Adult bronchiolitis differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Overview

Adult bronchiolitis must be differentiated from other diseases that cause dyspnea, wheezing, and cough, such asthma, emphysema and chronic bronchitis.

Differentiating Adult bronchiolitis from other Diseases

Adult bronchiolitis must be differentiated from other diseases that cause dyspnea, wheezing, and cough, such asthma, emphysema and chronic bronchitis.

Below is a table discussing the differential diagnoses for dyspnea with wheezing

Abbreviations: ABG (arterial blood gas); ACE (angiotensin converting enzyme); BMI (body mass index); CBC (complete blood count); CSF (cerebrospinal fluid); CXR (chest X-ray); ECG (electrocardiogram); FEF (forced expiratory flow rate); FEV1 (forced expiratory volume); FVC (forced vital capacity); JVD (jugular vein distention); MCV (mean corpuscular volume); Plt (platelet); RV (residual volume); SIADH (syndrome of inappropriate antidiuretic hormone); TSH (thyroid stimulating hormone); Vt (tidal volume); WBC (white blood cell);

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

Anaphylaxis[1] +/- + - +/- - - +/- - - - Scattered wheezing Normal Normal Normal N/A Vital sign Type 1 hypersensitivity
Chest and Pleura,

Lower airway

Asthma attack[2] - + - - +/- + + - - - Wheeze Eosinophil Respiratory alkalosis Normal FEV1, PEF Physical exam and

Spirometry

Chest pain
Bronchospasm[3] +/- + - - + +/- + - - - Wheeze Normal O2, ↑CO2 Normal Vt, ↑RV Physical exam Allergic reaction
Bronchiolitis[4] - - - + +/- + - - - - Wheeze and Crackles WBC Normal Bronchovascular markings Vt Clinical assessment Respiratory syncytial virus (RSV)
COPD exacerbation[5] - + - + + + + +/- +/- +/- Wheeze, Rhonchi, and Crackles WBC, ↑RBC Respiratory alkalosis Hyperexpansion FEV1/FVC Clinical assessment Acute exacerbations of chronic bronchitis (AECB)
Lung carcinoma[6] - - + - - + + + - - Wheeze and Crackles Normal Normal Mass lesion, hilar lymphadenopathy Vt, ↑RV Bronchoscopy  Paraneoplastic syndromes, such as SIADH and lambert-Eaton
Pneumonia[7] - - - + + + - - - - Wheeze, Rhonchi, and Crackles WBC, neutrophilia Normal Lobar consolidation Normal Chest X-ray and CT Scan productive cough
Toxic/Metabolic Organophosphate poisoning[8] + - - + - - - - - - Wheeze Normal O2, ↑CO2 Normal Normal Blood test Salivation, Lacrimation, Emesis, Miosis
Carbon monoxide poisoning[9] + - - - + + + - - - Wheeze Carboxyhemoglobin O2, ↑CO2 Normal N/A Carboxyhemoglobin (HbCO) level Headache, Dizziness, Weakness, Vomiting, Confusion
Diabetic ketoacidosis[10] + +/- - - - - - - - - Scattered wheeze, Kussmaul's respiration WBC Metabolic acidosis Normal Normal Blood test (acidosis, hyperglycemia, ketonemia) Vomiting, Abdominal pain, Weakness, 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 Spirometry Gold standard
Chronic Dyspnea Respiratory system Chest and Pleura,

Lower airway

Bronchial asthma[2] - + +/- - +/- + + + - - Wheeze Eosinophil Respiratory alkalosis, Metabolic acidosis Pulmonary hyperinflation,

Bronchial wall thickening

FEV1/FVC Spirometry before and after bronchodilator Paroxysmal respiratory distress
Bronchiectasis[11] - - - + + + + + - - Rhonchi, Wheezing, Crackles WBC, neutrophilia O2, ↑CO2 Tram-track opacities FEV1/FVC High resolution computed tomography (HRCT) Chronic productive cough
COPD[5] - - +/- - - + + + + +/- Expiratory wheeze RBC Respiratory alkalosis, Metabolic acidosis ↑ Bronchovascular markings, Cardiomegaly FEV1/FVC Physical exam and

Spirometry

Heavy smoking history
Emphysema[12] - - - - - +/- + + - - Expiratory wheeze, Hyperinflation Normal Respiratory alkalosis, Metabolic acidosis Flattening of diaphragm, vertical heart FEV1/FVC Physical exam and

Spirometry

Barrel chest
Interstitial lung disease[13] - - - - + + + + - - Rhonchi, Wheezing, Crackles Normal O2, ↑CO2 Peripheral pulmonary infiltrative opacification FEV1/FVC High resolution computed tomography (HRCT) Pneumoconiosis
Bronchiolitis obliterans[4] - - - + + + + + - - Expiratory wheeze WBC O2, ↑CO2 Hyperinflation, Reticulonodular opacities FEV1/FVC Lung biopsy Complication of allogeneic hematopoietic stem cell transplantation
Cystic fibrosis[14] - - + + - +/- + + - - Rhonchi, Wheezing, Crackles Normal Metabolic alkalosis Thick-walled bronchiectasis FEF75%/FVC Sweat test Absent vas deferens
Tuberculosis[15] - - + + + + +/- - - - Rhonchi, Wheezing, Crackles WBC O2, ↑CO2 Patchy consolidation or poorly defined linear and nodular opacities Restrictive, obstructive, or mixed IFN-γ release assay (IGRA)

Acid-fast staining

Night sweat
Neuromuscular disease Mitochondrial diseases[16] - - +/- - - - - - - - Wheeze WBC, Plt Normal Normal Vt, ↑RV Muscle biopsy Muscle pain
Systemic Kyphoscoliosis[17] - - - - - - - - - - Wheeze Normal Normal Deviated vertebral column Vt, ↑RV

(anatomical)

Standing lateral spine radiograph Low back pain
Autoimmune Churg-Strauss syndrome[18] - - - - - + - - - - Scattered wheezing Normal Normal Areas of parenchymal opacification Vt, ↑RV Biopsy  Fatigue,Numbness
Microscopic polyangiitis[19] - - +/- + + - - - - +/- Scattered wheezing WBC O2, ↑CO2 Normal Vt, ↑RV Histological confirmation Skin lesions, Nerve damage
Wegener's granulomatosis[20] - - +/- - - + - - - - Wheezing, Crackles RBC O2, ↑CO2 Cavitate nodules, ground-glass opacity FEV1/FVC Biopsy demonstrating a granulomatous vasculitis Chronic rhinosinusitis

References

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