Diaphragmatic paralysis differential diagnosis: Difference between revisions

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{{Diaphragmatic paralysis}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Diaphragmatic_paralysis]]
{{CMG}}; {{AE}}  
{{CMG}}; {{AE}} {{MA}}


==Overview==
==Overview==
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
Unilateral diaphragmatic paralysis must be differentiated from eventration of the [[diaphragm]]. Eventration of the diaphragm is an abnormal elevation of the  hemidiaphragm. [[Bilateral]] diaphragmatic paralysis must be differentiated from other diseases that cause elevation of the diaphragm such as pleural adhesions, subpulmonic effusions, [[obesity]], [[ascites]], abdominal organomegaly and [[ileus]]. Diaphragmatic paralysis must be differentiated from other disease that cause [[dyspnea]] such as [[dermatomyositis]], [[polymyositis]], [[rib fracture]], [[Pleural effusion|pleural effusions]], [[amyotrophic lateral sclerosis]].  


OR
==Differentiating diaphragmatic paralysis from other Diseases  ==
Unilateral diaphragmatic paralysis must be differentiated from eventration of the diaphragm. Eventration of the diaphragm is an abnormal elevation of the  hemidiaphragm that some parts of hemidiaphragm are replaced by [[fibrous tissue]].  Clinical manifestations of eventration of the [[diaphragm]] include [[asymptomatic]], [[infection]] and [[respiratory distress]].<ref name="RavisagarAbhinav2015">{{cite journal|last1=Ravisagar|first1=Patel|last2=Abhinav|first2=Singh|last3=Mathur|first3=R.M.|last4=Anula|first4=Sisodia|title=Eventration of diaphragm presenting as recurrent respiratory tract infections – A case report|journal=Egyptian Journal of Chest Diseases and Tuberculosis|volume=64|issue=1|year=2015|pages=291–293|issn=04227638|doi=10.1016/j.ejcdt.2014.10.002}}</ref> 


[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
[[Bilateral]] diaphragmatic paralysis must be differentiated from other diseases that cause elevation of the diaphragm such as:    
 
==Differentiating diaphragmatic paralysis from other Diseases==
Unilateral diaphragmatic paralysis must be diffrentiated from eventration of the diaphragm. Eventration of the diaphragm is an abnormal elevation of the  hemidiaphragm that some parts of hemidiaphragm are replaced by fibrous tissue.  Clinical manifetations of  eventration of the diaphragm include asymptomatic, infection and respiratory distress.<ref name="RavisagarAbhinav2015" /> 
 
Bilateral diaphragmatic paralysis must be differentiated from other diseases that cause elevation of the diaphragm such as     
* Pleural adhesions     
* Pleural adhesions     
* Subpulmonic effusions   
* Subpulmonic effusions   
* Obesity with decreased chest wall compliance     
* [[Obesity]] with decreased chest wall compliance     
* Ascites  
* [[Ascites]]  
* Abdominal organomegaly   
* [[Abdominal]] [[organomegaly]]  
* Ileus 
* [[Ileus]]  
Diaphragmatic paralysis must be differentiated from other disease that cause dyspnea such as:
'''Diaphragmatic paralysis must be differentiated from other disease that cause dyspnea such as:'''
*
The differential diagnosis of bilateral diaphragmatic elevation on the plain chest radiograph includes subpulmonic effusions, pleural adhesions, obesity with decreased chest wall and abdominal compliance, and subdiaphragmatic processes such as ascites, organomegaly, and ileus.<ref name="RavisagarAbhinav2015">{{cite journal|last1=Ravisagar|first1=Patel|last2=Abhinav|first2=Singh|last3=Mathur|first3=R.M.|last4=Anula|first4=Sisodia|title=Eventration of diaphragm presenting as recurrent respiratory tract infections – A case report|journal=Egyptian Journal of Chest Diseases and Tuberculosis|volume=64|issue=1|year=2015|pages=291–293|issn=04227638|doi=10.1016/j.ejcdt.2014.10.002}}</ref>
 
EVENTRATION OF THE DIAPHRAGM — Eventration of the diaphragm is a disorder in which all or part of the diaphragmatic muscle is replaced by fibroelastic tissue, leading to a thinned and pliable central portion of the diaphragm.
 
Etiology — Eventration may be congenital or acquired; the congenital form reflects a failure of the fetal diaphragm to muscularize, whereas the acquired form is associated with phrenic nerve injury or is idiopathic [4,25]. The continuity of the diaphragm and normal attachments to the costal margin are maintained. (See "Eventration of the diaphragm in infants".)
 
Clinical manifestations — In adults, diaphragmatic eventration is rarely symptomatic. When present, the symptoms associated with diaphragmatic eventration include dyspnea, palpitations, chest pain, dyspepsia, and recurrent pneumonia [26]. The degree of respiratory impairment ranges from the more common asymptomatic elevation of the diaphragmatic dome to the much less common degree of respiratory impairment seen in unilateral diaphragmatic paralysis. (See 'Clinical manifestations'above.)
 
The severe congenital diaphragmatic eventration seen in newborns is discussed separately. (See "Eventration of the diaphragm in infants".)
*[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
*[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
 
*As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4].
 
===Preferred Table===
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
! colspan="4" |History and Symptoms
! colspan="4" |Physical Examination
! colspan="4" |Laboratory Findings
! rowspan="2" |Other Findings
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Finding
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!Physical Finding 1
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!Lab Test 1
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 1
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 2
| style="background: #F5F5F5; padding: 5px;" |'''↑'''
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 3
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| style="background: #F5F5F5; padding: 5px;" |↓
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 4
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 5
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===Use if the above table can not be made===
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
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|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differential Diagnosis}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Similar Features}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Differentiating Features}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 1
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 2
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 3
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 4
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 5
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
|}


<small>'''''Abbreviations:''''' '''ABG ('''[[arterial blood gas]]'''); ACE ('''[[Angiotensin-converting enzyme|angiotensin converting enzyme]]'''); BMI ('''[[body mass index]]'''); CBC ('''[[Complete blood counts|complete blood count]]'''); CSF ('''[[cerebrospinal fluid]]'''); CXR ('''[[chest X-ray]]'''); DOE ('''dyspnea on [[exercise]]'''); ECG ('''[[electrocardiogram]]'''); FEF ('''[[Spirometry|forced expiratory flow rate]]'''); FEV1 ('''[[forced expiratory volume]]'''); FVC ('''[[forced vital capacity]]'''); JVD ('''[[jugular vein distention]]''');''' '''MCV ('''[[mean corpuscular volume]]'''); Plt ('''[[platelet]]'''); RV ('''[[residual volume]]'''); SIADH ('''[[syndrome of inappropriate antidiuretic hormone]]'''); TSH ('''[[thyroid stimulating hormone]]'''); Vt ('''[[tidal volume]]''');''' '''WBC ('''[[White blood cells|white blood cell]]''');'''</small>  
<small>'''''Abbreviations:''''' '''ABG ('''[[arterial blood gas]]'''); ACE ('''[[Angiotensin-converting enzyme|angiotensin converting enzyme]]'''); BMI ('''[[body mass index]]'''); CBC ('''[[Complete blood counts|complete blood count]]'''); CSF ('''[[cerebrospinal fluid]]'''); CXR ('''[[chest X-ray]]'''); DOE ('''dyspnea on [[exercise]]'''); ECG ('''[[electrocardiogram]]'''); FEF ('''[[Spirometry|forced expiratory flow rate]]'''); FEV1 ('''[[forced expiratory volume]]'''); FVC ('''[[forced vital capacity]]'''); JVD ('''[[jugular vein distention]]''');''' '''MCV ('''[[mean corpuscular volume]]'''); Plt ('''[[platelet]]'''); RV ('''[[residual volume]]'''); SIADH ('''[[syndrome of inappropriate antidiuretic hormone]]'''); TSH ('''[[thyroid stimulating hormone]]'''); Vt ('''[[tidal volume]]''');''' '''WBC ('''[[White blood cells|white blood cell]]''');'''</small>  
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[[Sweating]]
[[Sweating]]
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|}</small></small>
</small></small>
 
==Related Chapters==
 
* [[Air hunger]] - The sensation of an urgent need to breathe, sensation that you cannot take in a full breath
* [[Tachypnea]] - Breathing rapidly
* [[Bradypnea]] - Breathing slowly
* [[Eupnea]] - Normal unlabored breathing
* [[Orthopnea]] - Dyspnea that occurs with lying flat
* [[Trepopnea]] - An abnormal awareness of one's own breathing that is seen in one lateral position but not in the other
* [[Paroxysmal nocturnal dyspnea]] - Sudden, severe shortness of breath at night that awakens a person from sleep, often with coughing and wheezing.
 
[[es:Disnea]]
[[es:Disnea]]
[[fr:Dyspnée]]
[[fr:Dyspnée]]
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==References==
==References==
[[Category:Medicine]]
[[Category:Emergency medicine]]
[[Category:Pulmonology]]
[[Category:Cardiology]]
[[Category:primary care]]
[[Category:Up-To-Date]]


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Latest revision as of 21:22, 29 July 2020

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

Overview

Unilateral diaphragmatic paralysis must be differentiated from eventration of the diaphragm. Eventration of the diaphragm is an abnormal elevation of the hemidiaphragm. Bilateral diaphragmatic paralysis must be differentiated from other diseases that cause elevation of the diaphragm such as pleural adhesions, subpulmonic effusions, obesity, ascites, abdominal organomegaly and ileus. Diaphragmatic paralysis must be differentiated from other disease that cause dyspnea such as dermatomyositis, polymyositis, rib fracture, pleural effusions, amyotrophic lateral sclerosis.

Differentiating diaphragmatic paralysis from other Diseases

Unilateral diaphragmatic paralysis must be differentiated from eventration of the diaphragm. Eventration of the diaphragm is an abnormal elevation of the hemidiaphragm that some parts of hemidiaphragm are replaced by fibrous tissue. Clinical manifestations of eventration of the diaphragm include asymptomatic, infection and respiratory distress.[1]

Bilateral diaphragmatic paralysis must be differentiated from other diseases that cause elevation of the diaphragm such as:

Diaphragmatic paralysis must be differentiated from other disease that cause dyspnea such as:

Abbreviations: ABG (arterial blood gas); ACE (angiotensin converting enzyme); BMI (body mass index); CBC (complete blood count); CSF (cerebrospinal fluid); CXR (chest X-ray); DOE (dyspnea on exercise); ECG (electrocardiogram); FEF (forced expiratory flow rate); FEV1 (forced expiratory volume); FVC (forced vital capacity); JVD (jugular vein distention); MCV (mean corpuscular volume); Plt (platelet); RV (residual volume); SIADH (syndrome of inappropriate antidiuretic hormone); TSH (thyroid stimulating hormone); Vt (tidal volume); WBC (white blood cell);

Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Loss of consciousness Agitation Weight loss Fever Chest pain Cough Orthopnea DOE Cyanosis Clubbing JVD Peripheral edema Auscultation CBC ABG Imaging Spirometry Gold standard
Acute Dyspnea Respiratory system Head and Neck,

Upper airway

Aspiration[2] - + - - +/- + - - + - - - Diminished breath sounds Normal Normal Atelectasis ↓Vt, ↑RV Bronchoscopy Choking
Chest and Pleura,

Lower airway

Atelectasis - - - +/- +/- +/- - - +/- - - - Diminished breath sounds, Wheeze Normal ↓O2, Normal/↓CO2 Collapsed lung lobe, fissuresdisplacement ↓ FVC Chest CT scan Surgical procedure, Aspiration,

Mechanical ventilation

Bronchitis[3] - - - + + + - - - - - - Rhonchi  ↑WBC Normal Normal Normal Physical exam Rhonchi relieved by cough
Bronchiolitis[4] - - - + +/- + - - - - - - Wheeze and Crackles ↑WBC Normal Bronchovascular markings ↓Vt Clinical assessment Respiratory syncytial virus (RSV)
Lung carcinoma[5] - - + - - + - - + + - - Wheeze and Crackles Normal Normal Mass lesion, hilar lymphadenopathy ↓Vt, ↑RV Bronchoscopy  Paraneoplastic syndromes, such as SIADH and lambert-Eaton
Pneumonia[6] - - - + + + - - - - - - Wheeze, Rhonchi, and Crackles ↑WBC, neutrophilia Normal Lobar consolidation Normal Chest X-ray and CT Scan productive cough
Pneumothorax[7] - - - - + - - - - - +/- - Diminished breath sounds Normal ↓O2, ↑CO2 Radiolucency without lung marking ↓Vt CXR and Chest CT scan Tracheal deviation
Pulmonary embolism[8] - - - - + - - +/- - - - - Normal Normal Respiratory alkalosis Normal Normal Pulmonary CT angiography Pleuritic chest pain
Rib fractures (flail chest)[9] - + - - + - - - - - - - Normal Normal Respiratory acidosis Fracture marks Normal Chest X-ray Pneumothorax
Cardiovascular system Pericardial tamponade[10] +/- - - - + - +/- +/- - - + - Muffled heart sounds Normal Normal Water bottle appearance enlarged heart Normal Echocardiography Fluid accumulation in pericardium
Pulmonary edema[11] +/- + - + + + + + + + + + Basal crackle Normal Respiratory alkalosis Bat wing pattern, air bronchograms ↓Vt, ↑RV Cardiac Catheterization Tachypnea
Central nervous system Stroke + - - +/- - - - - - - - - Normal Normal Normal Intracranial infarct or hemorrhage Normal Brain MRI Paralysis or paresthesia
Encephalitis[12] + + - + - - - - - - - - Normal ↑WBC, neutrophilia Normal Normal Normal CSF PCR Confusion
Traumatic brain injury[13] + +/- - - - - - - - - - - Normal Normal Respiratory acidosis Intracerebral hemorrhage Normal Brain CT scan Lucid interval
Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Loss of consciousness Agitation Weight loss Fever Chest pain Cough Orthopnea DOE Cyanosis Clubbing JVD Peripheral edema Auscultation CBC ABG Imaging Spirometry Gold standard
Chronic Dyspnea Respiratory system Head and Neck,

Upper airway

Goiter[14] - - - - - - - - - - - + Normal Normal Normal Normal Normal Blood test (TSH, T4) Weight gain
Laryngeal adenocarcinoma[15] - - + - - +/- - - - - - - Stridor Normal ↓O2, ↑CO2 Retropharyngeal tissue thickness Normal Laryngoscopy Choking sensation
Chest and Pleura,

Lower airway

COPD[16] - - +/- - - + + + + + + +/- Expiratory wheeze ↑ RBC Respiratory alkalosis, Metabolic acidosis ↑ Bronchovascular markings, Cardiomegaly ↓ FEV1/FVC Physical exam and

Spirometry

Heavy smoking history
Emphysema[17] - - - - - +/- - - + + - - Expiratory wheeze, Hyperinflation Normal Respiratory alkalosis, Metabolic acidosis Flattening of diaphragm, vertical heart ↓ FEV1/FVC Physical exam and

Spirometry

Barrel chest
Pulmonary hypertension[18] - - - - +/- +/- - - +/- +/- + + Accentuated S2 Normal Hypoxia and acidosis Enlarged pulmonary arteries ↑Physiologic RV Cardiac catheterization Syncope,

Ascites, Pleural effusion

Sarcoidosis[19] - - +/- - +/- + - - + - - - Crackles Normal ↓O2, ↑CO2 Hilar adenopathy ↑ FEV1/FVC High resolution computed tomography (HRCT) Hypercalcemia, high ACE
Pleural effusion[20] - +/- + - + - +/- - - - +/- +/- Egophony ("E-to-A" change) Normal Normal Blunting of the costophrenic and cardiophrenic angle ↓Vt, ↑RV Light's criteria ↓Tactile fremitus, Asymmetrical chest expansion
Diaphragmatic paralysis[21] - - - +/- +/- +/- + + - - - - Normal Normal Normal Unilateral or bilateral diaphragmatic flattening ↓Vt, ↑RV

(anatomical)

CXR confirmed by fluoroscopic sniff test Respiratory insufficiency
Tuberculosis[22] - - + + + + - - +/- - - - Rhonchi, Wheezing, Crackles ↑WBC ↓O2, ↑CO2 Patchy consolidation or poorly defined linear and nodular opacities Restrictive, obstructive, or mixed IFN-γ release assay (IGRA)

Acid-fast staining

Night sweat
Cardiovascular system Constrictive pericarditis[10] - - - - + - + + - - + - Muffled heart sounds Normal Normal Calcifications  Normal Chest CT scan Syncope
Pericardial effusion[23] - - - +/- + + +/- +/- - - + - Muffled heart sounds Normal Normal Fluid density around the heart Normal M-mode and 2-dimensional Doppler echocardiography Hoarseness, Palpitation
Neuromuscular disease Amyotrophic lateral sclerosis[24] +/- - +/- - - - - - - - - - Normal ↑WBC Normal Normal ↓Vt, ↑RV Revised El Escorial criteria (clinical) Muscle weakness, Dysphagia
Polymyositis/dermatomyositis[25] - - +/- - + - - - - - - +/- Normal ↑WBC Normal Normal ↓Vt, ↑RV Muscle biopsy Muscle weakness, Heliotrope
Mitochondrial diseases[26] - - +/- - - - - - - - - - Wheeze ↓WBC, Plt Normal Normal ↓Vt, ↑RV Muscle biopsy Muscle pain
Glycolytic enzyme defects (e.g., McArdle)[27] +/- - - - - - - - - - - +/- Normal Normal Normal Normal ↓Vt, ↑RV Muscle biopsy (ragged red fibers) Myoglobinuria,

Muscle weakness

Systemic Ascites[28] - - - - - - - - - - - - Normal Normal Normal Peritoneal fluid accumulation ↓Vt, ↑RV Abdominal ultrasound Abdominal distention
Kyphoscoliosis[29] - - - - - - - - - - - - Wheeze Normal Normal Deviated vertebral column ↓Vt, ↑RV

(anatomical)

Standing lateral spine radiograph Low back pain
Obesity[30] - - - - - - - - - - - - Normal Normal ↓O2 Normal ↓Vt, ↑RV

(anatomical)

BMI Low stamina,

Sweating

References

Template:WikiDoc Sources

  1. ↑ Ravisagar, Patel; Abhinav, Singh; Mathur, R.M.; Anula, Sisodia (2015). "Eventration of diaphragm presenting as recurrent respiratory tract infections – A case report". Egyptian Journal of Chest Diseases and Tuberculosis. 64 (1): 291–293. doi:10.1016/j.ejcdt.2014.10.002. ISSN 0422-7638.
  2. ↑ O'Horo JC, Rogus-Pulia N, Garcia-Arguello L, Robbins J, Safdar N (2015). "Bedside diagnosis of dysphagia: a systematic review". J Hosp Med. 10 (4): 256–65. doi:10.1002/jhm.2313. PMC 4607509. PMID 25581840.
  3. ↑ Cantin, Luce; Bankier, Alexander A.; Eisenberg, Ronald L. (2009). "Bronchiectasis". American Journal of Roentgenology. 193 (3): W158–W171. doi:10.2214/AJR.09.3053. ISSN 0361-803X.
  4. ↑ Holbro A, Lehmann T, Girsberger S, Stern M, Gambazzi F, Lardinois D, Heim D, Passweg JR, Tichelli A, Bubendorf L, Savic S, Hostettler K, Grendelmeier P, Halter JP, Tamm M (2013). "Lung histology predicts outcome of bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation". Biol. Blood Marrow Transplant. 19 (6): 973–80. doi:10.1016/j.bbmt.2013.03.017. PMID 23562737.
  5. ↑ Dela Cruz CS, Tanoue LT, Matthay RA (2011). "Lung cancer: epidemiology, etiology, and prevention". Clin Chest Med. 32 (4): 605–44. doi:10.1016/j.ccm.2011.09.001. PMC 3864624. PMID 22054876.
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  9. ↑ Swart E, Laratta J, Slobogean G, Mehta S (February 2017). "Operative Treatment of Rib Fractures in Flail Chest Injuries: A Meta-analysis and Cost-Effectiveness Analysis". J Orthop Trauma. 31 (2): 64–70. doi:10.1097/BOT.0000000000000750. PMID 27984449.
  10. ↑ 10.0 10.1 van Steijn JH, Sleijfer DT, van der Graaf WT, van der Sluis A, Nieboer P (2002). "How to diagnose cardiac tamponade". Neth J Med. 60 (8): 334–8. PMID 12481882.
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  12. ↑ Debiasi RL, Tyler KL (2004). "Molecular methods for diagnosis of viral encephalitis". Clin Microbiol Rev. 17 (4): 903–25, table of contents. doi:10.1128/CMR.17.4.903-925.2004. PMC 523566. PMID 15489354.
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  14. ↑ Stang MT, Armstrong MJ, Ogilvie JB, Yip L, McCoy KL, Faber CN, Carty SE (July 2012). "Positional dyspnea and tracheal compression as indications for goiter resection". Arch Surg. 147 (7): 621–6. doi:10.1001/archsurg.2012.96. PMID 22430090.
  15. ↑ Schwenk NR, Schapira RM, Byrd JC (November 1994). "Laryngeal carcinoma presenting as platypnea". Chest. 106 (5): 1609–11. PMID 7956433.
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  17. ↑ Sharafkhaneh A, Hanania NA, Kim V (2008). "Pathogenesis of emphysema: from the bench to the bedside". Proc Am Thorac Soc. 5 (4): 475–7. doi:10.1513/pats.200708-126ET. PMC 2645322. PMID 18453358.
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  19. ↑ Moher D, Cole CW, Hill GB (November 1992). "Epidemiology of abdominal aortic aneurysm: the effect of differing definitions". Eur J Vasc Surg. 6 (6): 647–50. PMID 1451823.
  20. ↑ Thomas R, Jenkins S, Eastwood PR, Lee YC, Singh B (July 2015). "Physiology of breathlessness associated with pleural effusions". Curr Opin Pulm Med. 21 (4): 338–45. doi:10.1097/MCP.0000000000000174. PMC 5633324. PMID 25978627.
  21. ↑ Dubé BP, Dres M (2016). "Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies". J Clin Med. 5 (12). doi:10.3390/jcm5120113. PMC 5184786. PMID 27929389.
  22. ↑ Campbell IA, Bah-Sow O (2006). "Pulmonary tuberculosis: diagnosis and treatment". BMJ. 332 (7551): 1194–7. doi:10.1136/bmj.332.7551.1194. PMC 1463969. PMID 16709993.
  23. ↑ Jung HO (2012). "Pericardial effusion and pericardiocentesis: role of echocardiography". Korean Circ J. 42 (11): 725–34. doi:10.4070/kcj.2012.42.11.725. PMC 3518705. PMID 23236323.
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  25. ↑ Schwarz MI, Matthay RA, Sahn SA, Stanford RE, Marmorstein BL, Scheinhorn DJ (January 1976). "Interstitial lung disease in polymyositis and dermatomyositis: analysis of six cases and review of the literature". Medicine (Baltimore). 55 (1): 89–104. PMID 1246203.
  26. ↑ Heinicke K, Taivassalo T, Wyrick P, Wood H, Babb TG, Haller RG (2011). "Exertional dyspnea in mitochondrial myopathy: clinical features and physiological mechanisms". Am J Physiol Regul Integr Comp Physiol. 301 (4): R873–84. doi:10.1152/ajpregu.00001.2011. PMC 3197343. PMID 21813873.
  27. ↑ Tarui S (1995). "Glycolytic defects in muscle: aspects of collaboration between basic science and clinical medicine". Muscle Nerve Suppl. 3: S2–9. PMID 7603522.
  28. ↑ Perri GA (2013). "Ascites in patients with cirrhosis". Can Fam Physician. 59 (12): 1297–9, e538–40. PMC 3860926. PMID 24336542.
  29. ↑ Qiabi M, Chagnon K, Beaupré A, Hercun J, Rakovich G (2015). "Scoliosis and bronchial obstruction". Can Respir J. 22 (4): 206–8. PMC 4530852. PMID 26083538.
  30. ↑ Sin DD, Jones RL, Man SF (July 2002). "Obesity is a risk factor for dyspnea but not for airflow obstruction". Arch. Intern. Med. 162 (13): 1477–81. PMID 12090884.

References

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