Caplans syndrome differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Caplans syndrome]]
[[Image:Home_logo1.png|right|250px|link=http://www.wikidoc.org/index.php/Caplans_syndrome]]


 
{{CMG}}; {{AE}}{{SharmiB}}
{{CMG}}; {{AE}}  
==Overview==
==Overview==
[[Caplan's syndrome|Caplan syndrome]] must be differentiated from [[asbestosis]], [[silicosis]], and [[tuberculosis]].
[[Caplan's syndrome|Caplan syndrome]] must be differentiated from [[asbestosis]], [[silicosis]], and [[tuberculosis]].
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*[[Malignancy]] ([[Lung cancer|Primary lung cancer]]<ref name="pmid4353362">{{cite journal |vauthors=Chaudhuri MR |title=Primary pulmonary cavitating carcinomas |journal=Thorax |volume=28 |issue=3 |pages=354–66 |year=1973 |pmid=4353362 |pmc=470041 |doi= |url=}}</ref>)
*[[Malignancy]] ([[Lung cancer|Primary lung cancer]]<ref name="pmid4353362">{{cite journal |vauthors=Chaudhuri MR |title=Primary pulmonary cavitating carcinomas |journal=Thorax |volume=28 |issue=3 |pages=354–66 |year=1973 |pmid=4353362 |pmc=470041 |doi= |url=}}</ref>
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*Elderly male or female <ref name="pmid4353362">{{cite journal |vauthors=Chaudhuri MR |title=Primary pulmonary cavitating carcinomas |journal=Thorax |volume=28 |issue=3 |pages=354–66 |year=1973 |pmid=4353362 |pmc=470041 |doi= |url=}}</ref>
*Elderly male or female <ref name="pmid4353362">{{cite journal |vauthors=Chaudhuri MR |title=Primary pulmonary cavitating carcinomas |journal=Thorax |volume=28 |issue=3 |pages=354–66 |year=1973 |pmid=4353362 |pmc=470041 |doi= |url=}}</ref>
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*[[Hemoptysis]] is commonly associated with [[bronchogenic carcinoma]]
*[[Hemoptysis]] is commonly associated with [[bronchogenic carcinoma]]
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*A coin-shaped lesion with a thick wall(>15mm) is seen on CXR with fewer ground-glass opacities
*A coin-shaped lesion with a thick wall(>15mm) is seen on CXR with fewer ground-glass opacities
*[[Bronchoalveolar lavage]] [[cytology]] shows malignant cells
*[[Bronchoalveolar lavage]] [[cytology]] shows malignant cells
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*Pulmonary [[Tuberculosis, pulmonary|Tuberculosis]]
*Pulmonary [[Tuberculosis, pulmonary|Tuberculosis]]<ref name="pmid4353362">{{cite journal |vauthors=Chaudhuri MR |title=Primary pulmonary cavitating carcinomas |journal=Thorax |volume=28 |issue=3 |pages=354–66 |year=1973 |pmid=4353362 |pmc=470041 |doi= |url=}}</ref>
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*Mostly in endemic areas
*Mostly in endemic areas
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*[[Necrotizing Pulmonary Infections|Necrotizing]] [[Pneumonia]]
*[[Necrotizing Pulmonary Infections|Necrotizing]] [[Pneumonia]]<ref name="pmid4353362">{{cite journal |vauthors=Chaudhuri MR |title=Primary pulmonary cavitating carcinomas |journal=Thorax |volume=28 |issue=3 |pages=354–66 |year=1973 |pmid=4353362 |pmc=470041 |doi= |url=}}</ref>
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*Any age group
*Any age group
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*Loculated [[empyema]]
*Loculated [[empyema]]<ref name="pmid4353362">{{cite journal |vauthors=Chaudhuri MR |title=Primary pulmonary cavitating carcinomas |journal=Thorax |volume=28 |issue=3 |pages=354–66 |year=1973 |pmid=4353362 |pmc=470041 |doi= |url=}}</ref>
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*Children and elderly are at risk
*Children and elderly are at risk
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*[[Granulomatosis with polyangiitis]] ([[Wegener's granulomatosis|Wegener's]])
*[[Granulomatosis with polyangiitis]] ([[Wegener's granulomatosis|Wegener's]])<ref name="pmid10377211">{{cite journal |vauthors=Langford CA, Hoffman GS |title=Rare diseases.3: Wegener's granulomatosis |journal=Thorax |volume=54 |issue=7 |pages=629–37 |year=1999 |pmid=10377211 |pmc=1745525 |doi= |url=}}</ref>
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*Women are more commonly effected than man.
*Women are more commonly effected than man.
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*[[Rheumatoid nodule]]
*[[Rheumatoid nodule]]].<ref name="SchreiberKoschel2010">{{cite journal|last1=Schreiber|first1=J.|last2=Koschel|first2=D.|last3=Kekow|first3=J.|last4=Waldburg|first4=N.|last5=Goette|first5=A.|last6=Merget|first6=R.|title=Rheumatoid pneumoconiosis (Caplan's syndrome)|journal=European Journal of Internal Medicine|volume=21|issue=3|year=2010|pages=168–172|issn=09536205|doi=10.1016/j.ejim.2010.02.004}}</ref>
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*Elderly females of 40-50 age group
*Elderly females of 40-50 age group
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*[[Sarcoidosis]]
*[[Sarcoidosis]]<ref name="pmid4353362">{{cite journal |vauthors=Chaudhuri MR |title=Primary pulmonary cavitating carcinomas |journal=Thorax |volume=28 |issue=3 |pages=354–66 |year=1973 |pmid=4353362 |pmc=470041 |doi= |url=}}</ref>
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*More common in African-American females
*More common in African-American females
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*[[Bronchiolitis obliterans]] ([[Cryptogenic organizing pneumonia]])
*[[Bronchiolitis obliterans]] ([[Cryptogenic organizing pneumonia]])<ref name="pmid19561910">{{cite journal |vauthors=Al-Ghanem S, Al-Jahdali H, Bamefleh H, Khan AN |title=Bronchiolitis obliterans organizing pneumonia: pathogenesis, clinical features, imaging and therapy review |journal=Ann Thorac Med |volume=3 |issue=2 |pages=67–75 |year=2008 |pmid=19561910 |pmc=2700454 |doi=10.4103/1817-1737.39641 |url=}}</ref>
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*Rare condition and mimics [[asthma]], [[pneumonia]] and [[emphysema]]
*Rare condition and mimics [[asthma]], [[pneumonia]] and [[emphysema]]
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*[[Langerhans cell histiocytosis|Langerhans]] cell [[Langerhans cell histiocytosis|Histiocytosis]]
*[[Langerhans cell histiocytosis|Langerhans]] cell [[Langerhans cell histiocytosis|Histiocytosis]]<ref name="pmid4353362">{{cite journal |vauthors=Chaudhuri MR |title=Primary pulmonary cavitating carcinomas |journal=Thorax |volume=28 |issue=3 |pages=354–66 |year=1973 |pmid=4353362 |pmc=470041 |doi= |url=}}</ref>
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*Exclusively occurs in smokers, with a peak age of onset 20-40 years.
*Exclusively occurs in smokers, with a peak age of onset 20-40 years.
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*Miners with Caplan [[nodule]] without [[rheumatoid arthritis]] can develop [[arthritis]] after 5-10 years later.
*Miners with Caplan [[nodule]] without [[rheumatoid arthritis]] can develop [[arthritis]] after 5-10 years later.
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* Well-defined, cavitating [[lung]] [[nodules]] of 0.5-5 cm is the usual finding in a [[chest x-ray]] and [[CT scan]].  
*Well-defined, cavitating [[lung]] [[nodules]] of 0.5-5 cm is the usual finding in a [[chest x-ray]] and [[CT scan]].
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* [[Biopsy]] of the [[lung]] [[nodules]].
*[[Biopsy]] of the [[lung]] [[nodules]].
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==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Pulmonology]]
[[Category:Pulmonology]]
[[Category:Rheumatology]]
[[Category:Rheumatology]]

Latest revision as of 02:48, 22 July 2021

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sharmi Biswas, M.B.B.S

Overview

Caplan syndrome must be differentiated from asbestosis, silicosis, and tuberculosis.

Differentiating Caplan syndrome from other Diseases

Caplan syndrome must be differentiated from asbestosis, silicosis and other respiratory diseases with lung lesions.


Disease Findings
Bacterial pneumonia Sudden onset of symptoms, such as high fever, cough, purulent sputum, chest pain, leukocytosis, chest X-ray shows consolidation.
Bronchogenic carcinoma may be asymptomatic, usually at older ages (> 50 years old), cough, hemoptysis, weight loss
Brucellosis Fever, anorexia, night sweats, malaise,back pain , headache, and depression. History of exposure to infected animal
Hodgkin lymphoma Fever, night sweats, pruritus, painless adenopathy, mediastinal mass
Mycoplasmal pneumonia Gradual onset of dry cough, headache, malaise, sore throat. Diffuse bilateral infiltrates on chest X-ray.
Sarcoidosis Non-caseating granulomas in lungs and other organs, bilateral hilar lymphadenopathy, mostly in African American females.
Caplan syndrome Initially asymptomatic but advanced stages are associated with shortness of breath, cough and wheeze in the chest. Mostly in miners with preexisting rheumatoid arthritis.
Adapted from Mandell, Douglas, and Bennett's principles and practice of infectious diseases 2010 [1]


Causes of

lung cavities

Differentiating Features Differentiating radiological findings Diagnosis

confirmation

  • CXR and CT demonstrates cavities in the upper lobe of the lung
  • Sputum smear-positive for acid-fast bacilli and nucleic acid amplification tests (NAAT) is used on sputum or any sterile fluid for rapid diagnosis and is positive for mycobacteria.
  • Any age group
  • Acute, fulminant life threating complication of prior infection
  • >100.4F fever, with hemodynamic instability
  • Worsening pneumonia-like symptoms
  • CBC is positive for the causative organism
  • Children and elderly are at risk
  • Empyema appears lenticular in shape and has a thin wall with smooth luminal margins
  • Pulmonary nodules with cavities and infiltrates are a frequent manifestation of CXR
  • Elderly females of 40-50 age group
  • Manifestation of rheumatoid arthritis
  • Presents with other systemic symptoms including symmetric arthritis of the small joints of the hands and feet and morning stiffness are common manifestations.
  • Pulmonary nodules with cavitation are present in the upper lobe (Caplan syndrome) on Xray.
  • On CXR bilateral adenopathy and coarse reticular opacities are seen.
  • CT of the chest demonstrates extensive hilar and mediastinal adenopathy
  • Additional findings on CT include fibrosis (honeycomb, linear, or associated with bronchial distortion), pleural thickening, and ground-glass opacities.
  • Common appearance on CT is patchy consolidation,often accompanied by ground-glass opacities and nodules.
  • Exclusively occurs in smokers, with a peak age of onset 20-40 years.
  • Clinical presentation is variable, but symptoms generally include months of dry cough, fever, night sweats and weight loss.
  • Skin is involved in 80% of the cases, scaly erythematous rash is typical.
  • Thin-walled cystic cavities are the usual radiographic manifestation, observed in over 50% of patients by either CXR or CT scans.
  • Biopsy of the lung
Caplan syndrome

References

  1. Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0443068399.
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Chaudhuri MR (1973). "Primary pulmonary cavitating carcinomas". Thorax. 28 (3): 354–66. PMC 470041. PMID 4353362.
  3. 3.0 3.1 Langford CA, Hoffman GS (1999). "Rare diseases.3: Wegener's granulomatosis". Thorax. 54 (7): 629–37. PMC 1745525. PMID 10377211.
  4. 4.0 4.1 Schreiber, J.; Koschel, D.; Kekow, J.; Waldburg, N.; Goette, A.; Merget, R. (2010). "Rheumatoid pneumoconiosis (Caplan's syndrome)". European Journal of Internal Medicine. 21 (3): 168–172. doi:10.1016/j.ejim.2010.02.004. ISSN 0953-6205.
  5. 5.0 5.1 Al-Ghanem S, Al-Jahdali H, Bamefleh H, Khan AN (2008). "Bronchiolitis obliterans organizing pneumonia: pathogenesis, clinical features, imaging and therapy review". Ann Thorac Med. 3 (2): 67–75. doi:10.4103/1817-1737.39641. PMC 2700454. PMID 19561910.