Dyspnea differential diagnosis

Revision as of 21:37, 13 February 2018 by Eiman (talk | contribs)
Jump to navigation Jump to search

Dyspnea Microchapters

Patient Information

Overview

Pathophysiology

Causes

Differentiating Dyspnea from other Diseases

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Differential Diagnosis

  • Air hunger - the sensation of an urgent need to breathe, sensation that you cannot take in a full breath
  • Tachypnea - breathing rapidly
  • Bradypnea - breathing slowly
  • Eupnea - normal unlabored breathing
  • Orthopnea - dyspnea that occurs with lying flat
  • Trepopnea - an abnormal awareness of one's own breathing that is seen in one lateral position but not in the other
  • Paroxysmal nocturnal dyspnea - sudden, severe shortness of breath at night that awakens a person from sleep, often with coughing and wheezing.

 Shortness of breath/Dyspnea

Differential diagnosis[1]

[2]

[3]

[4]

[5]

Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Loss of consciousness Agitation Weight loss Fever Chest pain Cough Cyanosis Clubbing JVD Peripheral edema Auscultation CBC ABG Imaging Spirometry Gold standard
Acute Dyspnea Respiratory system Head and Neck,

Upper airway

Angioedema - - - - - +/- - +/- - ++ Normal Normal ↓O2, ↑CO2 Normal ↓Vt, ↑RV Physical exam Generalized edema
Anaphylaxis + + - +/- - - +/- - - - Scattered wheeze Normal Normal Normal ↓Vt, ↑RV Vital sign Type 1 hypersensitivity
Aspiration - + - - +/- + + - - - Diminished breath sounds Normal Normal Atelectasis ↓Vt, ↑RV Bronchoscopy Choking
Croup - + - +/- - + + - - - Stridor ↑WBC Normal Steeple sign Normal Physical exam Barking cough
Epiglottitis - + - + - + - - - - Stridor ↑WBC Normal Thumb sign Normal Laryngoscopy Drooling
Rhinosinusitis - - - + - +/- - - - - Normal ↑WBC Normal Sinus inflammation Normal Physical exam Headache
Vocal cord dysfunction - - - - - +/- - - - - Stridor Normal Normal Normal ↓ FVC Laryngoscopy Choking sensation
Chest and Pleura,

Lower airway

Asthma attack - + - - +/- + + - - - Wheeze ↑ Eosinophil Respiratory alkalosis Normal ↓ FEV1/FVC Physical exam and

Spirometry

Chest pain
Bronchitis - - - + + + - - - - Rhonchi  ↑WBC Normal Normal Normal Physical exam Rhonchi relieved by cough
Bronchospasm +/- + - - + +/- + - - - Wheeze Normal ↓O2, ↑CO2 Normal ↓Vt, ↑RV Physical exam Allergic reaction
Bronchiolitis - - - + +/- + - - - - Wheeze and Crackles ↑WBC Normal Bronchovascular markings ↓Vt Clinical assessment Respiratory syncytial virus (RSV)
COPD exacerbation - + - + + + + - - - Wheeze, Rhonchi, and Crackles ↑WBC, ↑RBC Respiratory alkalosis Hyperexpansion ↓ FEV1/FVC Clinical assessment Acute exacerbations of chronic bronchitis (AECB)
Lung carcinoma - - + - - + + + - - Wheeze and Crackles Normal Normal Mass lesion, hilar lymphadenopathy ↓Vt, ↑RV Bronchoscopy  SIADH
Pneumonia - - - + + + - - - - Wheeze, Rhonchi, and Crackles ↑WBC, neutrophilia Normal Lobar consolidation Normal Chest X-ray productive cough
Pneumothorax - - - - + - - - +/- - Diminished breath sounds Normal ↓O2, ↑CO2 Radiolucency without lung marking ↓Vt Chest CT scan Tracheal deviation
Pulmonary embolism - - - - + - - - - - Normal Normal Respiratory alkalosis Normal Normal Pulmonary CT angiography Pleuritic chest pain
Rib fractures (flail chest) - + - - + - - - - - Normal Normal Respiratory acidosis Broken rib Normal Chest X-ray Pneumothorax
Cardiovascular system Acute myocardial ischemia +/- + - +/- + - - - - - Normal Normal Normal Normal Normal Cardiac troponin I Nausea and vomiting
Acute heart failure +/- + - - +/- + + - + + S3 Normal Respiratory alkalosis ↑ Cardiothoracic ratio ↓Vt B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) Excessive sweating, high blood pressure
Pericardial tamponade +/- - - - + - - - + - Muffled heart sounds Normal Normal Water bottle appearance enlarged heart Normal Echocardiography Fluid accumulation in pericardium
Tachyarrhythmia - + - - +/- - - - - - High pulse rate Normal Normal Normal Normal ECG Palpitation
Pulmonary edema +/- + - + + + + + + + Basal crackle Normal Respiratory alkalosis Bat wing pattern, air bronchograms ↓Vt, ↑RV Lung ultrasound Tachypnea
Central nervous system Stroke + - - +/- - - - - - - Normal Normal Normal Intracranial infarct or hemorrhage Normal Brain MRI Paralysis or paresthesia
Encephalitis + + - + - - - - - - Normal ↑WBC, neutrophilia Normal Normal Normal CSF PCR Confusion
Traumatic brain injury + +/- - - - - - - - - Normal Normal Respiratory acidosis Intracerebral hemorrhage Normal Brain CT scan Lucid interval
Toxic/Metabolic Organophosphate poisoning + - - + - - - - - - Wheeze Normal ↓O2, ↑CO2 Normal Normal Blood test Salivation, Lacrimation, Emesis, Miosis
Salicylate poisoning + - - - - - + - - - Normal Normal Metabolic acidosis, Respiratory alkalosis Normal Normal Blood test Vomiting, Tinnitus, Confusion, Hyperthermia
Carbon monoxide poisoning + - - - + + + - - - Wheeze Carboxyhemoglobin ↓O2, ↑CO2 Normal ↓Vt, ↑RV Carboxyhemoglobin (HbCO) level Headache, Dizziness, Weakness, Vomiting, Confusion
Diabetic ketoacidosis + +/- - - - - - - - - Scattered wheeze ↑WBC Metabolic acidosis Normal Normal Blood test (acidosis, hyperglycemia, ketonemia) Vomiting, Abdominal pain, Weakness, Confusion
Systemic Panic attack +/- + - - - - - - - - Normal Normal Normal Normal Normal Clinical assessment Severe anxiety
Pregnancy - - - - +/- - - - - + Normal ↑WBC, RBC ↓O2, ↑CO2 Normal ↓Vt, ↑RV βhCG Hyperemesis
Sepsis +/- - - + - - - - - - Normal ↑WBC, neutrophilia ↓O2, ↑CO2 Normal Normal SIRS criteria Chills, Confusion
Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Loss of consciousness Agitation Weight loss Fever Chest pain Cough Cyanosis Clubbing JVD Peripheral edema Auscultation CBC ABG Imaging PFT Gold standard
Chronic Dyspnea Respiratory system Head and Neck,

Upper airway

Goiter
Laryngeal adenocarcinoma
Vocal cord paralysis
Tracheal stenosis
Chest and Pleura,

Lower airway

Bronchial asthma
Bronchiectasis
COPD
Emphysema
Pulmonary hypertension
Interstitial lung disease
Sarcoidosis
Alveolitis
Bronchiolitis obliterans
Cystic fibrosis
Pleural effusion
Pulmonary right-to-left shunt
Phrenic nerve palsy
Tuberculosis
Cardiovascular system Constrictive pericarditis
Restrictive cardiomyopathy
Valvular heart disease
Bradyarrhythmia
Pericardial effusion
Coronary heart disease
Intracardiac shunt
Neuromuscular disease Amyotrophic lateral sclerosis
Polymyositis/dermatomyositis
Mitochondrial diseases
Glycolytic enzyme defects (e.g., McArdle)
Toxic/Metabolic Metabolic acidosis
Renal failure
Systemic Anemia
Anxiety
Ascites
Depression
Kyphoscoliosis
Obesity
Autoimmune Churg-Strauss syndrome
Microscopic polyangiitis
Wegener's granulomatosis
Goodpasture's disease

References

  1. ↑ Gaggin, Hanna K.; Januzzi, James L. (2013). "Biomarkers and diagnostics in heart failure". Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease. 1832 (12): 2442–2450. doi:10.1016/j.bbadis.2012.12.014. ISSN 0925-4439.
  2. ↑ van Steijn JH, Sleijfer DT, van der Graaf WT, van der Sluis A, Nieboer P (2002). "How to diagnose cardiac tamponade". Neth J Med. 60 (8): 334–8. PMID 12481882.
  3. ↑ Martindale, Jennifer L.; Noble, Vicki E.; Liteplo, Andrew (2013). "Diagnosing pulmonary edema". European Journal of Emergency Medicine. 20 (5): 356–360. doi:10.1097/MEJ.0b013e32835c2b88. ISSN 0969-9546.
  4. ↑ Debiasi RL, Tyler KL (2004). "Molecular methods for diagnosis of viral encephalitis". Clin Microbiol Rev. 17 (4): 903–25, table of contents. doi:10.1128/CMR.17.4.903-925.2004. PMC 523566. PMID 15489354.
  5. ↑ Lane TR, Williamson WJ, Brostoff JM (2008). "Carbon monoxide poisoning in a patient with carbon dioxide retention: a therapeutic challenge". Cases J. 1 (1): 102. doi:10.1186/1757-1626-1-102. PMC 2533003. PMID 18710551.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Dyspnea_differential_diagnosis&oldid=1444163"