Bronchiectasis differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2], Saarah T. Alkhairy, M.D.

Overview

Bronchiectasis must be differentiated from other diseases that cause dyspnea and cough, such as COPD, asthma, pneumonia, tuberculosis, chronic sinusitis, lung cancer, postnasal drip and inhaled foreign body.

Bronchiectasis Differential Diagnosis

The following table lists the most common differential diagnoses of bronchiectasis based on chronic cough:[1][2]

Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Onset Duration Productive cough Hemoptysis Weight lost Fever Dyspnea Ascultation Lab findings Imaging PFT Gold standard
Respiratory Upper airway diseases Laryngopharyngeal reflux[3][4] Chronic
  • Variable
+ +
  • Normal function
  • 24 hour−dual sensor pH probe
Rhinosinusitis[5][6] Acute, subacute, chronic, recurrent
  • Acute: Less than 4 weeks
  • Subacute: 4−12 weeks
  • Chronic: More than 12 weeks
  • Recurrent: 4 or more episodes or acute rhinosinusitis per year
+ + +
  • Clear chest
  • Air−fluid level, mucosal edema and bony erosion of sinus on CT
  • MRI for distinguish the etiology
  • Normal function
Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Onset Duration Productive cough Hemoptysis Weight lost Fever Dyspnea Ascultation Lab findings Imaging PFT Gold standard
Respiratory Lower airway Asthma[7] Chronic
  • Years
+ Clear mucoid or yellow sputum +
  • Family history
  • Seasonal variation
Chronic Bronchitis[8][9] Chronic
  • Most of the days for three months in the las two years.
+ Clear sputum + +
Non−asthmatic eosinophilic bronchitis[10][11] Chronic
  • More than 8 weeks
+ Eosinophilic sputum +
  • Exposure to an occupational cause
Bronchiectasis[12] Chronic
  • Months to years
+ Mucopurulent sputum + +
  • CT of chest
Emphysema [13] Chronic
  • Months to years
+ Mucoid or purulent sputum + +
  • Exposure of tobacco and air pollution
Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Onset Duration Productive cough Hemoptysis Weight lost Fever Dyspnea Ascultation Lab findings Imaging PFT Gold standard
Respiratory Parenchyma Pneumoconioses[14][15] Acute, Chronic
  • Years
+ + +
Lung cancer[16][17] Chronic
  • Years
+ + + +/− + The following investigations may be helpful:
  • Not specific
Interstitial lung disease[18][19] Chronic
  • Variable
+ + + The following investigations may be helpful:
  • Lung biopsy when lab, imaging, and PFT has indeterminate result
Tuberculosis (TB)[20][21] Chronic
  • More than 2 or 3 weeks
+ + + + +
Cystic fibrosis (CF)[22][23] Chronic
  • Variable
+ + +/− +
  • Evidence of CFTR dysfunction
Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Onset Duration Productive cough Hemoptysis Weight lost Fever Dyspnea Ascultation Lab findings Imaging PFT Gold standard
[[[Heart|Cardiac]] Mitral Stenosis[24][25] Chronic
  • Variable
+ Pink frothy + +
  • Not specifc
Pulmonary hypertension[26][27] Chronic
  • More than 2 years
+ + + The following investigations may be helpful:
Gastrointestinal Gastroesophageal reflux[28][29] Chronic
  • Variable
+ + +
  • Not specific
  • Normal function
  • PH testing
−−
Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Onset Duration Productive cough Hemoptysis Weight lost Fever Dyspnea Ascultation Lab findings Imaging PFT Gold standard
Autoimmune Goodpasture syndrome[30][31] Chronic
  • Variable
+ + The following investigations may be helpful:
  • Pulmonary infiltratation in chest X−Ray
  • CT scan for parenchymal involvement
Wegener's disease (GPA) [32][33] Chronic
  • Months
+ + + + + The following investigations may be helpful:
Sarcoidosis[34][35] Chronic
  • Years
+ + + The following investigations may be helpful:
Microscopic polyangitis (MPA)[36] Chronic
  • Variable
+ + + + + The following investigations may be helpful:
Churg−Strauss[37][38] Chronic
  • Variable
+ + + + +
  • Infiltrates in chest X−Ray
  • Ground glass opacities, tree−in−bud sign and small nodules in chest CT

Cough

The differential diagnosis according to cough for bronchiectasis is shown in the table below:

Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Onset Duration Productive cough Hemoptysis Weight lost Fever Dyspnea Ascultation Lab findings Imaging PFT Gold standard
Respiratory Upper airway diseases Epiglottitis[39][40] Abrupt or acute
  • 12-24 hours
- - -
  • Elevated white blood count in CBC
  • Blood culture may show bacterial growth
  • Epiglottal culture in intubated patients may show bacterial growth
  • Normal function
Croup[41] Acute
  • 3-5 days
- - -
  • Clinical diagnosis.
  • Laboratory findings and imaging are not necessary for diagnosis
Pertussis[42][43] Acute
  • Two weeks
✔ Whooping sound - -
  • Clear chest
  • Normal function
  • Culture
Laryngopharyngeal reflux[3][4] Chronic
  • Variable
- - -
  • Normal function
  • 24 hour-dual sensor pH probe
Common Cold[44] Acute
  • 3-10 days
- - -
  • Bacterial culture is not indicated
  • Normal function
  • Clinical diagnosis
Seasonal Influenza [45] Acute
  • 5-10 days
- - -
  • Normal function
  • Clinical diagnosis
Rhinosinusitis[5][6] Acute, subacute, chronic, recurrent
  • Acute: Less than 4 weeks
  • Subacute: 4-12 weeks
  • Chronic: More than 12 weeks
  • Recurrent: 4 or more episodes or acute rhinosinusitis per year
- -
  • Clear chest
  • Air-fluid level, mucosal edema and bony erosion of sinus on CT
  • MRI for distinguish the etiology
  • Normal function
Lower airway Asthma[7] Chronic
  • Years
✔ Clear mucoid or yellow sputum - - -
  • Family history
  • Seasonal variation
Acute Bronchitis[46] Acute
  • From 5 days to 1 or 3 weeks
- - -
  • FEV1 < 80%
  • Clinical diagnosis
Chronic Bronchitis[8][9] Chronic
  • Most of the days for three months in the las two years.
✔ Clear sputum - -
Non-asthmatic eosinophilic bronchitis[10][11] Chronic
  • More than 8 weeks
Eosinophilic sputum - -
  • Exposure to an occupational cause
Bronchiectasis[12] Chronic
  • Months to years
✔ Mucopurulent sputum -
  • CT of chest
Emphysema [13] Chronic
  • Months to years
✔ Mucoid or purulent sputum - -
  • Exposure of tobacco and air pollution
Foreing body aspiration[47][48][49] Acute
  • Variable
-
  • No specific
  • Not specific
  • In children <1 year and adults >75 years
  • Organic materials in children
  • Inorganic materials in adults
Bronchiolitis[50][51] Acute
  • 8-15 days
-
  • Clinical diagnosis
Parenchyma Pneumonia[52][53] Acute
  • Variable
✔ Mucopurulent sputum - -
  • Not specific
Pneumoconioses[14][15] Acute, Chronic
  • Years
- -
Lung cancer[16][17] Chronic
  • Years
-
  • Not specific
Interstitial lung disease[18][19] Chronic
  • Variable
- -
  • Lung biopsy when lab, imaging, and PFT has indeterminate result
Tuberculosis (TB)[20][21] Chronic
  • More than 2 or 3 weeks
Cystic fibrosis (CF)[22][23] Chronic
  • Variable
-
  • Evidence of CFTR dysfunction
Cardiac Cardiogenic pulmonary edema[54][55] Acute
  • Days to weeks
✔ Pink frothy, liquid - -
  • Not specific
  • Clinical diagnosis
  • Tests are supportive
Mitral Stenosis[24][25] Chronic
  • Variable
✔ Pink frothy - -
  • Not specifc
Pulmonary hypertension[26][27] Chronic
  • More than 2 years
- -
Gastrointestinal Gastroesophageal reflux[28][29] Chronic
  • Variable
- -
  • Not specific
  • Normal function
  • PH testing
--
Autoinmune Goodpasture syndrome[30][31] Chronic
  • Variable
- - -
Wegener's disease (GPA) [32][33] Chronic
  • Months
Sarcoidosis[34][35] Chronic
  • Years
- -
Microscopic polyangitis (MPA)[36] Chronic
  • Variable
Churg-Strauss[37][38] Chronic
  • Variable
  • Infiltrates in chest X-Ray
  • Ground glass opacities, tree-in-bud sign and small nodules in chest CT
Medication ACE inhibitors[56][57] Acute (depend on the medication)
  • From 2 weeks to 6 months
- - - -
  • Not required
  • No required
  • Normal function
  • Clinical diagnosis
  • Resolves in four to five days of stopping the medication
  • Angioedema

Features that may suggest bronchiectasis in a patient presenting with chronic respiratory symptoms

References

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