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Disease Clinical manifestations Diagnosis
Symptoms Physical exam Lab findings Imaging Gold standard
Cough Dyspnea Hemoptysis Fever History/Exposure Cyanosis Clubbing JVD Peripheral edema Auscultation Other prominent findings CXR CT DLCco
Acute Respiratory Distress Syndrome (ARDS) - + - - Inciting event, such as: + - - -
  • Initially respiratory alkalosis transforming to respiratory acidosis
  • BNP level of less than 100 pg/mL
  • PaO2 / FiO2 <300
  • CBC
    • Leukopenia
    • Leukocytosis
    • Thrombocytopenia
  • Bilateral pulmonary infiltrates
    • Initially patchy peripheral
    • Later diffuse bilateral
  • Ground glass
  • Frank alveolar infiltrate
  • Bronchial dilatation within areas of ground-glass opacification
  • PaO2 / FiO2 <300
Bronchitis Acute + - +/- + - - - - -
  • Diffuse wheezes
  • High-pitched continuous sounds
  • The use of accessory muscles 
  • Prolonged expiration
  • Rhonchi
  • Rales
  • N/A
  • Normal
  • N/A
  • Clinical diagnosis
Chronic + + - -
  • A positive history of chronic productive cough 
  • Shortness of breath 
+ - + +
  • Prolonged expiration; wheezing
  • Diffusely decreased breath sound
  • Coarse crackles with inspiration
  • Coarse rhonchi
  • Radiolucency
  • Diaphragmatic flattening due to hyperinflation
  • Increased retrosternal airspace on the lateral radiograph
  • N/A
Hypersensitivity Pneumonitis + + - +
  • History of allergen exposure
- + - -
  • Constitutional symptoms
    • Weight loss
    • Anorexia
    • Muscle weakness
  • Neutrophilia
  • Elevated ESR
  • Elevated CRP
  • Elevated immunoglobulin
  • No peripheral blood eosinophilia
  • Poorly defined micronodular or diffuse interstitial pattern
  • In chronic form
    • Fibrosis
    • Loss of lung volume
    • Coarse linear opacities
  • Ground-glass opacities or
  • Diffusely increased radiodensities
  • Diffuse micronodules
  • Focal air trapping
  • Mosaic perfusion
  • Occasionaly thin-walled cysts
  • Mild fibrotic changes 
Pneumoconiosis SIlicosis + + +/- -
  • History of substantial exposure to silica dusts
  • Occupational history
    • Sandblasting
    • Bystanders
    • Quartzite miller
    • Tunnel workers
    • Silica flour workers
    • Workers in the scouring powder industry
+ + + -
    • Lungs are hyperresonant
    • Finecrackles upon auscultation of the lung bases or apices, unilaterally or bilaterally
    • Rhonchi
    • Bronchial breath sounds
    • Expiratory wheezing with normal or delayed expiratory phase
    • Wheezing may be present
    • Egophony present
    • Bronchophony present
    • Increased tactile fremitus.
    • Loud P2
  • Increased susceptiblity to tuberculosis.
  • Abnormal ABG

[1][2][3]

    • May indicate hypoxia, hypercapnia and respiratory acidosis
  • Abnormal sputum analysis
    • May contain bacteria, such as mycobacterium tuberculosis or inorganic particles, such as asbestos bodies or organic particles
  • Peak flow assessment
    • May be below normal range which is 100 liters/minute for men, and 80 liters/minute for women
  • Spirometry
    • May indicate an obstructive or restrictive pulmonary disease
    • A FEV1/FVC ratio < 80% indicates and obstructive disease,such as asthma, whilst a FEV1/FVC ratio higher than restrictive pulmonary disease indicates a restrictive disease, such as pulmonary fibrosis
  • CBC
    • May indicate anemia, neutrophilia, elevated ESR, elevated CRP, and elevated immunoglobulin
  • Bronchoscopy and bronchoalveolar lavage
    • May reveal mineral dust
  • Tuberculin skin test
    • To test for tuberculosis, and induration > 5mm is positive
  • Stool examination for occult blood
    • May indicate colorectal carcinoma
  • Small round opacities
    • Symmetrically distributed
    • Upper-zone predominance
  • Diffuse interstitial pattern of fibrosis without the typical nodular opacities in chronic case
  • Nodular changes in lung parenchyma
  • Progressive massive fibrosis
  • Bullae, emphysema
  • Pleural, mediastinal, and hilar changes
  • Lung biopsy
Asbestosis
  • Shipyard workers
  • Pipe fitting
  • Insulators
  • Lung cancer
  • Mesothelioma
  • Predilection to lower lobes
  • Fine and coarse linear, peripheral, reticular opacities
Berylliosis 
  • Electronic manufactures
  • Multiple, rounded opacities with or without calcification
  • Architectural distortion
  • Loss of lung tissue volume
  • Shadows
  • Upper lobe predominance
  • Chronic berylliosis shows emphysema with bulla formation
Byssinosis 
  • Cotton wool workers
Sarcodiosis + + + +
  •  African Americans
  • Autoimmune
- - - -
  • Usually normal
  • Crackles may be audible
  • Dermatologic manifestations
  • Ocular involvement
  • Osseous involvement
  • Heart failure from cardiomyopathy
  • Lymphocytic meningitis
  • Cranial nerve palsies
  • Hypercalcemia or hypercalciuria 
  • Elevated 1, 25-dihydroxyvitamin D levels
  • Elevated angiotensin-converting enzyme (ACE)
  • Bilateral hilar lymphadenopathy
  • High-resolution CT (HRCT) scanning of the chest may identify
    • Active alveolitis
    • Fibrosis
  • Biopsy
    • Non-caseating granuolma
Pleural Effusion + + +/- +/- Transudate
  • Congestive heart failure
  • Cirrhosis (hepatic hydrothorax)
  • Atelectasis (may be due to occult malignancy or pulmonary embolism)
  • Hypoalbuminemia
  • Nephrotic syndrome

Exudate

  • Parapneumonic causes 
  • Malignancy (most commonly lung or breast cancer, lymphoma, and leukemia; less commonly ovarian carcinoma, stomach cancer, sarcomas, melanoma) 
  • Pulmonary embolism
  • Collagen-vascular conditions (rheumatoid arthritis, systemic lupus erythematosus 
  • Tuberculosis (TB)
  • Pancreatitis
+/- +/- +/- +/-
  • Dullness to percussion
  • Decreased tactile fremitus,
  • Asymmetrical chest expansion,
  • Diminished or delayed expansion on the side of the effusion: 
  • Diminished or inaudible breath sounds
  • Pleural friction rub
  • Peripheral edema, distended neck veins, and S3 gallop suggest congestive heart failure.
  • Edema may also be a manifestation of nephrotic syndrome, pericardial disease, or, when combined with yellow nailbeds, the yellow nail syndrome.
  • Cutaneous changes and ascites suggest liver disease.
  • Lymphadenopathy or a palpable mass suggests malignancy.
  • Thoracentesis 
    • Exudate
    • Transudate
    • LDH, Glucose, cytology
  • Other specific labs of underlying etiology
Supine
  • Blunting of the costophrenic angle
  • Homogenous increase in density spread over the lower lung fields

Lateral decubitus

  • Free flowing effusion as layers
  • Thickened pleura
  • Mild effusions can aslo be detected
  • Thoracocentesis
Neuromuscular disease Scoliosis - + - -
  • Postural abnormality
- - - -
  • Decreased breathe sounds
  • In severe scoliosis, the rib cage may press against the lungs making it more difficult to breathe.
  • R/0 genetic conditions
    • Marfan's syndrome
    • Edward's syndrome
  • Total lymphocyte count (should be >1500/μL)
  • Nutritional status must be assessed
  • Accurate depiction of the true magnitude of the spinal deformity can be assessed by supine anteroposterior (AP) and lateral spinal radiographs
  • N/A
  • Clinical
  • Radiographs
Muscular dystrophy - + - -
  • Proximal muscle weakness (shoulder and pelvic girdle)
- - - -
  • Decreased breathe sounds
  • Decreased chest expansion
  • Rash
  • Elevated CPK and aldolase
  • +ANA
  • +Anti-Jo abs
  • Elevated ESR, CRP and RF
  • N/A
  • N/A
  • Muscle biopsy
ALS - + - -
  • Muscle weakness
- - - -
  • Decreased breathe sounds
  • Decreased chest expansion
  • Symptoms begin with limb involvement diue to muscle weakness and atrophy. 
  • Cognitive or behavioral dysfunction
  • Sensory nerves and the autonomic nervous system are generally unaffected
N/A Not significant/diagnostic Not significant/diagnostic -
  • Clinical diagnosis
  • Nerve conduction studies and needle electromyography (EMG) 
Myasthenia gravis - + - + H/O of difficulty getting up from chair
  • Combing
  • Difficulty in swallowing
- - - -
  • Decreased breathe sounds
  • Decreased chest expansion
  • Extraocular, bulbar, or proximal limb muscles.
  • Breathing as rapid and shallow,
  • Respiratory muscle weakness can lead to acute respiratory failure may require immediate intubation.
  • Anti–acetylcholine receptor (AChR) antibody (Ab) test +
  • Thymoma as an anterior mediastinal mass.
  • Thymoma as an anterior mediastinal mass.
  • Electromyography
Interstitial (Nonidiopathic) Pulmonary Fibrosis + ++ + -
  • Connective-tissue disorder
  • Pneumoconiosis
+ + + +
  • Wheezing
  • S3
  • P2
  • End-inspiratory rales
  • Increased A-a gradient
  • Elevated ESR
  • Serologic testing for ANA, RF, ANCA & ASCA may be positive
  •  Reticular and/or nodular opacities
  • Honeycomb appearance (late finding)
  • Bilateral reticular and nodular interstitial infiltrates
Video-assisted thoracoscopic lung biopsy
Lymphocytic Interstitial Pneumonia + + + +
  •  Autoimmune
  • Lymphoproliferative disorders
- + - -
  • Wheezing
  • Rales
  • Increased A-a gradient
  • Polyclonal hypergammaglobulinemia
  • Increased LDH
  • Bibasilar interstitial or micronodular infiltrates
  • Determines the degree of fibrosis
  • Cysts (characterstic)
N Open lung biopsy
Obesity + + - -
  • Overweight
  • Diabetes mellitus
  • Asthma
- - - +
  • Wheezing
  • Increased hematocrit
  • X ray findings are often limited due to body habitus
  • CT findings are variable and depends upon severity of obesity
N Clinical
Pulmonary Eosinophilia + + + + Infections
  • Prasitic
  • Fungal
  • Mycobacterial
+ - + +
  • Wheezing
  • Rales
  • Increased A-a gradient
  • Leukocytosis with eosinophilia (> 250/µL)
  • Interstitial or diffuse nodular densities
  • Determines extent and distribution of the disease
  • Interstitial infiltrates
  • Cysts and nodules
Biopsy of lesion (skin or lung)
  1. du Bois RM (2006). "Evolving concepts in the early and accurate diagnosis of idiopathic pulmonary fibrosis". Clin. Chest Med. 27 (1 Suppl 1): S17–25, v–vi. doi:10.1016/j.ccm.2005.08.001. PMID 16545629.
  2. Gay SE, Kazerooni EA, Toews GB, Lynch JP, Gross BH, Cascade PN, Spizarny DL, Flint A, Schork MA, Whyte RI, Popovich J, Hyzy R, Martinez FJ (1998). "Idiopathic pulmonary fibrosis: predicting response to therapy and survival". Am. J. Respir. Crit. Care Med. 157 (4 Pt 1): 1063–72. doi:10.1164/ajrccm.157.4.9703022. PMID 9563720.
  3. Neghab M, Mohraz MH, Hassanzadeh J (2011). "Symptoms of respiratory disease and lung functional impairment associated with occupational inhalation exposure to carbon black dust". J Occup Health. 53 (6): 432–8. PMID 21996929.