Caplans syndrome differential diagnosis: Difference between revisions

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{| style="border: 0px; font-size: 90%; margin: 3px; width: 700px;" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Disease}}
! style="background: #4479BA; width: 400px;" |{{fontcolor|#FFF|Findings}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Bacterial pneumonia]]
| style="padding: 5px 5px; background: #F5F5F5;" |Sudden onset of symptoms, such as high [[fever]], [[cough]], [[purulent]] [[sputum]], [[chest pain]], [[leukocytosis]], chest X-ray shows consolidation.
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Bronchogenic carcinoma]]
| style="padding: 5px 5px; background: #F5F5F5;" |may be asymptomatic, usually at older ages (> 50 years old), [[cough]], [[hemoptysis]], [[weight loss]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Brucellosis]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Fever]], [[anorexia]], [[night sweats]], [[malaise]],[[back pain]] , [[headache]], and [[depression]].  History of exposure to infected animal
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Hodgkin lymphoma]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Fever]], [[night sweats]], [[pruritus]], painless [[adenopathy]], [[mediastinal mass]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Mycoplasmal pneumonia]]
| style="padding: 5px 5px; background: #F5F5F5;" |Gradual onset of [[dry cough]], [[headache]], [[malaise]], [[sore throat]]. Diffuse bilateral infiltrates on [[chest X-ray]].
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Sarcoidosis]]
| style="padding: 5px 5px; background: #F5F5F5;" |Non-[[caseating]] [[granulomas]] in lungs and other organs, bilateral [[hilar]] [[lymphadenopathy]], mostly in African American females.
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Caplan syndrome
| style="padding: 5px 5px; background: #F5F5F5;" |
|-
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" |<small>Adapted from Mandell, Douglas, and Bennett's principles and practice of infectious diseases 2010  </small>
|}


===Differentiating [disease name] from other diseases on the basis of [symptom 1], [symptom 2], and [symptom 3]===


On the basis [symptom 1], [symptom 2], and [symptom 3], [disease name] must be differentiated from [disease 1], [disease 2], [disease 3], [disease 4], [disease 5], and [disease 6].
{| class="wikitable"
{|
!Causes of
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
lung cavities
! rowspan="4"  style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases
!Differentiating Features
| colspan="6" rowspan="1"  style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Clinical manifestations'''
!Differentiating radiological findings
! colspan="7" rowspan="2"  style="background: #4479BA; color: #FFFFFF; text-align: center;|Para-clinical findings
!Diagnosis
| colspan="1" rowspan="4"  style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Gold standard'''
confirmation
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Additional findings
|-
|
*[[Malignancy]] ([[Lung cancer|Primary lung cance<nowiki/>r]])
|
*Elderly male or female <ref name="pmid4353362">{{cite journal |vauthors=Chaudhuri MR |title=Primary pulmonary cavitating carcinomas |journal=Thorax |volume=28 |issue=3 |pages=354–66 |year=1973 |pmid=4353362 |pmc=470041 |doi= |url=}}</ref>
*Chronic smokers
*Presents with a [[low-grade fever]], absence of [[leukocytosis]], systemic complaints [[weight loss]], [[fatigue]]
*Absence of factors that predispose to [[gastric content aspiration]], no response to [[antibiotics]] within 10 days
*[[Hemoptysis]] is commonly associated with [[bronchogenic carcinoma]]
|
*A coin-shaped lesion with thick wall(>15mm) is seen on CXR with less ground glass opacities 
*[[Bronchoalveolar lavage]] [[cytology]] shows malignant cells
|
*[[Biopsy]] of lung
|-
|
*Pulmonary [[Tuberculosis, pulmonary|Tuberculosis]]
|
*Mostly in endemic areas
*Symptoms include [[productive cough]],[[night sweats]], [[fever]] and [[weight loss]]
|
*CXR and CT demonstrates [[Internal|cavities]] in the upper lobe of the lung
|
*[[Sputum]] smear-positive for [[acid-fast bacilli]] and nucleic acid amplification tests (NAAT) is used on sputum or any sterile fluid for rapid diagnosis and is positive for mycobacteria.
|-
|-
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Symptoms'''
|
! colspan="3" rowspan="2"  style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical examination
*[[Necrotizing Pulmonary Infections|Necrotizing]] [[Pneumonia]]
|
*Any age group
*Acute, [[fulminant]] life threating complication of prior infection
*>100.4F fever, with [[Hemodynamically unstable|hemodynamic]] instability
*Worsening [[pneumonia]]-like symptoms
|
*CXR demonstrates multiple cavitary lesions
*[[Pleural effusion]] and [[empyema]] are common findings
|
*[[Complete blood count|CBC]] is positive for the causative organism
|-
|-
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;|Lab Findings
|
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging
*Loculated [[empyema]]
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Histopathology
|
|-
*Children and elderly are at risk
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptom 1
 
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptom 2
*Pleuritic [[chest pain]], [[dry cough]], [[fever]] with chills
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptom 3
*Dullness to [[Percussion of the lungs|percussion]] decreased [[breath sounds]], and reduced vocal resonance on examination
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical exam 1
|
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical exam 2
*[[Empyema]] appears lenticular in shape and has a thin wall with smooth luminal margins
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical exam 3
|
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Lab 1
*[[Thoracocentesis]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Lab 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Lab 3
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging 1
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging 3
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 1
|
| style="background: #F5F5F5; padding: 5px;" |
*[[Granulomatosis with polyangiitis]] ([[Wegener's granulomatosis|Wegener's]])
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" |
*Women are more commonly effected than man.
| style="background: #F5F5F5; padding: 5px;" |
*Kidneys are also involved
| style="background: #F5F5F5; padding: 5px;" |
*Upper respiratory tract symptoms , perforation of [[nasal septum]], [[chronic sinusitis]], [[otitis media]], [[mastoiditis]].
| style="background: #F5F5F5; padding: 5px;" |
*Lower respiratory tract symptoms, [[hemoptysis]],  [[cough]], [[dyspnea]].
| style="background: #F5F5F5; padding: 5px;" |
*Renal symptoms, [[hematuria]], red cell [[casts]]
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" |
*Pulmonary nodules with cavities and infiltrates are a frequent manifestation of CXR
| style="background: #F5F5F5; padding: 5px;" |
 
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" |
*Positive for [[P-ANCA]]
| style="background: #F5F5F5; padding: 5px;" |
*Biopsy of the affected tissue shows necrotizing [[granulomas]] <ref name="pmid10377211">{{cite journal |vauthors=Langford CA, Hoffman GS |title=Rare diseases.3: Wegener's granulomatosis |journal=Thorax |volume=54 |issue=7 |pages=629–37 |year=1999 |pmid=10377211 |pmc=1745525 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 2
|
| style="background: #F5F5F5; padding: 5px;" |
*[[Rheumatoid nodule]]
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" |
*Elderly females of 40-50 age group
| style="background: #F5F5F5; padding: 5px;" |
*Manifestation of [[rheumatoid arthritis]]
| style="background: #F5F5F5; padding: 5px;" |
*Presents with other systemic symptoms including symmetric [[arthritis]] of the small joints of the hands and feet and morning stiffness are common manifestations.
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" |
*Pulmonary nodules with cavitation are present in the upper lobe ([[Caplan syndrome]]) on Xray.
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" |
*Positive for both [[rheumatoid factor]] and anti-cyclic citrullinated peptide [[Antibody|antibody.]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 3
|
| style="background: #F5F5F5; padding: 5px;" |
*[[Sarcoidosis]]
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" |
*More common in African-American females
| style="background: #F5F5F5; padding: 5px;" |
*Often [[asymptomatic]] except for [[Lymphadenopathy|enlarged lymph nodes]]
| style="background: #F5F5F5; padding: 5px;" |
*Associated with [[restrictive lung disease]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Erythema nodosum]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Lupus pernio]] (skin lesions on face resembling lupus)
| style="background: #F5F5F5; padding: 5px;" |
*[[Bell's palsy|Bell palsy]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Epithelioid]] [[granuloma]]<nowiki/>s containing microscopic [[Schaumann bodies|Schaumann]] and asteroid bodies
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" |
*On CXR bilateral [[Lymphadenopathy|adenopathy]] and coarse reticular opacities are seen.
| style="background: #F5F5F5; padding: 5px;" |
*CT of the chest demonstrates extensive [[Hilar lymphadenopathy|hilar]] and mediastinal adenopathy
| style="background: #F5F5F5; padding: 5px;" |
*Additional findings on CT include [[fibrosis]] (honeycomb, linear, or associated with bronchial distortion), pleural thickening, and ground-glass opacities.
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" |
*Biopsy of lung reveals non-[[caseating]] [[granuloma]]
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Diseases
!Symptom 1
! colspan="1" rowspan="1" |Symptom 2
!Symptom 3
!Physical exam 1
! colspan="1" rowspan="1" |Physical exam 2
!Physical exam 3
!Lab 1
!Lab 2
!Lab 3
!Imaging 1
!Imaging 2
!Imaging 3
!Histopathology
|'''Gold standard'''
!Additional findings
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 4
|
| style="background: #F5F5F5; padding: 5px;" |
*[[Bronchiolitis obliterans]] ([[Cryptogenic organizing pneumonia]])
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" |
*Rare condition and mimics [[asthma]], [[pneumonia]] and [[emphysema]]
| style="background: #F5F5F5; padding: 5px;" |
*It is due to [[drug]] or [[toxin]] exposure, [[autoimmune diseases]], [[viral infections]], or [[radiation injury]]
| style="background: #F5F5F5; padding: 5px;" |
*Individuals working in industries are at high risk
| style="background: #F5F5F5; padding: 5px;" |
*Presents with [[Fever|feve]]<nowiki/>r, [[cough]], [[wheezing]] and [[shortness of breath]] over weeks to months,
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" |
*Common appearance on CT is patchy [[Consolidation (medicine)|consolidation,]]<nowiki/>often accompanied by ground-glass opacities and nodules.
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" |
*Biopsy of the lung <ref name="pmid19561910">{{cite journal |vauthors=Al-Ghanem S, Al-Jahdali H, Bamefleh H, Khan AN |title=Bronchiolitis obliterans organizing pneumonia: pathogenesis, clinical features, imaging and therapy review |journal=Ann Thorac Med |volume=3 |issue=2 |pages=67–75 |year=2008 |pmid=19561910 |pmc=2700454 |doi=10.4103/1817-1737.39641 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
*[[Pulmonary function tests]] demonstrate low fev1/fvc
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 5
|
| style="background: #F5F5F5; padding: 5px;" |
*[[Langerhans cell histiocytosis|Langerhans]] cell [[Langerhans cell histiocytosis|Histiocytosis]]
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" |
*Exclusively occurs in smokers, with a peak age of onset 20-40 years.
| style="background: #F5F5F5; padding: 5px;" |
*Clinical presentation is variable, but symptoms generally include months of dry [[cough]], [[fever]], [[night sweats]] and [[weight loss]].
| style="background: #F5F5F5; padding: 5px;" |
*Skin is involved in 80% of the cases, scaly [[erythematous rash]] is typical.
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" |
*Thin-walled cystic cavities are the usual radiographic manifestation, observed in over 50% of patients by either CXR or CT scans.
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" |
*Biopsy of the lung
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 6
|Caplan syndrome
| style="background: #F5F5F5; padding: 5px;" |
|
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|
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|
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|}
|}
<references />


==References==
==References==

Revision as of 21:31, 16 June 2021

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

Overview

Caplan syndrome must be differentiated from Asbestosis, Silicosis, and Tuberculsosis.

Differentiating Caplan syndrome from other Diseases

Caplan syndrome must be differentiated from asbestosis, silicosis.


Disease Findings
Bacterial pneumonia Sudden onset of symptoms, such as high fever, cough, purulent sputum, chest pain, leukocytosis, chest X-ray shows consolidation.
Bronchogenic carcinoma may be asymptomatic, usually at older ages (> 50 years old), cough, hemoptysis, weight loss
Brucellosis Fever, anorexia, night sweats, malaise,back pain , headache, and depression. History of exposure to infected animal
Hodgkin lymphoma Fever, night sweats, pruritus, painless adenopathy, mediastinal mass
Mycoplasmal pneumonia Gradual onset of dry cough, headache, malaise, sore throat. Diffuse bilateral infiltrates on chest X-ray.
Sarcoidosis Non-caseating granulomas in lungs and other organs, bilateral hilar lymphadenopathy, mostly in African American females.
Caplan syndrome
Adapted from Mandell, Douglas, and Bennett's principles and practice of infectious diseases 2010


Causes of

lung cavities

Differentiating Features Differentiating radiological findings Diagnosis

confirmation

  • CXR and CT demonstrates cavities in the upper lobe of the lung
  • Sputum smear-positive for acid-fast bacilli and nucleic acid amplification tests (NAAT) is used on sputum or any sterile fluid for rapid diagnosis and is positive for mycobacteria.
  • Any age group
  • Acute, fulminant life threating complication of prior infection
  • >100.4F fever, with hemodynamic instability
  • Worsening pneumonia-like symptoms
  • CBC is positive for the causative organism
  • Children and elderly are at risk
  • Empyema appears lenticular in shape and has a thin wall with smooth luminal margins
  • Pulmonary nodules with cavities and infiltrates are a frequent manifestation of CXR
  • Elderly females of 40-50 age group
  • Manifestation of rheumatoid arthritis
  • Presents with other systemic symptoms including symmetric arthritis of the small joints of the hands and feet and morning stiffness are common manifestations.
  • Pulmonary nodules with cavitation are present in the upper lobe (Caplan syndrome) on Xray.
  • On CXR bilateral adenopathy and coarse reticular opacities are seen.
  • CT of the chest demonstrates extensive hilar and mediastinal adenopathy
  • Additional findings on CT include fibrosis (honeycomb, linear, or associated with bronchial distortion), pleural thickening, and ground-glass opacities.
  • Common appearance on CT is patchy consolidation,often accompanied by ground-glass opacities and nodules.
  • Exclusively occurs in smokers, with a peak age of onset 20-40 years.
  • Clinical presentation is variable, but symptoms generally include months of dry cough, fever, night sweats and weight loss.
  • Skin is involved in 80% of the cases, scaly erythematous rash is typical.
  • Thin-walled cystic cavities are the usual radiographic manifestation, observed in over 50% of patients by either CXR or CT scans.
  • Biopsy of the lung
Caplan syndrome
  1. Chaudhuri MR (1973). "Primary pulmonary cavitating carcinomas". Thorax. 28 (3): 354–66. PMC 470041. PMID 4353362.
  2. Langford CA, Hoffman GS (1999). "Rare diseases.3: Wegener's granulomatosis". Thorax. 54 (7): 629–37. PMC 1745525. PMID 10377211.
  3. Al-Ghanem S, Al-Jahdali H, Bamefleh H, Khan AN (2008). "Bronchiolitis obliterans organizing pneumonia: pathogenesis, clinical features, imaging and therapy review". Ann Thorac Med. 3 (2): 67–75. doi:10.4103/1817-1737.39641. PMC 2700454. PMID 19561910.

References