Sandbox:Karina

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

Overview

Pathophysiology

Gross Pathophysiology

Macroscopic Pathology

Microscopic Pathology

Organ system	Diseases	Onset	Duration	Type of respiratory failure	Clinical manifestations	Diagnosis		Other features
Organ system	Diseases	Onset	Duration	Type of respiratory failure	Clinical manifestations	Lab findings	Gold standard	Other features
Upper airway	Foreign body aspiration	acute*
	Angioedema
	Anaphylaxis
	Trauma
	Sleep apnea
	Pharynx infection
Pulmonary	COPD
	Asthma
	Pneumonia
	Pneumothorax
	Adult respiratory distress
	Pulmonary embolism
	Chest trauma
Cardiac	Cardiac arrythmia
	Acute descompensated heart failure
	Acute coronary syndrome
	Cardiac tamponade
	Valvular dysfunction
Neurology	Encephalitis
	Phrenic nerve injury
	Myasthenia gravis
	Cervical spine injury
	Amyotropic lateral sclerosis
	Poliomyelitis
	Muscular dystrophy
	Guillan-Barre syndrome
	Polymyositis
	Ankylosing spondylitis
	Stroke
Metabolic	Hypothiroidism
	Hypophotasemia
	Diabetic Ketoacidosis
	Hypothermia
	Salycilate Poisoning
	Sickle cell disease
	Sedative use
	Ascites
Cage disorders	Pectus excavatum

Pathophysiology

Organ system		Diseases	Clinical manifestations								Diagnosis				Other features
			Symptoms							Physical exam	Diagnosis
			Onset	Duration	Productive cough	Hemoptysis	Weight lost	Fever	Dyspnea	Ascultation	Lab findings	Imaging	PFT	Gold standard
Respiratory	Upper airway	Epiglottitis^[1]^[2]	Abrupt or acute	12-24 hours	-	-	-	✔	✔	Stridor Hoarseness	Complete blood count (CBC) Blood culture Epiglottal culture in intubated patients	Enlarge epiglottis (>8 mm) , loss of vallecular air space and distended hypopharynx in neck X-ray	Normal function	Direct visualization of erythematous and edematous epiglottis	Tripod posture Drooling Tenderness of the anterior part of the neck Etiology: Haemophilus influenzae
		Croup^[3]	Acute	3-5 days	✔	-	-	-	✔	Stridor Crackles	Low White blood cell count (WBC) in Blood test	Subglottic narrowing (Steeple sign) in Postero-anterior radiograph chest	Decresed Tidal volume	Clinical diagnosis. Laboratory findings and imaging are not necessary for diagnosis	Barking cough Etiology: Parainfluenza virus type 1 (most common)
		Pertussis^[4]^[5]	Acute	Two weeks	✔ whooping sound	-	✔	-	✔	Clean lungs	Polymerase chain reaction (PCR) Serologic testing	Atelectasis Lymphadenopathy	Normal function	Culture	Etiology: Bordetella pertussis Phases: Catarrhal, Paroxysmal and Convalescent
		Laryngopharyngeal reflux^[6]^[7]	Chronic	Variable	✔	-	-	-	✔	Hoarseness Stridor	Decreased levels of Salivary epidermal growth factor (EGF) Increased levels of NKT Biopsy	X-Ray Endoscopy examination	Normal function	24 hour-dual sensor PH probe	Throath clearing Globus sensation
		Common Cold^[8]	Acute	3-10 days	✔	-	-	✔	-	Rales Wheezing	Bacterial cultures are not indicated	Chest X-Ray in patients with signs of consolidation	Normal function	Clinical diagnosis	Conjunctival injection Nasal congestion
		Seasonal Influenza ^[9]	Acute	5-10 days				✔	✔	Shorteness of breath	RT-PCR Antigen detection test	Reticular or reticulonodular opacities in chest X-Ray	Normal function	Clinical diagnosis	Etiology: A or B Influenza virus
		Rhinosinusitis^[10]^[11]	Acute, Subacute, Chronic, Recurrent	Acute: Less than 4 weeks Subacute: 4-12 weeks Chronic: More than 12 weeks Recurrent: 4 or more episodes or ARS per year	✔	-	-	✔	✔	Clear chest	In complicated acute bacterial rhinosinusitis Endoscopic cultures or sinus aspirate Nasal culture	Air-fluid level, mucosal edema and bony erosion in sinus CT MRI for distinguish the etiology	Normal function	Clinical diagnosis: Nasal congestion, obstruction, purulent rhinorrhea	Erythema in periorbital area
	Lower airway	Asthma^[12]^[13]	Chronic	Years	✔ Clear mucoid or yellow sputum	-	-	-	✔	Wheezing Rales Rhonchi Expiratory noises	Eosinophilia is observed in complete blood count (CBC) Total serum IgE in test for allergy	Normal airways in chest X-Ray CT as long as is there any abnormality in X-Ray	FEV1/FVC ratio (force vital capacity) <70% and FEV1 >15% measure after 15 minutes of puffs of beta 2 sympathomimetic drug After physical active FEV1 worse than >15% After Inhaled corticosteroid (ICS)FEV1 better than >15%	Airflow limitation in Spirometry	Family history Seasonal variation
		Acute Bronchitis^[14]	Acute	From 5 days to 1 or 3 weeks	✔	-	-	-	✔	Wheezing Rhonchi	Sputum culture is not indicated PCR in bacterial infection	Chest radiograph to exclude other diseases	FEV1 < 80%	Clinical diagnosis	Majority is caused by respiratory viruses
		Chronic Bronchitis^[15]^[16]	Chronic	Most of the days for three months in the las two years.	✔ Clear sputum	-	-	✔	✔	Wheezing Rhonchi	Blood test Arterial blood gas (ABG) Test Oxigen levels in blood	Chest X-Ray to exclude othe diseases CT	FEV1/FVC ratio < 70% Post bronchodilatador FEV1 > 80% Reduced FVC after bronchodilatador administration Decread vital capacity Increased total lung capacity	Demostration of airflow limitation in Spirometry	Smoker's cough Cigarette smoking Pollution
		Nonasthmatic eosinophilic bronchitis^[17]^[18]	Chronic	More than 8 weeks	✔ Eosinophilic sputum		-	-	✔	Wheezing Shortness of breath	High levels of IgE Airway eosinophilia in Sputum induction or Bronchial wash fluid from broncoscopy	Normal chest X-Ray	FEV1/FVC >70% No response of short acting bronchodilatador	Bronchial biopsy eosinophilia	Exposure to an occupational cause
		Bronchiectasis^[19]^[20]	Chronic	Months to years	✔ Mucopurulent sputum	✔		-	✔	Crackles Wheezing Shortness of breath	Complete blood count (CBC) IgG, IgM and IgA Sputum culture for fungi, bacteria and mycobacteria	Linear atelectasis and dilated airways in chest X.Ray	FEV1/FVC <70% Normal FVC Low levels of FEV1	CT of chest	Digital clubbing Recurrente pleurisy
		Emphysema ^[21]	Chronic	Months to years	✔ Mocuid or purulent sputum	-	-	✔	✔	Shortness of breath Wheezing Prolonged expiration Crackles	Blood test Testing for alpha 1-antitrypsin	Chest X-Ray to exclude other diseases CT	FEV1/FVC <70% Post bronchodilatador FEV1 >80	Detection of early emphysema in CT of chest	Exposure of tabacco and air pollution
		Foreing body aspiration^[22]^[23]	Acute	Variable	✔	✔	-	✔	✔	Wheezing Decreased of breath sounds	No specific	Hyperinflated lungs, atelectasis and mediastinitis shift in chest radiograph when the object is radio-opaque CT	Not specific	Bronchoscopy	In childrens <1 year and adults >75 years Organic materials in childrens Inorganic materials in adults
		Bronchiolitis^[24]^[25]	Acute	8-15 days	✔	-		✔	✔	Wheezing Crackles Increased respiratory rate	Complete blood count (CBC) Urinalysis (in infants) Urine culture ( in infants)	Chest X-Ray	Normal function or obstructive changes (FEV1/FVC <70%) Air trapping in Lung volumes Reduced Diffusing capacity of carbon monoxide ( DLCO)	Clinical diagnosis	Etiology: Respiratory syncytial virus, Rhinovirus Childrens <2 years
	Parenchyma	Pneumonia^[26]^[27]	Acute	Variable	✔ Mucopurulent sputum	-	-	✔	✔	Crackles Egophony Decreased bronquial sounds	Leftward shift leukocytosis Blood culture in hospitalized patients Sputum culture in hospitalized patients	Consolidation, cavitation and infiltrated interstitial in Chest X-Ray Anatomical changes observed in chest CT	Not specific	Infiltration observed in chest radiograph	Community-acquired pneumonia Hospital-acquired pneumonia Healthcare-associated pneumonia Ventilator-associated pneumonia Aspiration pneumonia
		Pneumoconioses^[28]^[29]	Acute, Chronic	Years	-	-	✔	✔	✔	Wheezing Rhonchi Crackles	Blood gas analysis Complete blood count (CBC)	Small oppacities and fibrosis observed in Chest X-Ray CT FDG-PET	FEV1/FVC <70% FEV1 <80%	Exposure story and chest radiograph	Fibrogenic: Silica, Asbestos Inert: Iron, Barium Granulomatous: Beryllium Giant cell pneumonia: Cobalt
		Lung cancer^[30]^[31]	Chronic	Years	✔	✔	✔	-	✔	Hoarseness	Complete blood count (CBC) ALT, AST Calcium Alkaline phosphatase LDH Creatinine	Contrast-enhance CT of chest and upper abdomen	Not specific	Tissue biopsy, large enough for molecular testing	Risk factor: Cigarette smoking Small cell lung cancer (SCLC) Non-small cell lung cancer (NSCLC)
		Interstitial lung disease^[32]^[33]	Chronic	Variable	-	✔	✔	-	✔	Wheezing Crackles or Velcro rales Inspiratory high-pitched rhonchi	Test for hepatic and renal function Hematologic test in differential CBC Serological testing	Nodular, reticular or both pattern in chest X-Ray CT in patients with diffuse pulmonary lung disease	Reduction in FVC, RV, FRC, TLC and FEV1 in Spirometry FEV1/FVC normal or increase Lung volumes Diffusing capacity, DLCO reduced	Lung biopsy when Lab, imaging and PFT do not allow to do the diagnosis	Clubbing is common in asbestosis and idiopathic pulmonary fibrosis
		Tuberculosis (TB)^[34]^[35]	Chronic	More than 2 or 3 weeks	✔	✔	✔	✔	✔	Pleural effusion Crackles Whispered pectoriloquy Decreased fremitus Rhonchi	Sputum acid-fast bacilli (AFB) Mycobacterial culture Molecular test	Reactivation of TB is observed as infiltration in the upper lobe in chest X-Ray In Patients with HIV is observed lobar infiltration, adenopathy, lung mass named tuberculoma, small fibronodular lesions and/or pleural effusion chest X-Ray CT can detect early nodal process	Decreased FEV1 Reduced FVC	Isolation of Mycobacterium tuberculosis from some secretion	Etiology: Mycobacterium tuberculosis Complications: Pneumothorax, Bronchiectasis, pulmonary destruction and chronic pulmonary aspergillosis
		Cystic fibrosis^[36]^[37]	Chronic	Variable	✔	-	✔		✔	Barrel-shaped chest Wheezing Tachypnea	Respiratory tract culture for CF Bronchoalveolar lavage for citology >= 60 mmol/L Sweat chloride test CFTR mutation in molecular test	Hyperinflation and bronchovascular in chest X-Ray More severe patients present bronchietasis, "tram tracks" peribronchial cuffing in chest X-Ray The extension of bronchietasis can be defined by CT	RV/TLC ratio increased FEV1/FVC ratio <70% Low levels of FEV1 High levels of TLC RV increased	Sweat chloride test	Clinical symptoms, one organ system and evidence of CFTR dysfunction
Cardiac		Cardiogenic pulmonary edema^[38]^[39]	Acute	Days to weeks	✔ Pink frothy liquid	-	✔	-	✔	Crackles Increased respiratory rate Wheezing Rhonchi Gurgling sounds	Arterial blood analysis BUN Serum creatinin Serum troponin Electrolytes Lactic acid Complete blood count	Cardiomegaly, pleural effusion, intersticial edema, alveolar edema and blood redistribution in lower lobes in chest X-Ray	Not specific	Clinical diagnosis. Test are supportive	12-lead ECG Plasma BNP and NT-proBNP Echocardiography
		Mitral Stenosis^[40]^[41]	Chronic	Variable	✔ Pink frothy	✔	-	-	✔	Crackles Hoarseness	Not specifc	Electrocardiogram Elargement of left atrium and appendage in chest radiograph	FVC reduced	Resting transthoracic echocardiography	Stress testing Cardiac catheterization
		Pulmonary hypertension^[42]^[43]	Chronic	More than 2 years	-	✔	✔	-	✔	Hoarseness	HIV serology Antinuclear antibody (ANA) Rheumatoid factor (RF) Anti-neutrophil cytoplasmatic antibody (ANCA)	Enlargement of the central pulmonary artery and right heart in chest X-Ray Pulmonary artery systolic pressure can be estimated in Echocardiography	Low levels of FEV1 Decreased FVC DLCO reduced	Mean pulmonary artery pressure more than 25 mmHg at rest	Chest pain Ascites Syncope Peripherial edema
Gastrointestinal		Gastroesophageal reflux^[44]^[45]	Chronic	Variable	✔	-	✔	-	✔	Wheezing Hoarseness	Not specific	Upper endoscopy Barium esophagram	Normal function	PH testing
Autoinmune		Goodpasture syndrome^[46]^[47]	Chronic	Variable	-	✔	-	-	✔	Shortness of breath	Complete blood count (CBC) ANCA positive Anti-GBM in ELISA or Western Blood	Pulmonary infiltratation in chest X-Ray CT parenchimal envolment	Increased DLCO Decreased TLC Decreased FVC	Renal biopsy	Hematuria Proteinuria
		Wegener's disease (GPA) ^[48]^[49]	Chronic	Months	✔	✔	✔	✔	✔	Hoarseness Stridor Wheezing	ANCA, P-ANCA, C-ANCA BUN Creatinine Complete blood count Urinalysis Lung biopsy	Nodules, pulmonary infiltrates, reticular margins, pleural opacities and cavities in chest X-Ray Nodules, cavities and stellate-shaped peripherial pulmonary in chest CT Bronchoscopy	Low levels of DLCO Reduce lung volumes	Tissue biopsy	Nasal crusting, sinus pain, chronic rhinosinusitis, nasal obstruction and discharge in upper airway Saddle nose deformity Purpura in lower extremities
		Sarcoidosis^[50]^[51]	Chronic	Years	-	-	✔	✔	✔	Wheezing Squeaky sounds	Complete blood count (CBC) Urinalysis BUN Liver function test Calcium Alkaline phosphatase levels Electrolytes Histopathologic detection	In chest X-Ray is observed bilateral hiliar adenopathy (stage 1), reticular opacities and hiliar adenopathy (stage 2), shrink hiliar nodules and reticular opacities (stage 3) and lost of volume (stage 4)	Reduced FVC Decreased of TLC	Clinical diagnosis, histopathologic detection of noncaseating granulomas and exclusion of other diseases	Young adults Skin, joint and eye lesions
		Microscopic polyangitis (MPA)^[52]^[53]	Chronic	Variable	✔	✔	✔	✔	✔	Hoarseness Stridor Wheezing	ANCA positive BUN Creatinine Complete blood count Urinalysis	Cavitation, nodules and alveolar oppacities in chest X-Ray Head and chest CT Electromyography/nerve conduction	Reduced lung volumes	Tissue biopsy	Nerve damage Rhinosinusitis Purpura involving lower extremities
		Churg-Strauss^[54]^[55]	Chronic	Variable	✔	✔	✔	✔	✔	Wheezing Rales Rhonchi Expiratory noises (related to asthma)	Peripherial eosinophilia In active phase CRP and erytrocyte sedimentation rate high High levels of IgE ANCA positive	Infiltrates in chest X-Ray Ground glass opacities , tree-in-bud sign and small nodules in chest CT	Lung volumes decreased FVC reduced FEV1/FVC ratio <70%	Tissue biopsy	Asthma Eosinophilia Rhinosinusitis
Medication		ACE inhibitors^[56]^[57]	Acute (depend on the medication)	From 2 weeks to 6 months	-	-	-	-	✔	Wheezing	Not required	No required	Normal function	Clinical diagnosis	Resolves in four or five days of stopping the medication

Microscopic Pathology

Transmission:^[58]
1. Multiplication
2. asjdh

Associated Conditions

Pathophysiology
	Pathophysiology	Gross Pathophysiology
Macroscopic	a	c
Microscopic	b	d

GASTROINTESTINAL

Condition	Onset	Duration	Type of pain	Location	Exacerbating factors	Alleviating factors	Radiation	Associated features	Labs	Imaging
GERD, Peptic Ulcer	Acute	Minutes to hours (gastroesophageal reflux) Prolonged (peptic ulcer)	Burning	Substernal Epigastric	Alcohol Aspirin Post meal Lying down Morning Empty stomach	Antiacid Food	Not specific	Not specific	Ambulatory reflux monitoring	Not specific
Esophageal Spasm	Acute	Minutes to hours	Burning Pressure	Retrosternal	Not specific	Sublingual nitroglycerine	Not specific	Not specific (closely mimic angina)	Esophageal manometry is more than 20% premature contractions	Not specific
Esophagitis^[59]	Acute	Variable	Burning	Epigastric	Immunosuppression alcohol smoking Excessive vomiting Radiation	Acid supression therapy Proton pump inhibitors Topical pain medication	Back	Not specific	Elevated IgE Elevated peripherial eosinophil Biopsies	Endoscopy
Eosinophilic esophagitis^[60]	Chronic	Variable	Burning	Retrosternal Abdominal	Cold and dry climates European ancestry	Proton pum inhibitors Corticosteroids Biologicals Amino acid-based diet	Not specific	Alergic diseases Asthma Rinithis Eczema	More than 15 eosinophils per high-power field	Not specific
Esophageal perforation^[61]	Acute	Minutes to hours	Burning	Upper abdominal	Excessive vomiting Weightlifing alcohol	Intravenos fluids Antibiotics Nasogastric suction NPO	Back Left shoulder	Eating disorders such as bulimia	Not specific	Confirmed by water-soluble contrast esophagram
Mediastinitis^[62]	Acute, Chronic	Variable	Irritation	Retrosternal	Recent chest surgery Smoking obesity endoscopy	Not specific	Not specific	Histoplasmosis tuberculosis Radiation	Postive organisms in sternal culture	CT X-Ray
Cholelithiasis^[63]	Acute, subacute	Minutes to hours	Burning Colicky	Right upper abdomen Substernal epigastric	Post meal Fatty foodd	Analgesics	Not specific	Not specific	Liver biochemical test Amylase levels Llipase levels	Transabdominal ultrasound (TAUS) X-ray
Pancreatitis^[64]	Acute, Chronic	Variable	Pressure	Epigastric Upper left side of the abdomen	Lying flat on the back After eating Drinking	Analgesics	Back Below the left shoulder	Primary cirrhosis Primary sclerosing colangitis	Amylase levels Lipase levels	CT MRI Transabdominal ultrasound ((TAUS)
Sliding hiatal hernia^[65]	Acute	Variable	Burning	Epigastric	Recumbent position Inspiration	Proton pump inhibitors H-2 blokers	Back	Obstruction Cameron ulcers	Not specific	Radiographic Endoscopy Manometry

Rheumatic diseases:

Condition	Onset	Duration	Type of pain	Location	Exacerbating factors	Alleviating factors	Radiation	Associated features	Labs	Imaging
Fibromyalgia^[66]	Chronic	Variable	Deep ache Burning	Shoulders Back of the Neck Chest Lower Back Elbows Hips Shin Knees	Stressful or traumatic events Post-traumatic stress disorder (PTSD) Worst at night During activity	During the day Physical therapy Stress-relief methods Exercise and fitness program	Spreads out the tender points	Somatization Depression	Normal Blood and urine test (mandatory to rule out other diseases)	Normal (mandatory to rule out other diseases)
Rheumatoid arthritis^[67]^[68]	Chronic	Years	Both sides in the same joint	Wrist Fingers Knees Feet Ankles	Increases at mornings Occupational activities related to silica and asbestos Smoking	Physical therapy Combination of three drugs DMARD Biologic medication Anti-inflammatory medication	Wildespread	Not specific	Positive Rheumatic Factor Anti-CCP body	Joint X-ray Joint ultrasound or MRI
Ankylosing spondylitis^[69]	Chronic	Years	Interminent	Spine joint Sacroiliac joint	Increases at morning and nights Less activity	NSAIDs Physical therapy Excersices DMARD TNF alpha	Not specific	Patients with HLA-27 variant	Complete blood count (CBC) Erythrocyte sedimetation rate (ESR) Antigen HLA-27 Negative Rheumatic Factor	X-Ray of Spine and Pelvis MRI of Spine and Pelvis
Psoriatic arthritis^[70]	Chronic	Years	Asymmetrical Intermitent (Comes and goes)	Interphalangeal joints Nails Wrist Knees Ankles Lower Back	Less activity	NSAIDs TNF inhibitors Physical therapy Glucocorticoids Heat therapy Splint Braces	Not specific	Psoriasis	Serum complement Levels of Long Prentaxin 3 protein (PTX3) Increased levels of CRP	X-Ray Utrasonography CT scan MRI
Sternocostoclavicular hyperostosis (SAPHO syndrome)^[71]	Chronic	Years	Recurrent Multifocal	Sternoclavicular joint	Shrugging or retractin the ipsilateral shoulder	NSAIDs Corticosteroid	Shoulder Neck Upper anterior wall chest	Palmoplantar pustulosis (PPP)	Serologic testing for exclude other diseases High levels of alcalin phosphatase	Hyperostosis, sclerosis and bone hypertrophy in X-Ray
Systemic lupus erythematosus ^[72]	Chronic	Years	Not specific	Skin Joints (fingers, wrist, knees) Kidneys	Sun exposure Sleep quality	Hydroxychloroquine NSAIDs Glucocorticoids Immunosuppressive therapy	Throught the body	HLA-genetic mutations Female gender Being younger than 50	Elevation of autoantibodies (ANA, anti-dsDNA, anti-SM, antiphospholipid) Complement levels decreased	Chest X-Ray
Relapsing polychondritis^[73]	Chronic	Years	Intermitent	Tissues that cover the end of the joints Cartilage of costal rib	Not specific	Corticosteroid	Nervous system Vascular system Kidneys	Hodkin's lymphoma Myelodysplastic syndromes Gastrointestinal disorders Type 1 Diabetes mellitus	Negative rheumatoid factor Biopsy	Not specific

MUSCULOSKELETAL

Condition	Onset	Duration	Type of pain	Location	Exacerbating factors	Alleviating factors	Radiation	Associated features	Diagnostic Tests
Musculo-skeletal Pain	Acute, subacute	Variable	Pressure, aching	Localized to involved area	Increases by movement and pressure on involved area	Analgesics	Not specific	Not specific	MRI
Rib pain	Acute, Chronic	Variable	Aching	Depend on the area involved	Movements during breathing Specific position that increases the pressure	Analgesics Compressive wraps Resting	Not specific	Broken ribs	X-Ray MRI
Isolated musculoskeletal chest pain syndromes^[74]	Acute, Chronic	Variable	Pressure	Ribs Sternum Joints	Overused Stress fractures Sporting activities	Analgesics	Not specific	Athlets injuries Costosternal pain syndromes Costochondral pain syndromes	CT X-Ray
Rheumatic diseases	Chronic	Variable	Intermitent	Depend on the area involve	Depend on the disease	Physical therapy NSAIDs Corticosteroids	Wildspread	Not specific	CT X-Ray
Traumatic	Acute	Variable	Aching	Localized to the area involved	Physicological distress	Pain management	Not specific	Tissue adjacent	X-Ray CT

Isolated musculoskeletal chest pain syndromes:

Condition	Onset	Duration	Type of pain	Location	Exacerbating factors	Alleviating factors	Radiation	Associated features	Diagnostic Tests
Costosternal syndromes (costochondritis)^[75]	Acute, subacute	Days to weeks	Pressure	Anterior part of chest wall	Deep breath Cough	Analgesics Lie down Breath quietly Lightly massage Hot or cold compresses	Back Stomach	Not specific	Palpation of tender areas Chest X-ray
Lower rib pain syndromes^[76]	Chronic	Variable	Aching	Lower chest Upper abdomen	Pressing in the spot Hypermobility of the anterior end of the costal cartilage	Analgesics	Not specific	Not specifc	Hooking maneuver
Sternalis syndrome^[77]	Chronic	Variable	Pressure	Over the body of sternum Sternalis muscle Left or middle side of the chest wall	Daily activities Emotional distress Anxiety	Not specific	Both arms	Cardiac diseases	X-ray
Tietze's syndrome^[78]	Acute	Weeks	Pressure	Costosternal joint Sternoclavicular joint Costochondral joint Second and thrid ribs	Exacerbated with respiration	Minimal physical activity NSAIDs Heat or ice	Arms Shoulders	Sneezing Exercise Cough Quick movements	Test are for rule out other diseases
Xiphoidalgia^[79]	Acute	Variable	Pressure	Over the xiphoid process Sternum Xiphosternal joint	Heavy meals Twisting movements Bending	Analgesics Topical heat and cold Elastic rib belt	Back	Cough Heavy work	Provocative test
Spontaneous sternoclavicular subluxation^[80]	Acute, Chronic	Variable	Aching	Sternoclavicular joint	Moderate to heavy repetitive tasks	Analgesics	Not specific	Abnormal contraction of pectoralis major	CT Esclerosis in X-ray
Posterior chest wall pain syndromes^[81]	Chronic	Variable	Band-like chest pain	Costovertebral joint Scapulothoracic articulation Posterior chest wall	Cough Deep breath Throwing activities	Physical therapy Muscular strengthening NSAIDs Corticosteroid injections	Not specific	Ankylosing spondylitis	Imaging test Pain by palpation

OTHER

Condition	Onset	Duration	Type of pain	Location	Exacerbating factors	Alleviating factors	Radiation	Associated features	Diagnostic Tests
Substance abuse (Cocaine)^[82]	Acute	Hours	Pressure	Chest	Beta Blockers (Not recommended)	Aspirin Calcium channels blockers Nitroglycerin Cessation of cocaine use	Not specific	Anxiety Dyspnea Nausea Palpitations	Frontal chest radiography Serum biomarkers (Troponin I, Troponin T) Electrocardiogram
Referred pain^[83]	Acute, Chronic	Variable	Visceral Somatic	Corresponding dermatomes Corresponding myotomes	Spurling maneuver	Shoulders abduction	Not specific	Pain in abdominal organs Disease in cervical discs	Neuroimaging Electrodiagnostic test
Herpes Zoster^[84]^[85]	Acute, Chronic	Variable	Burning	Chest Upper back Lower back	Light touch (in Postherpetic neuralgia PHN)	Pain medications (Tricyclic antidepressants) Physical therapy Relaxation therapy Massage Cold or heat pad	Dermatomal distribution	People who had chickenpox	Nerve test Blood test
Domestic abuse^[86]	Acute, chronic	Variable	Depend on the injury	Head Chest Neck Genital area Breast	Not specific	Pain medications	Not specific	Depression Anxiety Panic disorder Eating disorders Abortion	Assesment for IPV (intimate partner violence) in patients wiht suggested abuse
Stress fracture^[87]	Acute	Minutes	Aching	Lumbar spine Femoral head Superior side of femoral head Ribs Sacrum Patella	Increased activity History of prior stress fracture Low levels of physical activity	Pain medication Protection of the fracture Proper nutrition Minimal physical activity	Not specific	Athlets	MRI Radiography
Sickle cell disease^[88]	Chronic	From birth	Aching	Lower back Legs Chest Abdomen Arms	Ketorolac Miperidine	Opioid analgesia Massage	Not specific	Anxiety Depression	Blood test: High performance liquid chromatography Prenatal test: DNA samples from chorionic villus from 8-10 weeks of gestation

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↑ Belorusov OS, Iurasov SE (1991). "[Characteristics of the early postoperative period following kidney allotransplantation and immunosuppression using Sandimmune (cyclosporin A)]". Khirurgiia (Mosk) (in Russian) (7): 8–11. PMID 1921207.
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[pmid2696883-12] Wegiel J, Medyńska E, Dziedziak W, Szirkowiec-Gmurczyk W, Dymecki J (1989). "[Effect of histological technics on the volume and weight of various brain structures of rats at the early stages of life]". Neuropatol Pol (in Polish). 27 (2): 279–94. PMID 2696883.

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[pmid17108344-14] Wenzel RP, Fowler AA (2006). "Clinical practice. Acute bronchitis". N. Engl. J. Med. 355 (20): 2125–30. doi:10.1056/NEJMcp061493. PMID 17108344.

[pmid24692133-15] Brusasco V, Martinez F (2014). "Chronic obstructive pulmonary disease". Compr Physiol. 4 (1): 1–31. doi:10.1002/cphy.c110037. PMID 24692133.

[pmid17975186-16] Qaseem A, Snow V, Shekelle P, Sherif K, Wilt TJ, Weinberger S, Owens DK (2007). "Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline from the American College of Physicians". Ann. Intern. Med. 147 (9): 633–8. PMID 17975186.

[pmid16428700-17] Brightling CE (2006). "Chronic cough due to nonasthmatic eosinophilic bronchitis: ACCP evidence-based clinical practice guidelines". Chest. 129 (1 Suppl): 116S–121S. doi:10.1378/chest.129.1_suppl.116S. PMID 16428700.

[pmid5760521-18] Lesher S, Sacher GA (1968). "Effects of age on cell proliferation in mouse duodenal crypts". Exp. Gerontol. 3 (3): 211–7. PMID 5760521.

[pmid166509702-19] King PT, Holdsworth SR, Freezer NJ, Villanueva E, Holmes PW (2006). "Characterisation of the onset and presenting clinical features of adult bronchiectasis". Respir Med. 100 (12): 2183–9. doi:10.1016/j.rmed.2006.03.012. PMID 16650970.

[pmid16650970-20] King PT, Holdsworth SR, Freezer NJ, Villanueva E, Holmes PW (2006). "Characterisation of the onset and presenting clinical features of adult bronchiectasis". Respir Med. 100 (12): 2183–9. doi:10.1016/j.rmed.2006.03.012. PMID 16650970.

[pmid5587130-21] Queneau P, Le Guyader J, Detry, Pont M (1967). "[Clinical study of heptaminol acefyllinate]". Lyon Med (in French). 218 (50): 1561–6. PMID 5587130.

[pmid5708401-22] Harasawa M, Fukuchi Y (1968). "[Acute severe diseases in geriatrics and first aid]". Naika (in Japanese). 22 (1): 297–302. PMID 5708401.

[pmid11444115-23] Rafanan AL, Mehta AC (2001). "Adult airway foreign body removal. What's new?". Clin. Chest Med. 22 (2): 319–30. PMID 11444115.

[pmid14757603-24] Bordley WC, Viswanathan M, King VJ, Sutton SF, Jackman AM, Sterling L, Lohr KN (2004). "Diagnosis and testing in bronchiolitis: a systematic review". Arch Pediatr Adolesc Med. 158 (2): 119–26. doi:10.1001/archpedi.158.2.119. PMID 14757603.

[urlwww.nice.org.uk-25] "www.nice.org.uk".

[pmid10987697-26] Bartlett JG, Dowell SF, Mandell LA, File Jr TM, Musher DM, Fine MJ (2000). "Practice guidelines for the management of community-acquired pneumonia in adults. Infectious Diseases Society of America". Clin. Infect. Dis. 31 (2): 347–82. doi:10.1086/313954. PMID 10987697.

[pmid17278083-27] Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG (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.

[pmid27980247-28] Jp NA, Imanaka M, Suganuma N (2017). "Japanese workplace health management in pneumoconiosis prevention". J Occup Health. 59 (2): 91–103. doi:10.1539/joh.16-0031-RA. PMC 5478517. PMID 27980247.

[pmid12668748-29] Weiland DA, Lynch DA, Jensen SP, Newell JD, Miller DE, Crausman RS, Kuhn C, Kern DG (2003). "Thin-section CT findings in flock worker's lung, a work-related interstitial lung disease". Radiology. 227 (1): 222–31. doi:10.1148/radiol.2271011063. PMID 12668748.

[pmid21296855-30] Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D (2011). "Global cancer statistics". CA Cancer J Clin. 61 (2): 69–90. doi:10.3322/caac.20107. PMID 21296855.

[pmid23649435-31] Ost DE, Jim Yeung SC, Tanoue LT, Gould MK (2013). "Clinical and organizational factors in the initial evaluation of patients with lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines". Chest. 143 (5 Suppl): e121S–e141S. doi:10.1378/chest.12-2352. PMC 4694609. PMID 23649435.

[pmid15331185-32] Lama VN, Martinez FJ (2004). "Resting and exercise physiology in interstitial lung diseases". Clin. Chest Med. 25 (3): 435–53, v. doi:10.1016/j.ccm.2004.05.005. PMID 15331185.

[pmid15133338-33] Chetta A, Marangio E, Olivieri D (2004). "Pulmonary function testing in interstitial lung diseases". Respiration. 71 (3): 209–13. doi:10.1159/000077416. PMID 15133338.

[pmid9332519-34] Perlman DC, el-Sadr WM, Nelson ET, Matts JP, Telzak EE, Salomon N, Chirgwin K, Hafner R (1997). "Variation of chest radiographic patterns in pulmonary tuberculosis by degree of human immunodeficiency virus-related immunosuppression. The Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA). The AIDS Clinical Trials Group (ACTG)". Clin. Infect. Dis. 25 (2): 242–6. PMID 9332519.

[pmid2456183-35] Barnes PF, Verdegem TD, Vachon LA, Leedom JM, Overturf GD (1988). "Chest roentgenogram in pulmonary tuberculosis. New data on an old test". Chest. 94 (2): 316–20. PMID 2456183.

[pmid18639722-36] Farrell PM, Rosenstein BJ, White TB, Accurso FJ, Castellani C, Cutting GR, Durie PR, Legrys VA, Massie J, Parad RB, Rock MJ, Campbell PW (2008). "Guidelines for diagnosis of cystic fibrosis in newborns through older adults: Cystic Fibrosis Foundation consensus report". J. Pediatr. 153 (2): S4–S14. doi:10.1016/j.jpeds.2008.05.005. PMC 2810958. PMID 18639722.

[pmid1285737-37] Kerem E, Reisman J, Corey M, Canny GJ, Levison H (1992). "Prediction of mortality in patients with cystic fibrosis". N. Engl. J. Med. 326 (18): 1187–91. doi:10.1056/NEJM199204303261804. PMID 1285737.

[pmid16365214-38] Gheorghiade M, Zannad F, Sopko G, Klein L, Piña IL, Konstam MA, Massie BM, Roland E, Targum S, Collins SP, Filippatos G, Tavazzi L (2005). "Acute heart failure syndromes: current state and framework for future research". Circulation. 112 (25): 3958–68. doi:10.1161/CIRCULATIONAHA.105.590091. PMID 16365214.

[pmid23741058-39] Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL (2013). "2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines". Circulation. 128 (16): e240–327. doi:10.1161/CIR.0b013e31829e8776. PMID 23741058.

[pmid1921207-40] Belorusov OS, Iurasov SE (1991). "[Characteristics of the early postoperative period following kidney allotransplantation and immunosuppression using Sandimmune (cyclosporin A)]". Khirurgiia (Mosk) (in Russian) (7): 8–11. PMID 1921207.

[pmid19747723-41] Chandrashekhar Y, Westaby S, Narula J (2009). "Mitral stenosis". Lancet. 374 (9697): 1271–83. doi:10.1016/S0140-6736(09)60994-6. PMID 19747723.

[pmid21393391-42] Brown LM, Chen H, Halpern S, Taichman D, McGoon MD, Farber HW, Frost AE, Liou TG, Turner M, Feldkircher K, Miller DP, Elliott CG (2011). "Delay in recognition of pulmonary arterial hypertension: factors identified from the REVEAL Registry". Chest. 140 (1): 19–26. doi:10.1378/chest.10-1166. PMC 3198486. PMID 21393391.

[urlPulmonary_function_in_primary_pulmonary_hypertension_-_ScienceDirect-43] "Pulmonary function in primary pulmonary hypertension - ScienceDirect".

[pmid21508423-44] Kahrilas PJ, Hughes N, Howden CW (2011). "Response of unexplained chest pain to proton pump inhibitor treatment in patients with and without objective evidence of gastro-oesophageal reflux disease". Gut. 60 (11): 1473–8. doi:10.1136/gut.2011.241307. PMID 21508423.

[pmid4133436-45] Harland PS (1974). "Letter: Measuring malnutrition". Lancet. 1 (7863): 925. PMID 4133436.

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Sandbox:Karina

Overview

Pathophysiology

Microscopic Pathology

Associated Conditions

GASTROINTESTINAL

Rheumatic diseases:

MUSCULOSKELETAL

Isolated musculoskeletal chest pain syndromes:

OTHER

References

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