Bronchiectasis differential diagnosis: Difference between revisions

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==Bronchiectasis Differential  Diagnosis  ==
==Bronchiectasis Differential  Diagnosis  ==
The following table lists the most common differential diagnoses of bronchiectasis:<ref name="O'Donnell2008">{{cite journal|last1=O'Donnell|first1=Anne E.|title=Bronchiectasis|journal=Chest|volume=134|issue=4|year=2008|pages=815–823|issn=00123692|doi=10.1378/chest.08-0776}}</ref><ref>{{cite journal |author=Morrissey BM |title=Pathogenesis of bronchiectasis |language=English |journal=Clin Chest Med|volume=28 |issue=2 |pages=289-96 |year=2007 |pmid=17467548 |doi=}}</ref>
The following table lists the most common differential diagnoses of bronchiectasis based on chronic cough:<ref name="O'Donnell2008">{{cite journal|last1=O'Donnell|first1=Anne E.|title=Bronchiectasis|journal=Chest|volume=134|issue=4|year=2008|pages=815–823|issn=00123692|doi=10.1378/chest.08-0776}}</ref><ref>{{cite journal |author=Morrissey BM |title=Pathogenesis of bronchiectasis |language=English |journal=Clin Chest Med|volume=28 |issue=2 |pages=289-96 |year=2007 |pmid=17467548 |doi=}}</ref>
{| class="wikitable"
{|
! '''Differential  Diagnosis '''
! colspan="2" rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Organ system
! '''Description'''
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Diseases
! colspan="8" align="center" style="background:#4479BA; color: #FFFFFF;" + |Clinical manifestations
! colspan="4" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Diagnosis
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Other features
|-
|-
| '''Chronic obstructive pulmonary disease''' '''(COPD)'''
! colspan="7" align="center" style="background:#4479BA; color: #FFFFFF;" + |Symptoms
| Diminished breath sounds in [[COPD]] are not found in bronchiectasis; chest CT will be normal or show [[emphysema]] is patients with COPD
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Physical exam
|-
|-
| '''Asthma'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Onset
| [[Crackles]] found in bronchiectasis will not be found in [[asthma]], airflow [[obstruction]] is reversible in asthma
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Duration
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Productive cough
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hemoptysis
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Weight lost
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Fever
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Dyspnea
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Ascultation
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Lab findings
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Imaging
! align="center" style="background:#4479BA; color: #FFFFFF;" + |PFT
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Gold standard
|-
|-
| '''Pneumonia'''
| rowspan="2" align="center" style="background:#DCDCDC;" + |[[Respiratory system|'''Respiratory''']]
| Patients with pneumonia will express symptoms for a short duration of 7-10 days, whereas patients with bronchiectasis express symptoms for years; patients with [[pneumonia]] have bronchial breath sounds on auscultation; consolidation is seen on chest x-ray and chest CT in patients with pneumonia
| rowspan="2" align="center" style="background:#DCDCDC;" + |[[Upper respiratory tract|'''Upper airway diseases''']]
| align="center" style="background:#DCDCDC;" + |'''[[Laryngopharyngeal reflux disease|Laryngopharyngeal reflux]]'''<ref name="urlWhat is LPR? | American Academy of Otolaryngology-Head and Neck Surgery">{{cite web |url=http://www.entnet.org/content/what-lpr |title=What is LPR? &#124; American Academy of Otolaryngology-Head and Neck Surgery |format= |work= |accessdate=}}</ref><ref name="pmid12461340">{{cite journal |vauthors=Noordzij JP, Khidr A, Desper E, Meek RB, Reibel JF, Levine PA |title=Correlation of pH probe-measured laryngopharyngeal reflux with symptoms and signs of reflux laryngitis |journal=Laryngoscope |volume=112 |issue=12 |pages=2192–5 |year=2002 |pmid=12461340 |doi=10.1097/00005537-200212000-00013 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |Chronic
| style="background:#F5F5F5;" + |
*Variable
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| style="background:#F5F5F5;" + |
*[[Hoarseness]]
*[[Stridor]]
| style="background:#F5F5F5;" + |
*Decreased levels of salivary [[epidermal growth factor]] ([[EGF module-containing mucin-like hormone receptor|EGF]])
*Increased levels of [[NKTR]]
*[[Biopsy]] may be helpful
| style="background:#F5F5F5;" + |
*[[X-rays|X−Ray]] may be helpful
*[[Endoscopy]] examination may be helpful as well
| style="background:#F5F5F5;" + |
*Normal function
| style="background:#F5F5F5;" + |
*24 hour−dual sensor [[pH]] probe
| style="background:#F5F5F5;" + |
*Throat clearing
*[[Globus pharyngis|Globus sensation]]
|-
|-
| '''Tuberculosis'''
| align="center" style="background:#DCDCDC;" + |[[Rhinosinusitis|'''Rhinosinusitis''']]<ref name="pmid21490181">{{cite journal| author=Meltzer EO, Hamilos DL| title=Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines. | journal=Mayo Clin Proc | year= 2011 | volume= 86 | issue= 5 | pages= 427-43 | pmid=21490181 | doi=10.4065/mcp.2010.0392 | pmc=3084646 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21490181  }}</ref><ref name="pmid25832968">{{cite journal |vauthors=Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Ashok Kumar K, Kramper M, Orlandi RR, Palmer JN, Patel ZM, Peters A, Walsh SA, Corrigan MD |title=Clinical practice guideline (update): adult sinusitis |journal=Otolaryngol Head Neck Surg |volume=152 |issue=2 Suppl |pages=S1–S39 |year=2015 |pmid=25832968 |doi=10.1177/0194599815572097 |url=}}</ref>
| CT will show upper lobe consolidations or [[cavities]] in TB but not in bronchiectasis
| align="center" style="background:#F5F5F5;" + |[[Acute (medicine)|Acute]], [[subacute]], [[chronic]], recurrent
| style="background:#F5F5F5;" + |
*[[Acute (medicine)|Acute]]: Less than 4 weeks
*[[Subacute]]: 4−12 weeks
*[[Chronic (medical)|Chronic]]: More than 12 weeks
*Recurrent: 4 or more episodes or acute rhinosinusitis per year
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| style="background:#F5F5F5;" + |
*Clear chest
| style="background:#F5F5F5;" + |
*In complicated acute [[Rhinosinusitis|bacterial rhinosinusitis]], endoscopic cultures or [[sinus]] aspirate is indicated
*Nasal culture may also be helpful
| style="background:#F5F5F5;" + |
*Air−fluid level, mucosal [[edema]] and bony erosion of sinus on [[Computed tomography|CT]]
*[[Magnetic resonance imaging|MRI]] for distinguish the [[etiology]]
| style="background:#F5F5F5;" + |
*Normal function
| style="background:#F5F5F5;" + |
*Clinical diagnosis: [[Nasal congestion]], [[obstruction]], and purulent [[rhinorrhea]]
| style="background:#F5F5F5;" + |
*[[Erythema]] in [[Periorbital edema|periorbital]] area
|-
|-
| '''Chronic sinusitis'''
! colspan="2" rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Organ system
| [[Crackles]] found in bronchiectasis will not be found in [[chronic sinusitis]]; chest x-ray and chest CT are normal in [[chronic sinusitis]]
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Diseases
! colspan="8" align="center" style="background:#4479BA; color: #FFFFFF;" + |Clinical manifestations
! colspan="4" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Diagnosis
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Other features
|-
|-
| '''Cough due to gastrointestinal reflux (GERD)'''
! colspan="7" align="center" style="background:#4479BA; color: #FFFFFF;" + |Symptoms
| The cough can be alleviated by [[antacids]], [[proton pump inhibitors]] (PPI), or H2 blockers in GERD but not bronchiectasis
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Physical exam
|-
|-
| '''Upper airway cough syndrome''' '''(postnasal drip)'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Onset
| The cough can be alleviated by [[antihistamines]] or [[decongestants]] in upper airway syndrome but not bronchiectasis
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Duration
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Productive cough
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hemoptysis
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Weight lost
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Fever
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Dyspnea
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Ascultation
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Lab findings
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Imaging
! align="center" style="background:#4479BA; color: #FFFFFF;" + |PFT
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Gold standard
|-
|-
| '''Pulmonary carcinoma'''
| rowspan="5" align="center" style="background:#DCDCDC;" + |[[Respiratory system|'''Respiratory''']]
| These patients have similar symptoms to patients with bronchiectasis; they usually have a history of smoking and symptoms due to pressure from adjacent structures such as chest pain, bone pain, and difficulty in swallowingdiagnosis  can be made via a [[chest radiograph]] or [[CT scan]]
| rowspan="5" align="center" style="background:#DCDCDC;" + |[[Lower respiratory tract|'''Lower airway''']]
| align="center" style="background:#DCDCDC;" + |[[Asthma|'''Asthma''']]<ref name="pmid19626179">{{cite journal| author=Ukena D, Fishman L, Niebling WB| title=Bronchial asthma: diagnosis and long-term treatment in adults. | journal=Dtsch Arztebl Int | year= 2008 | volume= 105 | issue= 21 | pages= 385-94 | pmid=19626179 | doi=10.3238/arztebl.2008.0385 | pmc=2696883 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19626179  }}</ref>
| align="center" style="background:#F5F5F5;" + |Chronic
| style="background:#F5F5F5;" + |
*Years
| align="center" style="background:#F5F5F5;" + | + Clear [[Mucoid plaque|mucoid]] or yellow [[sputum]]
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| style="background:#F5F5F5;" + |
*[[Wheeze|Wheezing]] (expiratory)
*[[Rales]]
*[[Rhonchi]]
| style="background:#F5F5F5;" + |
*[[Eosinophilia]]
*Total [[serum]] [[Immunoglobulin E|IgE]] in test for [[allergy]] may be helpful
| style="background:#F5F5F5;" + |
*Normal [[Airway|airways]] in [[Chest X-ray|chest X−ray]]
*[[Computed tomography|CT]] if there any abnormality in [[Chest X-Ray|chest  X−Ray]]
| style="background:#F5F5F5;" + |
*[[FEV1/FVC ratio]] <70%  and [[FEV1]] >15% increase after 15 minutes of 2 puffs of [[Beta-2-adrenoreceptor agonists|beta 2 sympathomimetic drug]]
*After physical active [[FEV1]] decreases by >15%
*After inhaled [[corticosteroid]] (ICS)[[FEV1]] increased by >15%
| style="background:#F5F5F5;" + |
*Airflow limitation on [[spirometry]]
| style="background:#F5F5F5;" + |
*Family history
*Seasonal variation
|-
|-
| '''Inhaled foreign body'''
| align="center" style="background:#DCDCDC;" + |[[Chronic bronchitis|'''Chronic Bronchitis''']]<ref name="pmid24692133">{{cite journal |vauthors=Brusasco V, Martinez F |title=Chronic obstructive pulmonary disease |journal=Compr Physiol |volume=4 |issue=1 |pages=1–31 |year=2014 |pmid=24692133 |doi=10.1002/cphy.c110037 |url=}}</ref><ref name="pmid17975186">{{cite journal |vauthors=Qaseem A, Snow V, Shekelle P, Sherif K, Wilt TJ, Weinberger S, Owens DK |title=Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline from the American College of Physicians |journal=Ann. Intern. Med. |volume=147 |issue=9 |pages=633–8 |year=2007 |pmid=17975186 |doi= |url=}}</ref>
| These patients will have a sudden onset of [[cough]], [[wheeze]], and decreased breath sounds whereas bronchiectasis patients develop these symptoms for months/years
| align="center" style="background:#F5F5F5;" + |Chronic
| style="background:#F5F5F5;" + |
*Most of the days for three months in the las two years.
| align="center" style="background:#F5F5F5;" + | + Clear [[sputum]]
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| style="background:#F5F5F5;" + |
*[[Wheeze|Wheezing]]
*[[Rhonchi]]
| style="background:#F5F5F5;" + |
*[[CBC]] and [[ABG]] may be helpful
| style="background:#F5F5F5;" + |
*[[Chest X-ray|Chest X−Ray]] to exclude other diseases
*[[Computed tomography|CT]] may also be helpful
| style="background:#F5F5F5;" + |
*[[FEV1/FVC ratio]] < 70%
*Post bronchodilatador [[FEV1]] > 80%
*Reduced [[Vital capacity|FVC]] after bronchodilatador administration
*Decread [[vital capacity]]
*Increased [[total lung capacity]]
| style="background:#F5F5F5;" + |
*Demostration of airflow limitation on [[spirometry]]
| style="background:#F5F5F5;" + |
*[[Smoker's cough]]
*Cigarette smoking
*Pollution
|-
| align="center" style="background:#DCDCDC;" + |'''Non−asthmatic eosinophilic bronchitis'''<ref name="pmid16428700">{{cite journal |vauthors=Brightling CE |title=Chronic cough due to nonasthmatic eosinophilic bronchitis: ACCP evidence-based clinical practice guidelines |journal=Chest |volume=129 |issue=1 Suppl |pages=116S–121S |year=2006 |pmid=16428700 |doi=10.1378/chest.129.1_suppl.116S |url=}}</ref><ref name="pmid29317659">{{cite journal| author=Cho J, Choi SM, Lee J, Park YS, Lee SM, Yoo CG et al.| title=Clinical Outcome of Eosinophilic Airway Inflammation in Chronic Airway Diseases Including Nonasthmatic Eosinophilic Bronchitis. | journal=Sci Rep | year= 2018 | volume= 8 | issue= 1 | pages= 146 | pmid=29317659 | doi=10.1038/s41598-017-18265-2 | pmc=5760521 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29317659  }}</ref>
| align="center" style="background:#F5F5F5;" + |Chronic
| style="background:#F5F5F5;" + |
*More than 8 weeks
| align="center" style="background:#F5F5F5;" + | + [[Eosinophilic]] [[sputum]]
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| style="background:#F5F5F5;" + |
*[[Wheeze|Wheezing]]
*[[Shortness of breath]]
| style="background:#F5F5F5;" + |
*High levels of [[Immunoglobulin E|IgE]]
*Airway [[eosinophilia]] in [[sputum]] induction or bronchial wash fluid from [[bronchoscopy]] ([[bronchoalveolar lavage]])
| style="background:#F5F5F5;" + |
*Normal [[Chest X-Ray|chest X−Ray]]
| style="background:#F5F5F5;" + |
*[[FEV1/FVC ratio|FEV1/FVC]] >70%
*No response of short acting [[bronchodilator]]
| style="background:#F5F5F5;" + |
*[[Bronchial]] [[biopsy]]
*[[Eosinophilia]]
| style="background:#F5F5F5;" + |
*Exposure to an occupational cause
|-
| align="center" style="background:#DCDCDC;" + |[[Bronchiectasis|'''Bronchiectasis''']]<ref name="pmid166509702">{{cite journal |vauthors=King PT, Holdsworth SR, Freezer NJ, Villanueva E, Holmes PW |title=Characterisation of the onset and presenting clinical features of adult bronchiectasis |journal=Respir Med |volume=100 |issue=12 |pages=2183–9 |year=2006 |pmid=16650970 |doi=10.1016/j.rmed.2006.03.012 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |Chronic
| style="background:#F5F5F5;" + |
*Months to years
| align="center" style="background:#F5F5F5;" + | + Mucopurulent [[sputum]]
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| style="background:#F5F5F5;" + |
*[[Rales|Crackles]]
*[[Wheeze|Wheezing]]
*[[Shortness of breath]]
| style="background:#F5F5F5;" + |
*[[Complete blood count]] ([[Complete blood count|CBC]])
*[[Immunoglobulin G|IgG]], [[Immunoglobulin M|IgM]] and [[Immunoglobulin A|IgA]]
*[[Sputum]] culture for [[Fungus|fungi]], [[bacteria]] and [[Mycobacterium|mycobacteria]]
| style="background:#F5F5F5;" + |
*Linear [[atelectasis]] and dilated [[Airway|airways]] in [[Chest X-Ray|chest X−Ray]]
| style="background:#F5F5F5;" + |
*[[FEV1/FVC ratio|FEV1/FVC]] <70%
*Normal [[Vital capacity|FVC]]
*Low levels of [[Spirometry|FEV1]]
| style="background:#F5F5F5;" a+ |
*[[Computed tomography|CT]] of chest
| style="background:#F5F5F5;" + |
*[[Digital clubbing]]
*Recurrent [[pleurisy]]
|-
| align="center" style="background:#DCDCDC;" + |'''[[Emphysema]]''' <ref name="pmid28919728">{{cite journal| author=Rossi A, Butorac-Petanjek B, Chilosi M, Cosío BG, Flezar M, Koulouris N et al.| title=Chronic obstructive pulmonary disease with mild airflow limitation: current knowledge and proposal for future research - a consensus document from six scientific societies. | journal=Int J Chron Obstruct Pulmon Dis | year= 2017 | volume= 12 | issue=  | pages= 2593-2610 | pmid=28919728 | doi=10.2147/COPD.S132236 | pmc=5587130 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28919728  }}</ref>
| align="center" style="background:#F5F5F5;" + |Chronic
| style="background:#F5F5F5;" + |
*Months to years
| align="center" style="background:#F5F5F5;" + | + Mucoid or purulent [[sputum]]
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| style="background:#F5F5F5;" + |
*Shortness of [[Breathing|breath]]
*[[Wheeze|Wheezing]]
*Prolonged [[Exhalation|expiration]]
*[[Rales|Crackles]]
| style="background:#F5F5F5;" + |
*Testing for [[Alpha 1-antitrypsin|alpha 1−antitrypsin]] may be helpful
| style="background:#F5F5F5;" + |
*[[Chest X-ray|Chest X−Ray]] to exclude other diseases
*[[Computed tomography|CT]] may also be helpful
| style="background:#F5F5F5;" + |
*[[FEV1/FVC ratio|FEV1/FVC]] <70%
*Post [[bronchodilator]] [[FEV1]] >80
| style="background:#F5F5F5;" + |
*Detection of early [[emphysema]] in [[Computed tomography|CT]] of chest
| style="background:#F5F5F5;" + |
*Exposure of tobacco and air pollution
|-
! colspan="2" rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Organ system
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Diseases
! colspan="8" align="center" style="background:#4479BA; color: #FFFFFF;" + |Clinical manifestations
! colspan="4" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Diagnosis
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Other features
|-
! colspan="7" align="center" style="background:#4479BA; color: #FFFFFF;" + |Symptoms
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Physical exam
|-
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Onset
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Duration
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Productive cough
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hemoptysis
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Weight lost
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Fever
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Dyspnea
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Ascultation
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Lab findings
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Imaging
! align="center" style="background:#4479BA; color: #FFFFFF;" + |PFT
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Gold standard
|-
| rowspan="5" align="center" style="background:#DCDCDC;" + |[[Respiratory system|'''Respiratory''']]
| rowspan="5" align="center" style="background:#DCDCDC;" + |[[Parenchyma|'''Parenchyma''']]
| align="center" style="background:#DCDCDC;" + |[[Pneumoconiosis|'''Pneumoconioses''']]<ref name="pmid27980247">{{cite journal |vauthors=Jp NA, Imanaka M, Suganuma N |title=Japanese workplace health management in pneumoconiosis prevention |journal=J Occup Health |volume=59 |issue=2 |pages=91–103 |year=2017 |pmid=27980247 |pmc=5478517 |doi=10.1539/joh.16-0031-RA |url=}}</ref><ref name="pmid12668748">{{cite journal |vauthors=Weiland DA, Lynch DA, Jensen SP, Newell JD, Miller DE, Crausman RS, Kuhn C, Kern DG |title=Thin-section CT findings in flock worker's lung, a work-related interstitial lung disease |journal=Radiology |volume=227 |issue=1 |pages=222–31 |year=2003 |pmid=12668748 |doi=10.1148/radiol.2271011063 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |Acute, Chronic
| style="background:#F5F5F5;" + |
*Years
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| style="background:#F5F5F5;" + |
*[[Wheeze|Wheezing]]
*[[Rhonchi]]
*[[Rales|Crackles]]
| style="background:#F5F5F5;" + |
*[[CBC]] and [[ABG]] may be helpful
| style="background:#F5F5F5;" + |
*Small oppacities and [[fibrosis]] observed in [[Chest X-ray|chest X−ray]]
*[[Computed tomography|CT]] and [[Positron emission tomography|FDG−PET]] may be helpful
| style="background:#F5F5F5;" + |
*[[FEV1/FVC ratio|FEV1/FVC]] <70%
*[[FEV1]] <80%
| style="background:#F5F5F5;" + |
*Exposure history  and [[Chest X-ray|chest radiograph]]
| style="background:#F5F5F5;" + |
*Fibrogenic: [[Silica]], [[asbestos]]
*Inert: [[Iron]], [[barium]]
*Granulomatous: [[Beryllium]]
*Giant cell pneumonia: [[Cobalt]]
|-
| align="center" style="background:#DCDCDC;" + |[[Lung cancer|'''Lung cancer''']]<ref name="pmid21296855">{{cite journal |vauthors=Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D |title=Global cancer statistics |journal=CA Cancer J Clin |volume=61 |issue=2 |pages=69–90 |year=2011 |pmid=21296855 |doi=10.3322/caac.20107 |url=}}</ref><ref name="pmid23649435">{{cite journal |vauthors=Ost DE, Jim Yeung SC, Tanoue LT, Gould MK |title=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 |journal=Chest |volume=143 |issue=5 Suppl |pages=e121S–e141S |year=2013 |pmid=23649435 |pmc=4694609 |doi=10.1378/chest.12-2352 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |Chronic
| style="background:#F5F5F5;" + |
*Years
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +/−
| align="center" style="background:#F5F5F5;" + | +
| style="background:#F5F5F5;" + |
*[[Hoarseness]]
| style="background:#F5F5F5;" + |The following investigations may be helpful:
*[[Complete blood count]] ([[Complete blood count|CBC]])
*[[Alanine transaminase|ALT]], [[Aspartate transaminase|AST]]
*[[Calcium]]
*[[Alkaline phosphatase]]
*[[Lactate dehydrogenase|LDH]]
*[[Creatinine]]
| style="background:#F5F5F5;" + |
*[[Contrast enhanced CT|Contrast−enhanced CT]] of chest and upper abdomen
| style="background:#F5F5F5;" + |
*Not specific
| style="background:#F5F5F5;" + |
*Tissue [[biopsy]]  (sample should be sufficient for [[Molecule|molecular]] testing)
| style="background:#F5F5F5;" + |
*Risk factor:
**Cigarette smoking
*Types
**[[Small cell lung cancer|Small cell lung cance]]<nowiki/>r ([[Small cell lung cancer|SCLC]])
**[[Non small cell lung cancer|Non−small cell lung cance]]<nowiki/>r ([[Non small cell lung cancer|NSCLC]])
|-
| align="center" style="background:#DCDCDC;" + |'''[[Interstitial lung disease]]'''<ref name="pmid15331185">{{cite journal |vauthors=Lama VN, Martinez FJ |title=Resting and exercise physiology in interstitial lung diseases |journal=Clin. Chest Med. |volume=25 |issue=3 |pages=435–53, v |year=2004 |pmid=15331185 |doi=10.1016/j.ccm.2004.05.005 |url=}}</ref><ref name="pmid15133338">{{cite journal |vauthors=Chetta A, Marangio E, Olivieri D |title=Pulmonary function testing in interstitial lung diseases |journal=Respiration |volume=71 |issue=3 |pages=209–13 |year=2004 |pmid=15133338 |doi=10.1159/000077416 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |Chronic
| style="background:#F5F5F5;" + |
*Variable
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| style="background:#F5F5F5;" + |
*[[Wheeze|Wheezing]]
*[[Rales|Crackles]] or velcro rales
*[[Lung volumes|Inspiratory]] high−pitched [[rhonchi]]
| style="background:#F5F5F5;" + |The following investigations may be helpful:
*[[Hepatic function test]]
*[[Renal function tests|Renal function test]]
*[[Complete blood count|CBC]]
*[[Serology|Serological testing]]
| style="background:#F5F5F5;" + |
*[[Nodular]], [[reticular]] or both pattern in [[Chest X-ray|chest X−ray]]
*[[Computed tomography|CT]] in patients with diffuse pulmonary lung disease
| style="background:#F5F5F5;" + |
*Reduction in [[Vital capacity|FVC]], [[Residual volume|RV]], [[Functional residual capacity|FRC]], [[Total lung capacity|TLC]] and [[FEV1]] on spirometry
*[[FEV1/FVC ratio|FEV1/FVC]] normal or increase
*[[Lung volumes]]
*Diffusion capacity ([[DLCO]] reduced)
| style="background:#F5F5F5;" + |
*Lung [[biopsy]] when lab, imaging, and PFT has indeterminate result
| style="background:#F5F5F5;" + |
*Clubbing is common in [[asbestosis]] and [[idiopathic pulmonary fibrosis]]
|-
| align="center" style="background:#DCDCDC;" + |'''[[Tuberculosis]] ([[Tuberculosis|TB]])'''<ref name="pmid9332519">{{cite journal |vauthors=Perlman DC, el-Sadr WM, Nelson ET, Matts JP, Telzak EE, Salomon N, Chirgwin K, Hafner R |title=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) |journal=Clin. Infect. Dis. |volume=25 |issue=2 |pages=242–6 |year=1997 |pmid=9332519 |doi= |url=}}</ref><ref name="pmid2456183">{{cite journal |vauthors=Barnes PF, Verdegem TD, Vachon LA, Leedom JM, Overturf GD |title=Chest roentgenogram in pulmonary tuberculosis. New data on an old test |journal=Chest |volume=94 |issue=2 |pages=316–20 |year=1988 |pmid=2456183 |doi= |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |Chronic
| style="background:#F5F5F5;" + |
*More than 2 or 3 weeks
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| style="background:#F5F5F5;" + |
*[[Pleural effusion]]
*[[Crackles]]
*[[Whispered pectoriloquy]]
*Decreased fremitus
*[[Rhonchi]]
| style="background:#F5F5F5;" + |
*Sputum [[Acid-fast|acid−fast]] bacilli ([[Acid-fast|AFB]]) smear may be positive
*[[Mycobacterium|Mycobacterial]] [[Culture media|culture]] may be positive
*Molecular testing may be helpful
| style="background:#F5F5F5;" + |
*Reactivation of [[Tuberculosis|TB]] is observed as [[Infiltration (medical)|infiltration]] in the upper [[Lobe (anatomy)|lobe]] in [[Chest X-ray|chest X−Ray]]
*In patients with [[Human Immunodeficiency Virus (HIV)|HIV]], Tb is observed as lobar [[Infiltration (medical)|infiltration]], [[adenopathy]], lung mass named [[tuberculoma]], small fibronodular lesions, and/or [[pleural effusion]] on [[Chest X-ray|chest X−Ray]]
*[[Computed tomography|CT]] can detect early nodal process
| style="background:#F5F5F5;" + |
*Decreased [[FEV1]]
*Reduced  [[Vital capacity|FVC]]
| style="background:#F5F5F5;" + |
*Isolation of ''[[Mycobacterium tuberculosis]]'' from some [[secretion]]
| style="background:#F5F5F5;" + |
*Etiology: ''[[Mycobacterium tuberculosis]]''
*Complications: [[Pneumothorax]], [[bronchiectasis]], pulmonary destruction and [[chronic pulmonary aspergillosis]]
|-
| align="center" style="background:#DCDCDC;" + |[[Cystic fibrosis|'''Cystic fibrosis''']]  ([[Cystic fibrosis|CF]])<ref name="pmid18639722">{{cite journal |vauthors=Farrell PM, Rosenstein BJ, White TB, Accurso FJ, Castellani C, Cutting GR, Durie PR, Legrys VA, Massie J, Parad RB, Rock MJ, Campbell PW |title=Guidelines for diagnosis of cystic fibrosis in newborns through older adults: Cystic Fibrosis Foundation consensus report |journal=J. Pediatr. |volume=153 |issue=2 |pages=S4–S14 |year=2008 |pmid=18639722 |pmc=2810958 |doi=10.1016/j.jpeds.2008.05.005 |url=}}</ref><ref name="pmid1285737">{{cite journal |vauthors=Kerem E, Reisman J, Corey M, Canny GJ, Levison H |title=Prediction of mortality in patients with cystic fibrosis |journal=N. Engl. J. Med. |volume=326 |issue=18 |pages=1187–91 |year=1992 |pmid=1285737 |doi=10.1056/NEJM199204303261804 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |Chronic
| align="center" style="background:#F5F5F5;" + |
*Variable
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +/−
| align="center" style="background:#F5F5F5;" + | +
| style="background:#F5F5F5;" + |
*Barrel−shaped chest
*[[Wheezing]]
*[[Tachypnea]]
| style="background:#F5F5F5;" + |
*[[Respiratory tract]] [[Culture media|culture]] may be helpful for diagnosing secondary bacterial infection
*[[Bronchoalveolar lavage]] for cytology may be helpful
*≥ 60 mmol/L [[Sweat chloride test]]
*[[CFTR (gene)|CFTR]] [[mutation]] in molecular testing may be positive
| style="background:#F5F5F5;" + |
*Hyperinflation, [[atelectasis]], and infiltrates on [[Chest X-ray|chest X−Ray]]
*Severe patients present bronchietasis, "tram tracks" [[Peribronchial cuffing|peribronchial cuffin]]<nowiki/>g in [[Chest X-ray|chest X−Ray]]
*The extension of [[bronchietasis]] can be defined by [[Computed tomography|CT]]
| style="background:#F5F5F5;" + |
*[[Residual volume|RV]]/[[Total lung capacity|TLC]] ratio increased
*[[FEV1/FVC ratio]] <70%
*Low levels of [[FEV1]]
*High levels of [[Total lung capacity|TLC]]
*[[Residual volume|RV]] increased
| style="background:#F5F5F5;" + |
*[[Sweat chloride test]]
| style="background:#F5F5F5;" + |
*Evidence of [[Cystic fibrosis transmembrane conductance regulator|CFTR]] dysfunction
|-
! colspan="2" rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Organ system
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Diseases
! colspan="8" align="center" style="background:#4479BA; color: #FFFFFF;" + |Clinical manifestations
! colspan="4" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Diagnosis
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Other features
|-
! colspan="7" align="center" style="background:#4479BA; color: #FFFFFF;" + |Symptoms
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Physical exam
|-
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Onset
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Duration
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Productive cough
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hemoptysis
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Weight lost
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Fever
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Dyspnea
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Ascultation
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Lab findings
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Imaging
! align="center" style="background:#4479BA; color: #FFFFFF;" + |PFT
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Gold standard
|-
| colspan="2" rowspan="2" align="center" style="background:#DCDCDC;" + |<nowiki>[[[Heart|</nowiki>'''Cardiac''']]
| align="center" style="background:#DCDCDC;" + |[[Mitral stenosis|'''Mitral Stenosis''']]<ref name="pmid13936649">{{cite journal| author=MUNROE DS, RALLY CR| title=The diagnosis of mitral stenosis. | journal=Can Med Assoc J | year= 1963 | volume= 88 | issue=  | pages= 611-22 | pmid=13936649 | doi= | pmc=1921207 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13936649  }}</ref><ref name="pmid19747723">{{cite journal |vauthors=Chandrashekhar Y, Westaby S, Narula J |title=Mitral stenosis |journal=Lancet |volume=374 |issue=9697 |pages=1271–83 |year=2009 |pmid=19747723 |doi=10.1016/S0140-6736(09)60994-6 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |Chronic
| style="background:#F5F5F5;" + |
*Variable
| align="center" style="background:#F5F5F5;" + | + Pink frothy
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| style="background:#F5F5F5;" + |
*[[Crackles]]
*[[Hoarseness]]
| style="background:#F5F5F5;" + |
*Not specifc
| style="background:#F5F5F5;" + |
*[[Electrocardiogram]] may be helpful
*Enlargement of [[left atrium]] and [[appendage]] in [[Chest X-ray|chest radiograph]]
| style="background:#F5F5F5;" + |
*[[Vital capacity|FVC]] reduced
| style="background:#F5F5F5;" + |
*Resting [[transthoracic echocardiography]]
| style="background:#F5F5F5;" + |
*[[Stress testing]]
*[[Cardiac catheterization]]
|-
| align="center" style="background:#DCDCDC;" + |[[Pulmonary hypertension|'''Pulmonary hypertension''']]<ref name="pmid21393391">{{cite journal |vauthors=Brown LM, Chen H, Halpern S, Taichman D, McGoon MD, Farber HW, Frost AE, Liou TG, Turner M, Feldkircher K, Miller DP, Elliott CG |title=Delay in recognition of pulmonary arterial hypertension: factors identified from the REVEAL Registry |journal=Chest |volume=140 |issue=1 |pages=19–26 |year=2011 |pmid=21393391 |pmc=3198486 |doi=10.1378/chest.10-1166 |url=}}</ref><ref name="pmid12651053">{{cite journal| author=Sun XG, Hansen JE, Oudiz RJ, Wasserman K| title=Pulmonary function in primary pulmonary hypertension. | journal=J Am Coll Cardiol | year= 2003 | volume= 41 | issue= 6 | pages= 1028-35 | pmid=12651053 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12651053  }}</ref>
| align="center" style="background:#F5F5F5;" + |Chronic
| style="background:#F5F5F5;" + |
*More than 2 years
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| style="background:#F5F5F5;" + |
*[[Dysphonia|Hoarseness]]
| style="background:#F5F5F5;" + |The following investigations may be helpful:
*[[Human Immunodeficiency Virus (HIV)|HIV]] serology
*[[Anti-nuclear antibody|Antinuclear antibody]] ([[Antinuclear antibodies|ANA]])
*[[Rheumatoid factor]] ([[RF]])
*[[Anti-neutrophil cytoplasmic antibody|Anti−neutrophil  cytoplasmic antibody]] ([[Anti-neutrophil cytoplasmic antibody|ANCA]])
| style="background:#F5F5F5;" + |
*Enlargement of the central [[pulmonary artery]] and right heart  in [[Chest X-ray|chest X−Ray]]
*[[Pulmonary  artery]] systolic pressure can be estimated in [[echocardiography]]
| style="background:#F5F5F5;" + |
*Low levels of [[FEV1]]
*Decreased [[Vital capacity|FVC]]
*[[DLCO]] reduced
| style="background:#F5F5F5;" + |
*Mean [[pulmonary artery]] pressure more than 25 [[mmHg]] at rest
| style="background:#F5F5F5;" + |
*[[Chest pain]]
*[[Ascites]]
*[[Syncope]]
*Peripherial [[edema]]
|-
| colspan="2" align="center" style="background:#DCDCDC;" + |[[Gastrointestinal tract|'''Gastrointestinal''']]
| align="center" style="background:#DCDCDC;" + |[[Gastroesophageal reflux disease|'''Gastroesophageal reflux''']]<ref name="pmid21508423">{{cite journal |vauthors=Kahrilas PJ, Hughes N, Howden CW |title=Response of unexplained chest pain to proton pump inhibitor treatment in patients with and without objective evidence of gastro-oesophageal reflux disease |journal=Gut |volume=60 |issue=11 |pages=1473–8 |year=2011 |pmid=21508423 |doi=10.1136/gut.2011.241307 |url=}}</ref><ref name="pmid25133039">{{cite journal| author=Badillo R, Francis D| title=Diagnosis and treatment of gastroesophageal reflux disease. | journal=World J Gastrointest Pharmacol Ther | year= 2014 | volume= 5 | issue= 3 | pages= 105-12 | pmid=25133039 | doi=10.4292/wjgpt.v5.i3.105 | pmc=4133436 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25133039  }}</ref>
| align="center" style="background:#F5F5F5;" + |Chronic
| style="background:#F5F5F5;" + |
*Variable
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| style="background:#F5F5F5;" + |
*[[Wheeze|Wheezing]]
*[[Hoarseness]]
| style="background:#F5F5F5;" + |
*Not specific
| style="background:#F5F5F5;" + |
*[[Upper endoscopy]] may be helpful
*[[Barium]] esophagram may be helpful
| style="background:#F5F5F5;" + |
*Normal function
| style="background:#F5F5F5;" + |
*PH testing
| align="center" style="background:#F5F5F5;" + |−−
|-
! colspan="2" rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Organ system
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Diseases
! colspan="8" align="center" style="background:#4479BA; color: #FFFFFF;" + |Clinical manifestations
! colspan="4" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Diagnosis
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Other features
|-
! colspan="7" align="center" style="background:#4479BA; color: #FFFFFF;" + |Symptoms
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Physical exam
|-
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Onset
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Duration
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Productive cough
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hemoptysis
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Weight lost
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Fever
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Dyspnea
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Ascultation
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Lab findings
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Imaging
! align="center" style="background:#4479BA; color: #FFFFFF;" + |PFT
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Gold standard
|-
| colspan="2" rowspan="5" align="center" style="background:#DCDCDC;" + |'''[[Autoimmune]]'''
| align="center" style="background:#DCDCDC;" + |[[Goodpasture syndrome|'''Goodpasture syndrome''']]<ref name="pmid3728460">{{cite journal |vauthors=Boyce NW, Holdsworth SR |title=Pulmonary manifestations of the clinical syndrome of acute glomerulonephritis and lung hemorrhage |journal=Am. J. Kidney Dis. |volume=8 |issue=1 |pages=31–6 |year=1986 |pmid=3728460 |doi= |url=}}</ref><ref name="pmid27496347">{{cite journal| author=Foster MH| title=Basement membranes and autoimmune diseases. | journal=Matrix Biol | year= 2017 | volume= 57-58 | issue=  | pages= 149-168 | pmid=27496347 | doi=10.1016/j.matbio.2016.07.008 | pmc=5290253 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27496347  }}</ref>
| align="center" style="background:#F5F5F5;" + |Chronic
| style="background:#F5F5F5;" + |
*Variable
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| style="background:#F5F5F5;" + |
*[[Shortness of breath]]
| style="background:#F5F5F5;" + |The following investigations may be helpful:
*[[Complete blood count]] ([[Complete blood count|CBC]])
*[[Anti-neutrophil cytoplasmic antibody|ANCA]] positive
*[[Goodpasture syndrome|Anti−GBM]] in [[Enzyme linked immunosorbent assay (ELISA)|ELISA]] or [[western blot]]
| style="background:#F5F5F5;" + |
*Pulmonary infiltratation in [[Chest X-ray|chest X−Ray]]
*[[Computed tomography|CT]] scan for parenchymal involvement
| style="background:#F5F5F5;" + |
*Increased [[DLCO]]
*Decreased [[Total lung capacity|TLC]]
*Decreased [[Vital capacity|FVC]]
| style="background:#F5F5F5;" + |
*Renal [[biopsy]]
| style="background:#F5F5F5;" + |
*[[Hematuria]]
*[[Proteinuria]]
|-
| align="center" style="background:#DCDCDC;" + |[[Granulomatosis with polyangiitis|'''Wegener's disease''']] ([[Granulomatosis with polyangiitis|'''GPA''']]) <ref name="pmid1739240">{{cite journal |vauthors=Hoffman GS, Kerr GS, Leavitt RY, Hallahan CW, Lebovics RS, Travis WD, Rottem M, Fauci AS |title=Wegener granulomatosis: an analysis of 158 patients |journal=Ann. Intern. Med. |volume=116 |issue=6 |pages=488–98 |year=1992 |pmid=1739240 |doi= |url=}}</ref><ref name="pmid21374588">{{cite journal |vauthors=Falk RJ, Gross WL, Guillevin L, Hoffman GS, Jayne DR, Jennette JC, Kallenberg CG, Luqmani R, Mahr AD, Matteson EL, Merkel PA, Specks U, Watts RA |title=Granulomatosis with polyangiitis (Wegener's): an alternative name for Wegener's granulomatosis |journal=Arthritis Rheum. |volume=63 |issue=4 |pages=863–4 |year=2011 |pmid=21374588 |doi=10.1002/art.30286 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |Chronic
| style="background:#F5F5F5;" + |
*Months
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| style="background:#F5F5F5;" + |
*[[Hoarseness]]
*[[Stridor]]
*[[Wheeze|Wheezing]]
| style="background:#F5F5F5;" + |The following investigations may be helpful:
*[[Anti-neutrophil cytoplasmic antibody|ANCA]], [[P-ANCA|P−ANCA]], [[C-ANCA|C−ANCA]]
*[[Blood urea nitrogen|BUN]]
*[[Creatinine]]
*[[Complete blood count]]
*[[Urinalysis]]
*Lung [[biopsy]]
| style="background:#F5F5F5;" + |
*[[Nodules]], [[Lung|pulmonary]] infiltrates, reticular margins, pleural opacities and [[Cavity|cavities]] in [[Chest X-ray|chest X−Ray]]
*[[Nodule (medicine)|Nodules]], [[cavities]] and stellate−shaped peripherial [[pulmonary]] in chest [[Computed tomography|CT]]
*[[Bronchoscopy]] may be helpful
| style="background:#F5F5F5;" + |
*Low levels of [[DLCO]]
*Reduce [[lung volumes]]
| style="background:#F5F5F5;" + |
*Tissue [[biopsy]]
| style="background:#F5F5F5;" + |
*Nasal crusting, sinus pain, chronic [[rhinosinusitis]], nasal obstruction and discharge in [[Upper respiratory tract|upper airway]]
*[[Saddle nose|Saddle nose deformity]]
*[[Purpura]] in lower extremities
|-
| align="center" style="background:#DCDCDC;" + |[[Sarcoidosis|'''Sarcoidosis''']]<ref name="pmid27378039">{{cite journal |vauthors=Carmona EM, Kalra S, Ryu JH |title=Pulmonary Sarcoidosis: Diagnosis and Treatment |journal=Mayo Clin. Proc. |volume=91 |issue=7 |pages=946–54 |year=2016 |pmid=27378039 |doi=10.1016/j.mayocp.2016.03.004 |url=}}</ref><ref name="pmid12803116">{{cite journal |vauthors=Yanardağ H, Pamuk GE, Karayel T, Demirci S |title=Bone marrow involvement in sarcoidosis: an analysis of 50 bone marrow samples |journal=Haematologia (Budap) |volume=32 |issue=4 |pages=419–25 |year=2002 |pmid=12803116 |doi= |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |Chronic
| style="background:#F5F5F5;" + |
*Years
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| style="background:#F5F5F5;" + |
*[[Wheeze|Wheezing]]
*Squeaky sounds
| style="background:#F5F5F5;" + |The following investigations may be helpful:
*[[Complete blood count]] ([[CBC]])
*[[Urinalysis]]
*[[Blood urea nitrogen|BUN]]
*[[Liver function tests|Liver function test]]
*[[Calcium]]
*[[Alkaline phosphatase]] levels
*[[Electrolyte|Electrolytes]]
*[[Histopathology|Histopathologic]] detection
| style="background:#F5F5F5;" + |
*On [[Chest X-ray|chest X−Ray]]:
**Stage 1: Bilateral hiliar [[adenopathy]]
**Stage 2: [[Reticular]] opacities and hiliar adenopathy
**Stage 3: Shrink hiliar [[Nodule (medicine)|nodules]] and [[reticular]] opacities
**Stage 4: Lost of volume
| style="background:#F5F5F5;" + |
*Reduced [[FVC]]
*Decreased of [[Total lung capacity|TLC]]
| style="background:#F5F5F5;" + |
*Clinical diagnosis, [[Histopathology|histopathologic]] detection of noncaseating [[Granuloma|granulomas]] and exclusion of other diseases
| style="background:#F5F5F5;" + |
*Young adults
*[[Skin]], [[joint]] and [[eye]] lesions
|-
| align="center" style="background:#DCDCDC;" + |'''Microscopic polyangitis ([[Microscopic polyangiitis|MPA]])'''<ref name="JennetteFalk1997">{{cite journal|last1=Jennette|first1=J. Charles|last2=Falk|first2=Ronald J.|title=Small-Vessel Vasculitis|journal=New England Journal of Medicine|volume=337|issue=21|year=1997|pages=1512–1523|issn=0028-4793|doi=10.1056/NEJM199711203372106}}</ref>
| align="center" style="background:#F5F5F5;" + |Chronic
| style="background:#F5F5F5;" + |
*Variable
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| style="background:#F5F5F5;" + |
*[[Hoarseness]]
*[[Stridor]]
*[[Wheeze|Wheezing]]
| style="background:#F5F5F5;" + |The following investigations may be helpful:
*[[ANCA]] positive
*[[Blood urea nitrogen|BUN]]
*[[Creatinine]]
*[[Complete blood count]]
*[[Urinalysis]]
| style="background:#F5F5F5;" + |
*[[Cavitation]], [[Nodule (medicine)|nodules]], and alveolar opacities in [[Chest X-ray|chest X−ray]]
*Head and chest [[Computed tomography|CT]] may be helpful
*[[Electromyography]]/[[nerve conduction study]] may also be helpful
| style="background:#F5F5F5;" + |
*Reduced [[lung volumes]]
| style="background:#F5F5F5;" + |
*Tissue [[biopsy]]
| style="background:#F5F5F5;" + |
*[[Nerve]] damage
*[[Rhinosinusitis]]
*[[Purpura]] involving lower extremities
|-
| align="center" style="background:#DCDCDC;" + |[[Eosinophilic granulomatosis with polyangiitis|'''Churg−Strauss''']]<ref name="pmid23330816">{{cite journal |vauthors=Vaglio A, Buzio C, Zwerina J |title=Eosinophilic granulomatosis with polyangiitis (Churg-Strauss): state of the art |journal=Allergy |volume=68 |issue=3 |pages=261–73 |year=2013 |pmid=23330816 |doi=10.1111/all.12088 |url=}}</ref><ref name="pmid6366453">{{cite journal |vauthors=Lanham JG, Elkon KB, Pusey CD, Hughes GR |title=Systemic vasculitis with asthma and eosinophilia: a clinical approach to the Churg-Strauss syndrome |journal=Medicine (Baltimore) |volume=63 |issue=2 |pages=65–81 |year=1984 |pmid=6366453 |doi= |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |Chronic
| style="background:#F5F5F5;" + |
*Variable
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| style="background:#F5F5F5;" + |
*[[Wheeze|Wheezing]]
*[[Rales]]
*[[Rhonchi]]
*Expiratory sounds(related to [[asthma]])
| style="background:#F5F5F5;" + |
*Peripherial [[eosinophilia]]
*In active phase [[C-reactive protein|CRP]] and [[Red blood cell|erytrocyte]] [[sedimentation]] rate high
*Elevated [[Immunoglobulin E|IgE]]
*[[Anti-neutrophil cytoplasmic antibody|ANCA]] positive
| style="background:#F5F5F5;" + |
*Infiltrates in [[Chest X-ray|chest X−Ray]]
*Ground glass opacities, tree−in−bud sign and small nodules  in chest [[Computed tomography|CT]]
| style="background:#F5F5F5;" + |
*[[Lung volumes]] decreased
*[[Vital capacity|FVC]] reduced
*[[FEV1/FVC ratio]] <70%
| style="background:#F5F5F5;" + |
*Tissue [[biopsy]]
| style="background:#F5F5F5;" + |
*[[Asthma]]
*[[Eosinophilia]]
*[[Rhinosinusitis]]
|}
|}



Revision as of 17:04, 23 April 2018

Bronchiectasis Microchapters

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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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