Bronchiolitis should be differentiated with other diseases that cause cough and dysnea.
| Diseases
|
Symptoms
|
|
Signs
|
Diagosis
|
| Fever
|
Cough
|
Chest pain
|
Wheezes
|
Crackles
|
Edema
|
Tachycaria
|
Lab tests
|
Imaging
|
| Bronchiolitis
|
+/-
|
Dry
|
-
|
+
|
+
|
-
|
+/-
|
- No specific lab findings
- Viral tests like ELISA and immunoassays may be done in case of RSV infection.
- Pulmonary function test is performed to exclude other lung diseases.
|
- Ct scan shows Intense bronchiolar mural inflammation of cellular bronchiolitis results in centrilobular nodulesthat are usually associated with the tree-in-bud pattern and bronchial wall thickening
|
| Asthma
|
-
|
Dry/Productive
|
-
|
+
|
-
|
|
|
- Lab tests are not specific for asthma but they are performed to exclude other diseases.
- Serum examination shows elevated level of esoinophils due to allergy.
|
- CT scan shows dilated bronchi, bronchial wall thickening and air trapping.
|
| COPD
|
+
|
Productive
|
|
|
|
|
|
|
|
| Bacterial pneumonia
|
+
|
Productive
|
|
|
|
|
|
|
|
| Pulmonary embolism
|
-
|
Bloody
|
+
|
|
|
+
|
|
|
|
| Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia
|
-
|
Dry
|
-
|
+
|
-
|
|
|
- Pulmonary function test shows obstructive lung disease
|
- CT scan shows multiple nodules , ground glass appearance and bronchiectasis.
|
| Tuberculosis
|
+
|
Bloody
|
|
|
|
|
|
|
|
| Interstitial pneumonitis (Hamman - Rich syndrome)
|
+
|
Productive
|
|
|
|
|
|
|
|
| Foreign body aspiration
|
-
|
Dry
|
|
|
|
|
|
|
|
| Sarcoidosis
|
-
|
Dry
|
|
|
|
|
|
|
|
| Pertussis
|
+
|
Dry
|
|
-
|
-
|
|
|
- Nasopharyngeal swab
- Culture
- Serology to detect pertussis toxin.
|
- No remarkable imaging findings.
|
| Congestive heart failure
|
-
|
Dry/Productive
|
+ while walking
|
-
|
-
|
+
|
+
|
- Routine lab tests in order to know the cause of the heart failure:
- Renal function tests including urinalysis and electrolytes assessment
- Complete blood count
- Thyroid studies specially in patients who are being treated with concomitant therapy with an agent such as amiodarone.
- Biomarkers:
- Natriuretic Peptides: BNP or NT-proBNP
- Biomarkers of myocardial Injury: Cardiac Troponin T or I
- Carbohydrate Antigen 125
|
- EKG can be performed to detect the underlaying cause.
- Chest x ray shows cardiomegaly.
- Echocardiography is used to determine the stroke volume and to assess the heart failure.
|
Differential diagnosis of bronchiolitis: Asthma, COPD, sarcoidosis, pneumonia, heart failure, DIPNECH, foreign body inhalation, pulmonary embolism and GERD (in case it is associated with asthma).