Chest pain, fever and dyspnea

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

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); Coronary CT angiography (CCTA); multidetector row scanners (MDCT); Cardiovascular magnetic resonance — CMRI; Myocardial perfusion imaging (MPI); single-photon emission CT (SPECT); Positron emission tomography (PET) scanning; Magnetic resonance (MR) angiography, Computed tomographic (CT) angiography, and Transesophageal echocardiography (TEE), late gadolinium enhancement (LGE); right ventricular hypertrophy (RVH), right atrial enlargement (RAE), functional tricuspid regurgitation (TR), Pulmonary artery systolic pressure (PASP; adenosine deaminase (ADA); Serum amyloid A (SAA), soluble interleukin-2 receptor (sIL2R); High-resolution CT (HRCT) scanning

Differentials on the basis of Etiology	Disease	Clinical manifestations										Diagnosis
		Symptoms								Risk factors	Physical exam	Lab Findings	EKG	Imaging	Gold standard
		Onset	Duration	Quality of Pain	Cough	Fever	Dyspnea	Weight loss	Associated Features	Risk factors	Physical exam	Lab Findings	EKG	Imaging	Gold standard
Cardiac	Pericarditis^[1]^[2]^[3]	Acute or subacute	May last for hours to days	Sharp & localized retrosternal pain	+	+	+	-	Pericardial friction rub	HIV TB Immunosuppression Acute trauma	Pericardial friction rub heard with the diaphragm of stethoscope	Leukocytosis ↑Troponin level ↑Erythrocyte sedimentation rate ↑C-reactive protein level	EKG changes (typically widespread ST segment elevation or PR depressions)	Chest x-ray typically normal Echocardiogram: normal or pericardial effusion CT scan: Noncalcified pericardial thickening with pericardial effusion CMR: inflamed pericardium and myocarditis	Pericardiocentesis Pericardial biopsy
	Pericardial Tamponade^[4]^[5]	Acute or subacute	May last for hours to days	Sharp and stabbing retrosternal pain	+/-	+	+	-	Pulsus paradoxus Pericardial rub	HIV TB Immunosuppression Acute trauma	Kussmaul sign Beck triad Pulsus paradoxus	Creatine kinase and isoenzymes Abnormal LFTs Antinuclear antibody assay, erythrocyte sedimentation rate and rheumatoid factor HIV testing	EKG findings: Sinus tachycardia Low QRS voltage Electrical alternans	CXR: enlarged cardiac silhouette with clear lung fields Echocardiography: Chamber collapse, Respiratory variation in volumes and flows, IVC plethora Swan-Ganz Catheterization: Equilibration of average intracardiac diastolic pressures (usually between 10 and 30 mmHg)	Echocardiography
	Myocarditis^[6]^[7]^[8]	Acute or subacute	Variable	Sharp & localized retrosternal pain reflects associated pericarditis	+/-	+	+	-	Heart failure Sudden cardiac death Arrythmias	Ischemic heart disease Valvular heart disease	S3 and S4 gallop Cardiac murmurs Pericardial friction rub	Serum cardiac troponin levels ↑ BNP or NT-proBNP level	Nonspecific ST changes, single atrial or ventricular ectopic beats, complex ventricular arrhythmias	CXR: Normal to enlarged with or without pulmonary vascular congestion and pleural effusions Echo: Left ventricular dilation, changes in left ventricular geometry (eg, development of a more spheroid shape), and wall motion abnormalities CMR: T1 and T2 signal intensity consistent with edema, presence of LGE consistent with necrosis or scar Radionuclide ventriculography: ↓ EF Cardiac catheterization: Assessment of hemodynamic status	Endomyocardial biopsy
	Heart Failure^[9]^[10]^[11]	Subacute or chronic	Variable	Dull Left sided chest pain	+	+/-	+	+	Orthopnea Peripheral edema Hemoptysis	Dyslipidemia, hypertension, smoking, family history of premature disease, and diabetes	S3 Elevated JVP Peripheral edema	Hyponatremia Hypoalbuminemia ↑ Serum brain natriuretic peptide (BNP) or NT-proBNP level A mild elevation in serum bilirubin (total bilirubin <3 mg/dL)	EKG findings are specific according to each cause of heart failure Q waves, ST and T wave abnormalities in patients with prior MI New onset arrhythmias (atrial fibrillation and ventricular tachycardia)	CXR: Cardiomegaly Echocardiography: ↓ EF Right heart catheterization: Pulmonary capillary wedge pressure >20 mmHg, right atrial pressure ≥12 mmHg) and/or decreased cardiac index (≤2.2 L/min/m2	Echocardiography
Differentials on the basis of Etiology	Disease	Clinical manifestations										Diagnosis
		Symptoms								Risk factors	Physical exam	Lab Findings	EKG	Imaging	Gold standard
		Onset	Duration	Quality of Pain	Cough	Fever	Dyspnea	Weight loss	Associated Features	Risk factors	Physical exam	Lab Findings	EKG	Imaging	Gold standard
Pulmonary	Pulmonary Embolism^[12]^[13]	Acute	May last minutes to hours	Sharp or knifelike or pleuritic pain Localized to side of lesion	+	+/-	+	-	Hemoptysis History of venous thromboembolism or coagulation abnormalities.	Hormone replacement therapy Cancer Oral contraceptive pills Stroke Pregnancy Postpartum Prior history of VTE Thrombophilia	S3 or S4 gallop Low grade fever Tachycardia Tachypnea Hypoxia	↑D-dimer ≥500 ng/mL Arterial blood gases (Respiratory alkalosis) ↑Troponin levels Hypercoagulation workup	Tachycardia and nonspecific ST-segment and T-wave changes (70 percent) S1Q3T3 pattern New right bundle branch block Inferior Q-waves (leads II, III, and aVF)	Duplex Ultrasonography: DVT CXR: Westermark sign, Hampton hump, Palla's sign Echocardiography: RV dilation (ratio of apical 4-chamber RV diameter to left ventricle (LV) diameter > 0.9) RV systolic dysfunction Ventilation-Perfusion Scanning: High probability	CT pulmonary angiography
	Pneumonia^[14]^[15]^[16]	Acute or chronic	Variable	Dull Localized to side of lesion	+	+	+	+/-	Altered mental status Tachycardia Rust-colored sputum Green sputum Red currant-jelly sputum Central cyanosis	Long hospital stay Ill contact exposure Aspiration	Wheezing Rhonchi Rales Decreased breath sounds Pleural friction rub	Arterial blood gas : Hypoxia, hypoxemia ↑ Procalcitonin Leukocytosis Sputum evaluation Positive blood cultures	Sinus tachycardia Nonspecific ST-segment or T-wave changes	CXR: Interstitial infiltrates, lobar consolidation, cavitation	CXR
	Tracheitis/ Bronchitis^[17]^[18]^[19]^[20]	Acute	Variable	Dull Substernal	+	+	+	-	Tachypnea Respiratory distress Hoarseness Dyspnea Cyanosis Sore throat Odynophagia Dysphonia	Aspiration Pneumonia	Inspiratory stridor (with or without expiratory stridor) Nasal flaring Wheezing	Gram stain of exudates: Neutrophils	Peaked P-wave	Radiography of the neck: Steeple sign Laryngotracheobronchoscopy: a normal epiglottis with subglottic narrowing, thick and purulent secretions in the trachea, pseudomembranes	Endoscopy
	Pleuritis	Acute or subacute or chronic	May last minutes to hours	Sharp Localized pleuritic	+	+	+	-	Sharp chest pain with breathing Itching in sites on the back Dizziness	Autoimmune conditions Infections	Tachypnea Tachycardia Pleural Rubs Decreased breath sounds	Leukocytosis Arterial blood gas (ABG): Hypoxia Thoracocentesis	EKG done to rule out other causes in differential diagnoses	Chest X Ray: Pleural fluid on one or both sides Computerized tomography (CT) scan: Pleural effusions	CXR
	Pleural Effusion^[21]^[22]^[23]	Acute or subacute or chronic	Variable	Dull Pleuritic pain	+	+/-	+	+/-	Increasing lower extremity edema Orthopnea Paroxysmal nocturnal dyspnea Night sweats Hemoptysis	Pneumonia	Diminished or inaudible breath sounds Pleural friction rub Egophony (known as "E-to-A" changes)	Pleural fluid LDH levels above 1000 IU/L Nucleated cells - Lymphocytosis - Eosinophilia - Mesothelial cells Pleural fluid culture and cytology Pleural fluid antinuclear antibody and rheumatoid factor	Typically not indicated	Chest X Ray: Pleural fluid on one or both sides Computerized tomography (CT) scan: Detects small pleural effusions, ie, less than 10 mL and possibly as little as 2 mL of liquid in the pleural space, Thickening of the visceral and parietal pleura MRI: Characterize the content of pleural effusions	Computed tomography
	Asthma & COPD^[24]^[25]^[26]^[27]	Acute or subacute or chronic	Variable	Tightness	+	+/-	+	+/-	Cyanosis	Smoking HF HTN	Elevated jugular venous pulse (JVP) Hyperinflation (barrel chest) Peripheral edema Clubbing Wheezing Rhonchi Diffusely decreased breath sounds Coarse crackles beginning with inspiration	Leukocytosis Eosinophilia Respiratory alkalosis	Peaked P-wave Reduced amplitude of the QRS complexes Multifocal atrial tachycardia (MAT)	CXR: Hyperinflation Spirometry: ↓ FEV1, PEF, ↓ FEV1/FVC	Spirometry
	Pulmonary Malignancy^[28]^[29]^[30]^[31]	Chronic	Variable	Dull aching	+	+/-	+	+	Bone pain Fatigue Neurologic dysfunction Superior vena cava (SVC) obstruction Hoarseness Hemidiaphragm paralysis Dysphagia Paraneoplastic syndromes Hypercalcemia	Smoking Metastasis	Wheeze Crackles Depending upon complications caused by the spread of cancer	Hypercalcemia	EKG may be performed before cancer treatment to identify any pre-existing conditions, or during treatment to check for possible heart damage	CXR and CT scan: Mass lesion, hilar lymphadenopathy Spirometry: ↓Vt, ↑RV Bronchoscopy: Biopsy	Bronchoscopy
	Acute chest syndrome (Sickle cell anemia)^[32]^[33]^[34]	Acute	May last minutes to hours	Chest tightness	+	+/-	+	-	Sickle cell anemia Vaso-occlusive crisis Pain crises	↑ WBC ↑ Hb levels ↓ fetal hemoglobin levels Smoking Vaso-occlusive pain events	Systolic murmur may be heard over the entire precordium	↑Erythrocyte sedimentation rate Peripheral blood smears: Schistiocytes ↑ Reticulocyte count	EKG typically not indicated	Plain radiography of the extremities: Avascular necrosis	---
Differentials on the basis of Etiology	Disease	Clinical manifestations										Diagnosis
		Symptoms								Risk factors	Physical exam	Lab Findings	EKG	Imaging	Gold standard
		Onset	Duration	Quality of Pain	Cough	Fever	Dyspnea	Weight loss	Associated Features	Risk factors	Physical exam	Lab Findings	EKG	Imaging	Gold standard
Gastrointestinal	Esophageal Perforation^[35]	Acute	Minutes to hours	Burning Upper abdominal	-	+/-	+	-	Eating disorders such as bulimia Repeated episodes of retching and vomiting with either recent excessive dietary or alcohol intake Subcutaneous emphysema	Instrumentation/surgery Penetrating or blunt trauma Medications, other ingestions, foreign body Violent retching/vomiting Hernia/intestinal volvulus/obstruction Inflammatory bowel disease Appendicitis Peptic ulcer disease	Mild tachycardia or hypothermia Hamman crunch (crackling sound upon chest auscultation occurs due to pneumomediastinum)	↑Serum amylase ↑C-reactive protein levels	EKG may be indicated to assess for myocardial ischemia due to acute gastrointestinal bleeding, especially if there is coexisting:Cardiovascular disease, significant anemia and advanced age	Plain chest films or chest CT: Pneumomediastinum, Free air under the diaphragm, •Pleural effusion •Pneumothorax (Macklin effect). •Subcutaneous emphysema Plain abdominal films (or abdominal CT scout film):The appearance of pneumoperitoneum -Free air under the diaphragm -Cupola sign (inverted cup) -Rigler sign (double-wall sign) -Psoas sign -Urachus sign	Confirmed by water-soluble contrast esophagram
	Mediastinitis^[36]^[37]^[38]^[39]	Acute, Chronic	Variable	Retrosternal irritation	+/-	+	+	-	Nonspecific	Infection Esophageal perforation Post operative complication	Dysphagia Dysphonia Stridor Hamman sign	Positive organisms in sternal culture Leukocytosis Positive blood cultures	Diffuse ST elevation	CT: Localize the infection and extent of spread MRI: Assesses vascular involvement and complications	CT scan
	Pancreatitis^[40]^[41]^[42]^[43]^[44]	Acute, Chronic	Variable	Epigastric Upper left side of the abdomen Pressure like	-	+	+	+/-	Primary cirrhosis Primary sclerosing cholangitis Cystic fibrosis Autoimmune diseases	Alcohol abuse Smoking Genetic predisposition	Tachypnea Hypoxemia Hypotension Cullen's sign Grey Turner sign	↑Amylase levels ↑Lipase levels ↑ALT ↑ALP Leukocytosis	T-wave inversion ST-segment depression ST-segment elevation rarely Q-waves	CT: focal or diffuse enlargement of the pancreas MRI: Pancreatic enlargement	CT Scan
Rheumatic	Systemic lupus erythematosus^[45] ^[46]^[47]	Chronic	Years	Skin Joints (fingers, wrist, knees) Kidneys SLE can affect any organ of the body	+/-	+	+	+	HLA-genetic mutations Female gender Being younger than 50	Autoimmune conditions Genetic predisposition Positive family history	Malar rash Photosensitive rash Discoid rash Arthritis of the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints of the hands Pleuro-pericardial friction rubs Systolic murmurs	Elevation of autoantibodies (ANA, anti-dsDNA, anti-SM, antiphospholipid) Complement levels decreased Anemia	Sinus tachycardia, ST segment changes, and ventricular conduction disturbances	Related to specific organ involvent	Anti-dsDNA antibody test
Rheumatic	Relapsing polychondritis^[48]	Chronic	Years	Intermittent pain in: Tissues that cover the end of the joints Cartilage of costal rib	+	+	+	+	Hodkin's lymphoma Myelodysplastic syndromes Gastrointestinal disorders Type 1 Diabetes mellitus Auricular chondritis	Autoimmune diseases	Physical examinations findings are seen related to nasal chondritis, ocular inflammation, cardiovascular disease, skin disease, CNS and pulmonary system	Negative rheumatoid factor Anti-type II collagen antibodies Antineutrophil cytoplasmic antibodies	ECG is done to rule out the cardiovascular complications of this disease	Non specific Related to specific organ involvent	No gold standard test for this disease
Others	Substance abuse (Cocaine)^[49]^[50]^[51]	Acute (hours)	Minutes to hours	Pressure like pain in the center of chest	+	+	+	+	Anxiety Dyspnea Nausea Palpitations	Psychiatric disorders	Signs of injection drug use Signs of drug inhalation Poor personal hygiene	Serum biomarkers (Troponin I, Troponin T) Toxicologic tests or drug screens of bodily fluids (blood, urine, saliva) and hairs	QT prolongation Sinus Tachycardia Arrhythmias Cardiac conduction abnormalities	---	Gold standard test depends on the type of substance is abuse

References

↑ Imazio M, Demichelis B, Parrini I, Giuggia M, Cecchi E, Gaschino G, Demarie D, Ghisio A, Trinchero R (March 2004). "Day-hospital treatment of acute pericarditis: a management program for outpatient therapy". J. Am. Coll. Cardiol. 43 (6): 1042–6. doi:10.1016/j.jacc.2003.09.055. PMID 15028364.
↑ Troughton RW, Asher CR, Klein AL (February 2004). "Pericarditis". Lancet. 363 (9410): 717–27. doi:10.1016/S0140-6736(04)15648-1. PMID 15001332.
↑ Spodick DH (March 2003). "Acute pericarditis: current concepts and practice". JAMA. 289 (9): 1150–3. PMID 12622586.
↑ Ewart W (March 1896). "Practical Aids in the Diagnosis of Pericardial Effusion, in Connection with the Question as to Surgical Treatment". Br Med J. 1 (1838): 717–21. PMC 2406464. PMID 20756103.
↑ Adler Y, Charron P, Imazio M, Badano L, Barón-Esquivias G, Bogaert J, Brucato A, Gueret P, Klingel K, Lionis C, Maisch B, Mayosi B, Pavie A, Ristić AD, Sabaté Tenas M, Seferovic P, Swedberg K, Tomkowski W, Achenbach S, Agewall S, Al-Attar N, Angel Ferrer J, Arad M, Asteggiano R, Bueno H, Caforio AL, Carerj S, Ceconi C, Evangelista A, Flachskampf F, Giannakoulas G, Gielen S, Habib G, Kolh P, Lambrinou E, Lancellotti P, Lazaros G, Linhart A, Meurin P, Nieman K, Piepoli MF, Price S, Roos-Hesselink J, Roubille F, Ruschitzka F, Sagristà Sauleda J, Sousa-Uva M, Uwe Voigt J, Luis Zamorano J (November 2015). "2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS)". Eur. Heart J. 36 (42): 2921–64. doi:10.1093/eurheartj/ehv318. PMID 26320112.
↑ Dec GW, Palacios IF, Fallon JT, Aretz HT, Mills J, Lee DC, Johnson RA (April 1985). "Active myocarditis in the spectrum of acute dilated cardiomyopathies. Clinical features, histologic correlates, and clinical outcome". N. Engl. J. Med. 312 (14): 885–90. doi:10.1056/NEJM198504043121404. PMID 3974674.
↑ Caforio AL, Calabrese F, Angelini A, Tona F, Vinci A, Bottaro S, Ramondo A, Carturan E, Iliceto S, Thiene G, Daliento L (June 2007). "A prospective study of biopsy-proven myocarditis: prognostic relevance of clinical and aetiopathogenetic features at diagnosis". Eur. Heart J. 28 (11): 1326–33. doi:10.1093/eurheartj/ehm076. PMID 17493945.
↑ Ukena C, Mahfoud F, Kindermann I, Kandolf R, Kindermann M, Böhm M (April 2011). "Prognostic electrocardiographic parameters in patients with suspected myocarditis". Eur. J. Heart Fail. 13 (4): 398–405. doi:10.1093/eurjhf/hfq229. PMID 21239404.
↑ Anker SD, Sharma R (September 2002). "The syndrome of cardiac cachexia". Int. J. Cardiol. 85 (1): 51–66. PMID 12163209.
↑ Horwich TB, Kalantar-Zadeh K, MacLellan RW, Fonarow GC (May 2008). "Albumin levels predict survival in patients with systolic heart failure". Am. Heart J. 155 (5): 883–9. doi:10.1016/j.ahj.2007.11.043. PMID 18440336.
↑ Breathett K, Allen LA, Udelson J, Davis G, Bristow M (October 2016). "Changes in Left Ventricular Ejection Fraction Predict Survival and Hospitalization in Heart Failure With Reduced Ejection Fraction". Circ Heart Fail. 9 (10). doi:10.1161/CIRCHEARTFAILURE.115.002962. PMC 5082710. PMID 27656000.
↑ Stein PD, Beemath A, Matta F, Weg JG, Yusen RD, Hales CA, Hull RD, Leeper KV, Sostman HD, Tapson VF, Buckley JD, Gottschalk A, Goodman LR, Wakefied TW, Woodard PK (October 2007). "Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II". Am. J. Med. 120 (10): 871–9. doi:10.1016/j.amjmed.2007.03.024. PMC 2071924. PMID 17904458.
↑ "Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED)". JAMA. 263 (20): 2753–9. 1990. PMID 2332918.
↑ File TM (December 2003). "Community-acquired pneumonia". Lancet. 362 (9400): 1991–2001. doi:10.1016/S0140-6736(03)15021-0. PMID 14683661.
↑ Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG (March 2007). "Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults". Clin. Infect. Dis. 44 Suppl 2: S27–72. doi:10.1086/511159. PMID 17278083.
↑ Musher DM, Thorner AR (October 2014). "Community-acquired pneumonia". N. Engl. J. Med. 371 (17): 1619–28. doi:10.1056/NEJMra1312885. PMID 25337751.
↑ Conley SF, Beste DJ, Hoffmann RG (May 1993). "Measles-associated bacterial tracheitis". Pediatr. Infect. Dis. J. 12 (5): 414–5. PMID 8327305.
↑ Salamone FN, Bobbitt DB, Myer CM, Rutter MJ, Greinwald JH (December 2004). "Bacterial tracheitis reexamined: is there a less severe manifestation?". Otolaryngol Head Neck Surg. 131 (6): 871–6. doi:10.1016/j.otohns.2004.06.708. PMID 15577783.
↑ Hopkins A, Lahiri T, Salerno R, Heath B (October 2006). "Changing epidemiology of life-threatening upper airway infections: the reemergence of bacterial tracheitis". Pediatrics. 118 (4): 1418–21. doi:10.1542/peds.2006-0692. PMID 17015531.
↑ Liston SL, Gehrz RC, Siegel LG, Tilelli J (August 1983). "Bacterial tracheitis". Am. J. Dis. Child. 137 (8): 764–7. PMID 6869336.
↑ Feinsilver SH, Barrows AA, Braman SS (October 1986). "Fiberoptic bronchoscopy and pleural effusion of unknown origin". Chest. 90 (4): 516–9. PMID 3757561.
↑ Collins TR, Sahn SA (June 1987). "Thoracocentesis. Clinical value, complications, technical problems, and patient experience". Chest. 91 (6): 817–22. PMID 3581930.
↑ Venekamp LN, Velkeniers B, Noppen M (2005). "Does 'idiopathic pleuritis' exist? Natural history of non-specific pleuritis diagnosed after thoracoscopy". Respiration. 72 (1): 74–8. doi:10.1159/000083404. PMID 15753638.
↑ Kuempel ED, Wheeler MW, Smith RJ, Vallyathan V, Green FH (August 2009). "Contributions of dust exposure and cigarette smoking to emphysema severity in coal miners in the United States". Am. J. Respir. Crit. Care Med. 180 (3): 257–64. doi:10.1164/rccm.200806-840OC. PMID 19423717.
↑ Lamprecht B, McBurnie MA, Vollmer WM, Gudmundsson G, Welte T, Nizankowska-Mogilnicka E, Studnicka M, Bateman E, Anto JM, Burney P, Mannino DM, Buist SA (April 2011). "COPD in never smokers: results from the population-based burden of obstructive lung disease study". Chest. 139 (4): 752–763. doi:10.1378/chest.10-1253. PMC 3168866. PMID 20884729.
↑ Rennard S, Decramer M, Calverley PM, Pride NB, Soriano JB, Vermeire PA, Vestbo J (October 2002). "Impact of COPD in North America and Europe in 2000: subjects' perspective of Confronting COPD International Survey". Eur. Respir. J. 20 (4): 799–805. PMID 12412667.
↑ Badgett RG, Tanaka DJ, Hunt DK, Jelley MJ, Feinberg LE, Steiner JF, Petty TL (February 1993). "Can moderate chronic obstructive pulmonary disease be diagnosed by historical and physical findings alone?". Am. J. Med. 94 (2): 188–96. PMID 8430714.
↑ Kocher F, Hilbe W, Seeber A, Pircher A, Schmid T, Greil R, Auberger J, Nevinny-Stickel M, Sterlacci W, Tzankov A, Jamnig H, Kohler K, Zabernigg A, Frötscher J, Oberaigner W, Fiegl M (February 2015). "Longitudinal analysis of 2293 NSCLC patients: a comprehensive study from the TYROL registry". Lung Cancer. 87 (2): 193–200. doi:10.1016/j.lungcan.2014.12.006. PMID 25564398.
↑ Hyde L, Hyde CI (March 1974). "Clinical manifestations of lung cancer". Chest. 65 (3): 299–306. PMID 4813837.
↑ Chute CG, Greenberg ER, Baron J, Korson R, Baker J, Yates J (October 1985). "Presenting conditions of 1539 population-based lung cancer patients by cell type and stage in New Hampshire and Vermont". Cancer. 56 (8): 2107–11. PMID 2992757.
↑ Hiraki A, Ueoka H, Takata I, Gemba K, Bessho A, Segawa Y, Kiura K, Eguchi K, Yoneda T, Tanimoto M, Harada M (March 2004). "Hypercalcemia-leukocytosis syndrome associated with lung cancer". Lung Cancer. 43 (3): 301–7. doi:10.1016/j.lungcan.2003.09.006. PMID 15165088.
↑ Vichinsky EP, Styles LA, Colangelo LH, Wright EC, Castro O, Nickerson B (March 1997). "Acute chest syndrome in sickle cell disease: clinical presentation and course. Cooperative Study of Sickle Cell Disease". Blood. 89 (5): 1787–92. PMID 9057664.
↑ Castro O, Brambilla DJ, Thorington B, Reindorf CA, Scott RB, Gillette P, Vera JC, Levy PS (July 1994). "The acute chest syndrome in sickle cell disease: incidence and risk factors. The Cooperative Study of Sickle Cell Disease". Blood. 84 (2): 643–9. PMID 7517723.
↑ Vichinsky EP, Neumayr LD, Earles AN, Williams R, Lennette ET, Dean D, Nickerson B, Orringer E, McKie V, Bellevue R, Daeschner C, Manci EA (June 2000). "Causes and outcomes of the acute chest syndrome in sickle cell disease. National Acute Chest Syndrome Study Group". N. Engl. J. Med. 342 (25): 1855–65. doi:10.1056/NEJM200006223422502. PMID 10861320.
↑ Pate JW, Walker WA, Cole FH, Owen EW, Johnson WH (May 1989). "Spontaneous rupture of the esophagus: a 30-year experience". Ann. Thorac. Surg. 47 (5): 689–92. PMID 2730190.
↑ Loyd JE, Tillman BF, Atkinson JB, Des Prez RM (September 1988). "Mediastinal fibrosis complicating histoplasmosis". Medicine (Baltimore). 67 (5): 295–310. PMID 3045478.
↑ Feigin DS, Eggleston JC, Siegelman SS (January 1979). "The multiple roentgen manifestations of sclerosing mediastinitis". Johns Hopkins Med J. 144 (1): 1–8. PMID 762913.
↑ Garrett HE, Roper CL (December 1986). "Surgical intervention in histoplasmosis". Ann. Thorac. Surg. 42 (6): 711–22. PMID 3539049.
↑ Sherrick AD, Brown LR, Harms GF, Myers JL (August 1994). "The radiographic findings of fibrosing mediastinitis". Chest. 106 (2): 484–9. PMID 7774324.
↑ Dickson AP, Imrie CW (October 1984). "The incidence and prognosis of body wall ecchymosis in acute pancreatitis". Surg Gynecol Obstet. 159 (4): 343–7. PMID 6237447.
↑ Yadav D, Agarwal N, Pitchumoni CS (June 2002). "A critical evaluation of laboratory tests in acute pancreatitis". Am. J. Gastroenterol. 97 (6): 1309–18. doi:10.1111/j.1572-0241.2002.05766.x. PMID 12094843.
↑ Fortson MR, Freedman SN, Webster PD (December 1995). "Clinical assessment of hyperlipidemic pancreatitis". Am. J. Gastroenterol. 90 (12): 2134–9. PMID 8540502.
↑ Lecesne R, Taourel P, Bret PM, Atri M, Reinhold C (June 1999). "Acute pancreatitis: interobserver agreement and correlation of CT and MR cholangiopancreatography with outcome". Radiology. 211 (3): 727–35. doi:10.1148/radiology.211.3.r99jn08727. PMID 10352598.
↑ Stimac D, Miletić D, Radić M, Krznarić I, Mazur-Grbac M, Perković D, Milić S, Golubović V (May 2007). "The role of nonenhanced magnetic resonance imaging in the early assessment of acute pancreatitis". Am. J. Gastroenterol. 102 (5): 997–1004. doi:10.1111/j.1572-0241.2007.01164.x. PMID 17378903.
↑ Turner-Stokes L, Turner-Warwick M (April 1982). "Intrathoracic manifestations of SLE". Clin Rheum Dis. 8 (1): 229–42. PMID 6749397.
↑ Hunder GG, McDuffie FC, Hepper NG (March 1972). "Pleural fluid complement in systemic lupus erythematosus and rheumatoid arthritis". Ann. Intern. Med. 76 (3): 357–63. PMID 5015911.
↑ Porcel JM, Ordi-Ros J, Esquerda A, Vives M, Madroñero AB, Bielsa S, Vilardell-Tarrés M, Light RW (2007). "Antinuclear antibody testing in pleural fluid for the diagnosis of lupus pleuritis". Lupus. 16 (1): 25–7. doi:10.1177/0961203306074470. PMID 17283581.
↑ Chopra R, Chaudhary N, Kay J (May 2013). "Relapsing polychondritis". Rheum. Dis. Clin. North Am. 39 (2): 263–76. doi:10.1016/j.rdc.2013.03.002. PMID 23597963.
↑ Grant BF, Goldstein RB, Saha TD, Chou SP, Jung J, Zhang H, Pickering RP, Ruan WJ, Smith SM, Huang B, Hasin DS (August 2015). "Epidemiology of DSM-5 Alcohol Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions III". JAMA Psychiatry. 72 (8): 757–66. doi:10.1001/jamapsychiatry.2015.0584. PMC 5240584. PMID 26039070.
↑ Cosci F, Schruers KR, Abrams K, Griez EJ (June 2007). "Alcohol use disorders and panic disorder: a review of the evidence of a direct relationship". J Clin Psychiatry. 68 (6): 874–80. PMID 17592911.
↑ George DT, Nutt DJ, Dwyer BA, Linnoila M (February 1990). "Alcoholism and panic disorder: is the comorbidity more than coincidence?". Acta Psychiatr Scand. 81 (2): 97–107. PMID 2183544.

[pmid15028364-1] Imazio M, Demichelis B, Parrini I, Giuggia M, Cecchi E, Gaschino G, Demarie D, Ghisio A, Trinchero R (March 2004). "Day-hospital treatment of acute pericarditis: a management program for outpatient therapy". J. Am. Coll. Cardiol. 43 (6): 1042–6. doi:10.1016/j.jacc.2003.09.055. PMID 15028364.

[pmid15001332-2] Troughton RW, Asher CR, Klein AL (February 2004). "Pericarditis". Lancet. 363 (9410): 717–27. doi:10.1016/S0140-6736(04)15648-1. PMID 15001332.

[pmid12622586-3] Spodick DH (March 2003). "Acute pericarditis: current concepts and practice". JAMA. 289 (9): 1150–3. PMID 12622586.

[pmid20756103-4] Ewart W (March 1896). "Practical Aids in the Diagnosis of Pericardial Effusion, in Connection with the Question as to Surgical Treatment". Br Med J. 1 (1838): 717–21. PMC 2406464. PMID 20756103.

[pmid26320112-5] Adler Y, Charron P, Imazio M, Badano L, Barón-Esquivias G, Bogaert J, Brucato A, Gueret P, Klingel K, Lionis C, Maisch B, Mayosi B, Pavie A, Ristić AD, Sabaté Tenas M, Seferovic P, Swedberg K, Tomkowski W, Achenbach S, Agewall S, Al-Attar N, Angel Ferrer J, Arad M, Asteggiano R, Bueno H, Caforio AL, Carerj S, Ceconi C, Evangelista A, Flachskampf F, Giannakoulas G, Gielen S, Habib G, Kolh P, Lambrinou E, Lancellotti P, Lazaros G, Linhart A, Meurin P, Nieman K, Piepoli MF, Price S, Roos-Hesselink J, Roubille F, Ruschitzka F, Sagristà Sauleda J, Sousa-Uva M, Uwe Voigt J, Luis Zamorano J (November 2015). "2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS)". Eur. Heart J. 36 (42): 2921–64. doi:10.1093/eurheartj/ehv318. PMID 26320112.

[pmid3974674-6] Dec GW, Palacios IF, Fallon JT, Aretz HT, Mills J, Lee DC, Johnson RA (April 1985). "Active myocarditis in the spectrum of acute dilated cardiomyopathies. Clinical features, histologic correlates, and clinical outcome". N. Engl. J. Med. 312 (14): 885–90. doi:10.1056/NEJM198504043121404. PMID 3974674.

[pmid17493945-7] Caforio AL, Calabrese F, Angelini A, Tona F, Vinci A, Bottaro S, Ramondo A, Carturan E, Iliceto S, Thiene G, Daliento L (June 2007). "A prospective study of biopsy-proven myocarditis: prognostic relevance of clinical and aetiopathogenetic features at diagnosis". Eur. Heart J. 28 (11): 1326–33. doi:10.1093/eurheartj/ehm076. PMID 17493945.

[pmid21239404-8] Ukena C, Mahfoud F, Kindermann I, Kandolf R, Kindermann M, Böhm M (April 2011). "Prognostic electrocardiographic parameters in patients with suspected myocarditis". Eur. J. Heart Fail. 13 (4): 398–405. doi:10.1093/eurjhf/hfq229. PMID 21239404.

[pmid12163209-9] Anker SD, Sharma R (September 2002). "The syndrome of cardiac cachexia". Int. J. Cardiol. 85 (1): 51–66. PMID 12163209.

[pmid18440336-10] Horwich TB, Kalantar-Zadeh K, MacLellan RW, Fonarow GC (May 2008). "Albumin levels predict survival in patients with systolic heart failure". Am. Heart J. 155 (5): 883–9. doi:10.1016/j.ahj.2007.11.043. PMID 18440336.

[pmid27656000-11] Breathett K, Allen LA, Udelson J, Davis G, Bristow M (October 2016). "Changes in Left Ventricular Ejection Fraction Predict Survival and Hospitalization in Heart Failure With Reduced Ejection Fraction". Circ Heart Fail. 9 (10). doi:10.1161/CIRCHEARTFAILURE.115.002962. PMC 5082710. PMID 27656000.

[pmid17904458-12] Stein PD, Beemath A, Matta F, Weg JG, Yusen RD, Hales CA, Hull RD, Leeper KV, Sostman HD, Tapson VF, Buckley JD, Gottschalk A, Goodman LR, Wakefied TW, Woodard PK (October 2007). "Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II". Am. J. Med. 120 (10): 871–9. doi:10.1016/j.amjmed.2007.03.024. PMC 2071924. PMID 17904458.

[pmid2332918-13] "Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED)". JAMA. 263 (20): 2753–9. 1990. PMID 2332918.

[pmid14683661-14] File TM (December 2003). "Community-acquired pneumonia". Lancet. 362 (9400): 1991–2001. doi:10.1016/S0140-6736(03)15021-0. PMID 14683661.

[pmid17278083-15] Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG (March 2007). "Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults". Clin. Infect. Dis. 44 Suppl 2: S27–72. doi:10.1086/511159. PMID 17278083.

[pmid25337751-16] Musher DM, Thorner AR (October 2014). "Community-acquired pneumonia". N. Engl. J. Med. 371 (17): 1619–28. doi:10.1056/NEJMra1312885. PMID 25337751.

[pmid8327305-17] Conley SF, Beste DJ, Hoffmann RG (May 1993). "Measles-associated bacterial tracheitis". Pediatr. Infect. Dis. J. 12 (5): 414–5. PMID 8327305.

[pmid15577783-18] Salamone FN, Bobbitt DB, Myer CM, Rutter MJ, Greinwald JH (December 2004). "Bacterial tracheitis reexamined: is there a less severe manifestation?". Otolaryngol Head Neck Surg. 131 (6): 871–6. doi:10.1016/j.otohns.2004.06.708. PMID 15577783.

[pmid17015531-19] Hopkins A, Lahiri T, Salerno R, Heath B (October 2006). "Changing epidemiology of life-threatening upper airway infections: the reemergence of bacterial tracheitis". Pediatrics. 118 (4): 1418–21. doi:10.1542/peds.2006-0692. PMID 17015531.

[pmid6869336-20] Liston SL, Gehrz RC, Siegel LG, Tilelli J (August 1983). "Bacterial tracheitis". Am. J. Dis. Child. 137 (8): 764–7. PMID 6869336.

[pmid3757561-21] Feinsilver SH, Barrows AA, Braman SS (October 1986). "Fiberoptic bronchoscopy and pleural effusion of unknown origin". Chest. 90 (4): 516–9. PMID 3757561.

[pmid3581930-22] Collins TR, Sahn SA (June 1987). "Thoracocentesis. Clinical value, complications, technical problems, and patient experience". Chest. 91 (6): 817–22. PMID 3581930.

[pmid15753638-23] Venekamp LN, Velkeniers B, Noppen M (2005). "Does 'idiopathic pleuritis' exist? Natural history of non-specific pleuritis diagnosed after thoracoscopy". Respiration. 72 (1): 74–8. doi:10.1159/000083404. PMID 15753638.

[pmid19423717-24] Kuempel ED, Wheeler MW, Smith RJ, Vallyathan V, Green FH (August 2009). "Contributions of dust exposure and cigarette smoking to emphysema severity in coal miners in the United States". Am. J. Respir. Crit. Care Med. 180 (3): 257–64. doi:10.1164/rccm.200806-840OC. PMID 19423717.

[pmid20884729-25] Lamprecht B, McBurnie MA, Vollmer WM, Gudmundsson G, Welte T, Nizankowska-Mogilnicka E, Studnicka M, Bateman E, Anto JM, Burney P, Mannino DM, Buist SA (April 2011). "COPD in never smokers: results from the population-based burden of obstructive lung disease study". Chest. 139 (4): 752–763. doi:10.1378/chest.10-1253. PMC 3168866. PMID 20884729.

[pmid12412667-26] Rennard S, Decramer M, Calverley PM, Pride NB, Soriano JB, Vermeire PA, Vestbo J (October 2002). "Impact of COPD in North America and Europe in 2000: subjects' perspective of Confronting COPD International Survey". Eur. Respir. J. 20 (4): 799–805. PMID 12412667.

[pmid8430714-27] Badgett RG, Tanaka DJ, Hunt DK, Jelley MJ, Feinberg LE, Steiner JF, Petty TL (February 1993). "Can moderate chronic obstructive pulmonary disease be diagnosed by historical and physical findings alone?". Am. J. Med. 94 (2): 188–96. PMID 8430714.

[pmid25564398-28] Kocher F, Hilbe W, Seeber A, Pircher A, Schmid T, Greil R, Auberger J, Nevinny-Stickel M, Sterlacci W, Tzankov A, Jamnig H, Kohler K, Zabernigg A, Frötscher J, Oberaigner W, Fiegl M (February 2015). "Longitudinal analysis of 2293 NSCLC patients: a comprehensive study from the TYROL registry". Lung Cancer. 87 (2): 193–200. doi:10.1016/j.lungcan.2014.12.006. PMID 25564398.

[pmid4813837-29] Hyde L, Hyde CI (March 1974). "Clinical manifestations of lung cancer". Chest. 65 (3): 299–306. PMID 4813837.

[pmid2992757-30] Chute CG, Greenberg ER, Baron J, Korson R, Baker J, Yates J (October 1985). "Presenting conditions of 1539 population-based lung cancer patients by cell type and stage in New Hampshire and Vermont". Cancer. 56 (8): 2107–11. PMID 2992757.

[pmid15165088-31] Hiraki A, Ueoka H, Takata I, Gemba K, Bessho A, Segawa Y, Kiura K, Eguchi K, Yoneda T, Tanimoto M, Harada M (March 2004). "Hypercalcemia-leukocytosis syndrome associated with lung cancer". Lung Cancer. 43 (3): 301–7. doi:10.1016/j.lungcan.2003.09.006. PMID 15165088.

[pmid9057664-32] Vichinsky EP, Styles LA, Colangelo LH, Wright EC, Castro O, Nickerson B (March 1997). "Acute chest syndrome in sickle cell disease: clinical presentation and course. Cooperative Study of Sickle Cell Disease". Blood. 89 (5): 1787–92. PMID 9057664.

[pmid7517723-33] Castro O, Brambilla DJ, Thorington B, Reindorf CA, Scott RB, Gillette P, Vera JC, Levy PS (July 1994). "The acute chest syndrome in sickle cell disease: incidence and risk factors. The Cooperative Study of Sickle Cell Disease". Blood. 84 (2): 643–9. PMID 7517723.

[pmid10861320-34] Vichinsky EP, Neumayr LD, Earles AN, Williams R, Lennette ET, Dean D, Nickerson B, Orringer E, McKie V, Bellevue R, Daeschner C, Manci EA (June 2000). "Causes and outcomes of the acute chest syndrome in sickle cell disease. National Acute Chest Syndrome Study Group". N. Engl. J. Med. 342 (25): 1855–65. doi:10.1056/NEJM200006223422502. PMID 10861320.

[pmid2730190-35] Pate JW, Walker WA, Cole FH, Owen EW, Johnson WH (May 1989). "Spontaneous rupture of the esophagus: a 30-year experience". Ann. Thorac. Surg. 47 (5): 689–92. PMID 2730190.

[pmid3045478-36] Loyd JE, Tillman BF, Atkinson JB, Des Prez RM (September 1988). "Mediastinal fibrosis complicating histoplasmosis". Medicine (Baltimore). 67 (5): 295–310. PMID 3045478.

[pmid762913-37] Feigin DS, Eggleston JC, Siegelman SS (January 1979). "The multiple roentgen manifestations of sclerosing mediastinitis". Johns Hopkins Med J. 144 (1): 1–8. PMID 762913.

[pmid3539049-38] Garrett HE, Roper CL (December 1986). "Surgical intervention in histoplasmosis". Ann. Thorac. Surg. 42 (6): 711–22. PMID 3539049.

[pmid7774324-39] Sherrick AD, Brown LR, Harms GF, Myers JL (August 1994). "The radiographic findings of fibrosing mediastinitis". Chest. 106 (2): 484–9. PMID 7774324.

[pmid6237447-40] Dickson AP, Imrie CW (October 1984). "The incidence and prognosis of body wall ecchymosis in acute pancreatitis". Surg Gynecol Obstet. 159 (4): 343–7. PMID 6237447.

[pmid12094843-41] Yadav D, Agarwal N, Pitchumoni CS (June 2002). "A critical evaluation of laboratory tests in acute pancreatitis". Am. J. Gastroenterol. 97 (6): 1309–18. doi:10.1111/j.1572-0241.2002.05766.x. PMID 12094843.

[pmid8540502-42] Fortson MR, Freedman SN, Webster PD (December 1995). "Clinical assessment of hyperlipidemic pancreatitis". Am. J. Gastroenterol. 90 (12): 2134–9. PMID 8540502.

[pmid10352598-43] Lecesne R, Taourel P, Bret PM, Atri M, Reinhold C (June 1999). "Acute pancreatitis: interobserver agreement and correlation of CT and MR cholangiopancreatography with outcome". Radiology. 211 (3): 727–35. doi:10.1148/radiology.211.3.r99jn08727. PMID 10352598.

[pmid17378903-44] Stimac D, Miletić D, Radić M, Krznarić I, Mazur-Grbac M, Perković D, Milić S, Golubović V (May 2007). "The role of nonenhanced magnetic resonance imaging in the early assessment of acute pancreatitis". Am. J. Gastroenterol. 102 (5): 997–1004. doi:10.1111/j.1572-0241.2007.01164.x. PMID 17378903.

[pmid6749397-45] Turner-Stokes L, Turner-Warwick M (April 1982). "Intrathoracic manifestations of SLE". Clin Rheum Dis. 8 (1): 229–42. PMID 6749397.

[pmid5015911-46] Hunder GG, McDuffie FC, Hepper NG (March 1972). "Pleural fluid complement in systemic lupus erythematosus and rheumatoid arthritis". Ann. Intern. Med. 76 (3): 357–63. PMID 5015911.

[pmid17283581-47] Porcel JM, Ordi-Ros J, Esquerda A, Vives M, Madroñero AB, Bielsa S, Vilardell-Tarrés M, Light RW (2007). "Antinuclear antibody testing in pleural fluid for the diagnosis of lupus pleuritis". Lupus. 16 (1): 25–7. doi:10.1177/0961203306074470. PMID 17283581.

[pmid23597963-48] Chopra R, Chaudhary N, Kay J (May 2013). "Relapsing polychondritis". Rheum. Dis. Clin. North Am. 39 (2): 263–76. doi:10.1016/j.rdc.2013.03.002. PMID 23597963.

[pmid26039070-49] Grant BF, Goldstein RB, Saha TD, Chou SP, Jung J, Zhang H, Pickering RP, Ruan WJ, Smith SM, Huang B, Hasin DS (August 2015). "Epidemiology of DSM-5 Alcohol Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions III". JAMA Psychiatry. 72 (8): 757–66. doi:10.1001/jamapsychiatry.2015.0584. PMC 5240584. PMID 26039070.

[pmid17592911-50] Cosci F, Schruers KR, Abrams K, Griez EJ (June 2007). "Alcohol use disorders and panic disorder: a review of the evidence of a direct relationship". J Clin Psychiatry. 68 (6): 874–80. PMID 17592911.

[pmid2183544-51] George DT, Nutt DJ, Dwyer BA, Linnoila M (February 1990). "Alcoholism and panic disorder: is the comorbidity more than coincidence?". Acta Psychiatr Scand. 81 (2): 97–107. PMID 2183544.

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[9]

[10]

[11]

[12]

[13]

[14]

[15]

[16]

[17]

[18]

[19]

[20]

[21]

[22]

[23]

[24]

[25]

[26]

[27]

[28]

[29]

[30]

[31]

[32]

[33]

[34]

[35]

[36]

[37]

[38]

[39]

[40]

[41]

[42]

[43]

[44]

[45]

[46]

[47]

[48]

[49]

[50]

[51]

Chest pain, fever and dyspnea

References

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