngeal discomfort Usually asymptomati
	Epiglottitis (supraglottitis)	Acute	-	✔	✔	✔	-	-	Hoarseness Stridor	Elevated white blood count Epiglottal culture	Normal function	Clear chest	More than 8 mm of size epiglottal and distend hypopharynx in neck x-ray	Laryngoscopy where is visualizd a edematous epiglottis^[9]	Tripod posture Drooling Tenderness of the anterior part of the neck
	Goiter	Chronic	✔	✔	-	-	-	-	Stridor	Thyroid function tests: TSH, T3 and T4 Thyroid peroxide antibodies :TPO	Airflow limitation of the volume loop depend on the size and localization ^[10]	Substernal Goiter causes a deviation of the trachea	CT can be performed to visualized the cervical and substernal Gotier and its extention^[11]	Physical examination	Iodine deficiency is the most common cause ^[12]
	Postnasal drip syndrome	Acute	✔	✔	-	-	-	-	Stridor	Elevated eosinophils Increase of IgE Positive intradermic test^[13]	Normal response to bronchoprovocation Variable FV loop	Clear chest	Sinus CT	Clinical diagnosis	Nasal congestion Rhinorrhea
	Relapsing polychondritis	Acute	✔	✔	✔	-	-	-	Hoarseness Aphonia Inspiratory stridor	Leukocytosis or thrombocytosis Positive antinuclear antibodies ( ANA) and ANCA	Variable flow volume loop	Tracheal narrowing Cartilaginous calicification, bronchial Wall thickness and tracheal narrowing observed in CT MRI can distinguish fibrosis from inflammation	Cartilaginous calicification, bronchial wall thickness and tracheal narrowing observed in CT ^[14] MRI can distinguish fibrosis from inflammation	Mc Adam criteria: ^[15] Ear bilateral chondritis Seronegative inflammatory polyarthritis Respiratory tract chondritirs Coclear or vestibular dysfunction Ocular inflamation	Involment of cartilage, ears, ribs. nose and eyes
	Retropharyngeal abscess	Subacute	-	✔	✔	✔	-	-	Stridor Tachypnea	Increased of white blood cell count Aerobic and anaerobic blood cultures^[16]	Normal function	Lateral chest x-ray to determine the extension of the abscess	Increased vertebral space in lateral neck x-ray Cervical lordosis and gas collection in retropharyngeal space in neck CT with intravenous contrast	Neck CT or presence of pus during the surgical procedure ^[17]	Pain with neck extension Dysphagia Head in sniffing position
	Tonsillar hypertrophy	Acute, chronic	-	✔	-	✔ hyponasal speech	-	-	Stridor	Not specific	Flow loop shows inspiratory slowing	Clear chest	Not required	Direct visualization of enlarged tonsils in oropharyngeal exam ^[18]	More in children and adolescents
	Tumor of pharynx/larynx/upper trachea	Chronic	✔	✔	-	-	-	-	Stridor Hoarseness	Not specific	Flow loop shows inspiratory slowing	Not requered	CT provide information of the grade of invation MRI can make a difference between tumors in the mucos or bone marrow ^[19]	Fine needle aspiration biopsy	Risk factor: Tobacco and HPV infections
Central airway diseases (Intrathoracic upper airway obstruction)	Mediastinal mass/lymphadenopathy	Chronic	✔	✔	✔	-	-	-	Stridor Hoarseness	Anti-acetylcholine receptor antibodies present in thymic tumors High levels of AFP and beta-hCG present in germ cell tumors Increased lactate dehydrogenase in Seminomas	Expiratory flow rate decreased ^[20]	Size, location and density of the mass can be observed	In chest CT is observed location, size, tissue characteristic and relationship with other structures of the mass Information of posterior mediastinal mass can be provided in chest or spine MRI ^[21]	Chest CT
	Respiratory papillomatosis
	Tracheobronchomalacia
	Tracheal stenosis
	Tracheal and bronchial tumors
	Vascular ring or aneurysm
Lower airway obstruction	Bronchiectasis
	Bronchiolitis
	Carcinoid syndrome
	Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH)
	Heart failure
	Noncardiogenic pulmonary edema
	Parasitic infection with VLM (eg, Ascaris Strongyloides, filaria)
	Pulmonary thromboembolism
	Reactive airways dysfunction syndrome
	Tracheobronchomalacia

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References

↑ ^1.0 ^1.1 Greco A, Fusconi M, Macri GF, Marinelli C, Polettini E, Benincasa AT, de Vincentiis M (2012). "Cricoarytenoid joint involvement in rheumatoid arthritis: radiologic evaluation". Am J Otolaryngol. 33 (6): 753–5. doi:10.1016/j.amjoto.2012.06.004. PMID 22884484.
↑ Ishman SL, Halum SL, Patel NJ, Kerschner JE, Merati AL (October 2006). "Management of vocal paralysis: a comparison of adult and pediatric practices". Otolaryngol Head Neck Surg. 135 (4): 590–4. doi:10.1016/j.otohns.2006.04.014. PMID 17011423.
↑ Forrest LA, Husein T, Husein O (April 2012). "Paradoxical vocal cord motion: classification and treatment". Laryngoscope. 122 (4): 844–53. doi:10.1002/lary.23176. PMID 22434681.
↑ Nastasi KJ, Howard DA, Raby RB, Lew DB, Blaiss MS (June 1997). "Airway fluoroscopic diagnosis of vocal cord dysfunction syndrome". Ann. Allergy Asthma Immunol. 78 (6): 586–8. doi:10.1016/S1081-1206(10)63220-6. PMID 9207723.
↑ Chiang T, Marcinow AM, deSilva BW, Ence BN, Lindsey SE, Forrest LA (March 2013). "Exercise-induced paradoxical vocal fold motion disorder: diagnosis and management". Laryngoscope. 123 (3): 727–31. doi:10.1002/lary.23654. PMID 23097011.
↑ Nair S, Nilakantan A, Sood A, Gupta A, Gupta A (September 2016). "Challenges in the Management of Laryngeal Stenosis". Indian J Otolaryngol Head Neck Surg. 68 (3): 294–9. doi:10.1007/s12070-015-0936-2. PMC 4961642. PMID 27508129.
↑ Bogdasarian RS, Olson NR (1980). "Posterior glottic laryngeal stenosis". Otolaryngol. Head Neck Surg. 88 (6): 765–72. PMID 7208045.
↑ Chu L, Gussack GS, Orr JB, Hood D (April 1994). "Neonatal laryngoceles. A cause for airway obstruction". Arch. Otolaryngol. Head Neck Surg. 120 (4): 454–8. PMID 8166980.
↑ Glynn F, Fenton JE (May 2008). "Diagnosis and management of supraglottitis (epiglottitis)". Curr Infect Dis Rep. 10 (3): 200–4. PMID 18510881.
↑ Al-Bazzaz F, Grillo H, Kazemi H (May 1975). "Response to exercise in upper airway obstruction". Am. Rev. Respir. Dis. 111 (5): 631–40. doi:10.1164/arrd.1975.111.5.631. PMID 1130755.
↑ Bashist B, Ellis K, Gold RP (March 1983). "Computed tomography of intrathoracic goiters". AJR Am J Roentgenol. 140 (3): 455–60. doi:10.2214/ajr.140.3.455. PMID 6600532.
↑ Knudsen N, Perrild H, Christiansen E, Rasmussen S, Dige-Petersen H, Jørgensen T (March 2000). "Thyroid structure and size and two-year follow-up of solitary cold thyroid nodules in an unselected population with borderline iodine deficiency". Eur. J. Endocrinol. 142 (3): 224–30. PMID 10700715.
↑ Yu L, Xu X, Lv H, Qiu Z (May 2015). "Advances in upper airway cough syndrome". Kaohsiung J. Med. Sci. 31 (5): 223–8. doi:10.1016/j.kjms.2015.01.005. PMID 25910556.
↑ Behar JV, Choi YW, Hartman TA, Allen NB, McAdams HP (January 2002). "Relapsing polychondritis affecting the lower respiratory tract". AJR Am J Roentgenol. 178 (1): 173–7. doi:10.2214/ajr.178.1.1780173. PMID 11756115.
↑ McAdam LP, O'Hanlan MA, Bluestone R, Pearson CM (May 1976). "Relapsing polychondritis: prospective study of 23 patients and a review of the literature". Medicine (Baltimore). 55 (3): 193–215. PMID 775252.
↑ Knorr TL, Sinha V. PMID 28722903. Missing or empty |title= (help)
↑ Lazor JB, Cunningham MJ, Eavey RD, Weber AL (December 1994). "Comparison of computed tomography and surgical findings in deep neck infections". Otolaryngol Head Neck Surg. 111 (6): 746–50. doi:10.1177/019459989411100608. PMID 7991254.
↑ Jazi SM, Barati B, Kheradmand A (December 2011). "Treatment of adenotonsillar hypertrophy: A prospective randomized trial comparing azithromycin vs. fluticasone". J Res Med Sci. 16 (12): 1590–7. PMC 3434901. PMID 22973368.
↑ "CDC - Head and Neck Cancers".
↑ Shamberger RC, Holzman RS, Griscom NT, Tarbell NJ, Weinstein HJ, Wohl ME (September 1995). "Prospective evaluation by computed tomography and pulmonary function tests of children with mediastinal masses". Surgery. 118 (3): 468–71. PMID 7652680.
↑ Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L (February 2013). "A diagnostic approach to the mediastinal masses". Insights Imaging. 4 (1): 29–52. doi:10.1007/s13244-012-0201-0. PMC 3579993. PMID 23225215.

Template:WH Template:WS

[pmid22884484-1] 1.0 ^1.1 Greco A, Fusconi M, Macri GF, Marinelli C, Polettini E, Benincasa AT, de Vincentiis M (2012). "Cricoarytenoid joint involvement in rheumatoid arthritis: radiologic evaluation". Am J Otolaryngol. 33 (6): 753–5. doi:10.1016/j.amjoto.2012.06.004. PMID 22884484.

[pmid17011423-2] Ishman SL, Halum SL, Patel NJ, Kerschner JE, Merati AL (October 2006). "Management of vocal paralysis: a comparison of adult and pediatric practices". Otolaryngol Head Neck Surg. 135 (4): 590–4. doi:10.1016/j.otohns.2006.04.014. PMID 17011423.

[pmid22434681-3] Forrest LA, Husein T, Husein O (April 2012). "Paradoxical vocal cord motion: classification and treatment". Laryngoscope. 122 (4): 844–53. doi:10.1002/lary.23176. PMID 22434681.

[pmid9207723-4] Nastasi KJ, Howard DA, Raby RB, Lew DB, Blaiss MS (June 1997). "Airway fluoroscopic diagnosis of vocal cord dysfunction syndrome". Ann. Allergy Asthma Immunol. 78 (6): 586–8. doi:10.1016/S1081-1206(10)63220-6. PMID 9207723.

[pmid23097011-5] Chiang T, Marcinow AM, deSilva BW, Ence BN, Lindsey SE, Forrest LA (March 2013). "Exercise-induced paradoxical vocal fold motion disorder: diagnosis and management". Laryngoscope. 123 (3): 727–31. doi:10.1002/lary.23654. PMID 23097011.

[pmid27508129-6] Nair S, Nilakantan A, Sood A, Gupta A, Gupta A (September 2016). "Challenges in the Management of Laryngeal Stenosis". Indian J Otolaryngol Head Neck Surg. 68 (3): 294–9. doi:10.1007/s12070-015-0936-2. PMC 4961642. PMID 27508129.

[pmid7208045-7] Bogdasarian RS, Olson NR (1980). "Posterior glottic laryngeal stenosis". Otolaryngol. Head Neck Surg. 88 (6): 765–72. PMID 7208045.

[pmid8166980-8] Chu L, Gussack GS, Orr JB, Hood D (April 1994). "Neonatal laryngoceles. A cause for airway obstruction". Arch. Otolaryngol. Head Neck Surg. 120 (4): 454–8. PMID 8166980.

[pmid18510881-9] Glynn F, Fenton JE (May 2008). "Diagnosis and management of supraglottitis (epiglottitis)". Curr Infect Dis Rep. 10 (3): 200–4. PMID 18510881.

[pmid1130755-10] Al-Bazzaz F, Grillo H, Kazemi H (May 1975). "Response to exercise in upper airway obstruction". Am. Rev. Respir. Dis. 111 (5): 631–40. doi:10.1164/arrd.1975.111.5.631. PMID 1130755.

[pmid6600532-11] Bashist B, Ellis K, Gold RP (March 1983). "Computed tomography of intrathoracic goiters". AJR Am J Roentgenol. 140 (3): 455–60. doi:10.2214/ajr.140.3.455. PMID 6600532.

[pmid10700715-12] Knudsen N, Perrild H, Christiansen E, Rasmussen S, Dige-Petersen H, Jørgensen T (March 2000). "Thyroid structure and size and two-year follow-up of solitary cold thyroid nodules in an unselected population with borderline iodine deficiency". Eur. J. Endocrinol. 142 (3): 224–30. PMID 10700715.

[pmid25910556-13] Yu L, Xu X, Lv H, Qiu Z (May 2015). "Advances in upper airway cough syndrome". Kaohsiung J. Med. Sci. 31 (5): 223–8. doi:10.1016/j.kjms.2015.01.005. PMID 25910556.

[pmid11756115-14] Behar JV, Choi YW, Hartman TA, Allen NB, McAdams HP (January 2002). "Relapsing polychondritis affecting the lower respiratory tract". AJR Am J Roentgenol. 178 (1): 173–7. doi:10.2214/ajr.178.1.1780173. PMID 11756115.

[pmid775252-15] McAdam LP, O'Hanlan MA, Bluestone R, Pearson CM (May 1976). "Relapsing polychondritis: prospective study of 23 patients and a review of the literature". Medicine (Baltimore). 55 (3): 193–215. PMID 775252.

[pmid28722903-16] Knorr TL, Sinha V. PMID 28722903. Missing or empty |title= (help)

[pmid7991254-17] Lazor JB, Cunningham MJ, Eavey RD, Weber AL (December 1994). "Comparison of computed tomography and surgical findings in deep neck infections". Otolaryngol Head Neck Surg. 111 (6): 746–50. doi:10.1177/019459989411100608. PMID 7991254.

[pmid22973368-18] Jazi SM, Barati B, Kheradmand A (December 2011). "Treatment of adenotonsillar hypertrophy: A prospective randomized trial comparing azithromycin vs. fluticasone". J Res Med Sci. 16 (12): 1590–7. PMC 3434901. PMID 22973368.

[urlCDC_-_Head_and_Neck_Cancers-19] "CDC - Head and Neck Cancers".

[pmid7652680-20] Shamberger RC, Holzman RS, Griscom NT, Tarbell NJ, Weinstein HJ, Wohl ME (September 1995). "Prospective evaluation by computed tomography and pulmonary function tests of children with mediastinal masses". Surgery. 118 (3): 468–71. PMID 7652680.

[pmid23225215-21] Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L (February 2013). "A diagnostic approach to the mediastinal masses". Insights Imaging. 4 (1): 29–52. doi:10.1007/s13244-012-0201-0. PMC 3579993. PMID 23225215.

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Wheeze differential diagnosis

References

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