Sandbox g60
Differential Diagnosis
DDx [1][2][3][4][5][6][7]- Sarcoidosis
DDx - Lymphocytic lymphoma
DDx - Miliary tuberculosis
DDx - Infectious mononucleosis
DDx - Thoracic aortic aneurysm
DDx - Substernal goiter
DDx - Thymoma
DDx - Actinomycosis
DDx - Chronic lymphocytic leukemia
DDx - Superior vena cava syndrome
DDx - Unicentric Castleman disease
DDx - Adult Still disease
DDx - Small cell lung carcinoma
DDx - Malignant histiocytosis
DDx
Evidence of "HODGKINS DISEASE" (COMMON)
The following clinical manifestations (if present) would support this disease: mental nerve neuropathy alcohol intolerance dermatitis, exfoliative epitrochlear lymph node enlargement inguinal lymph node enlargement hepatomegaly liver mass superior vena cava obstruction inferior vena cava obstruction femoral lymph node enlargement popliteal lymph node enlargement Pemberton sign positive fever, Pel-Ebstein ascites, chylous axillary lymph node enlargement erythema multiforme erythema nodosum hepatosplenomegaly mesenteric lymph node enlargement paraplegia pruritus spinal cord compression spleen enlargement urinary tract obstruction generalized diffuse lymph node enlargement airway compression or obstruction cryptococcosis bone pain cervical lymph node enlargement fever, recurrent recurrent infection lymph node, fixed neck mass night sweats anergy supraclavicular lymph node enlargement sweating increase fever unknown origin fever, remittent painless lymphadenopathy regional lymph node enlargement
The following lab data (if present) would be useful in establishing the presence of the disease: nucleated red cells retroperitoneal lymph node enlargement hypogammaglobulinemia pancytopenia lymphocytes decreased abdominal ultrasound, biliary tract dilatation granulomas on biopsy bone lesion chest xray mediastinal mass, adenopathy, or widening chest xray mediastinal mass middle mediastinal lymph node enlargement chest xray mediastinal mass anterior bone marrow granulomas gallium scan, increased uptake, abdomen ivory vertebra gallium scan increased uptake, mediastinum
Evidence of "SARCOIDOSIS" (COMMON)
The following clinical manifestations (if present) would support this disease: corneal deposit corneal opacity parotid gland swelling polyneuropathy cranial nerve paralysis airway compression or obstruction retinal granuloma erythema nodosum uveitis ankle pain facial paralysis salivary gland swelling splenomegaly, massive cryptococcosis generalized rash, papules (elevated, <0.5cm) iridocyclitis iritis cough, dry night sweats spleen enlargement uveitis, bilateral generalized diffuse lymph node enlargement polyarthritis
The following lab data (if present) would be useful in establishing the presence of the disease: heart conduction abnormality, electrocardiographic atrioventricular block hypercalcemia retroperitoneal lymph node enlargement pleural effusion, lymphocytes increased CXR lung cyst lymphocytes decreased chest xray interstitial infiltrate ( incl. reticulonodular ) hypercalciuria alkaline phosphatase, mild-moderate elevation gallium scan increased uptake, mediastinum gallium scan increased uptake, lungs PFT's: restrictive defect PFT's: diffusion capacity decreased mediastinal lymph node enlargement bone marrow granulomas serum angiotensin-converting enzyme elevated vitamin D, 1,25-dihydroxy, increased chest xray mediastinal mass, adenopathy, or widening granulomas on biopsy chest xray hilar lymph node enlargement
Evidence of "LYMPHOCYTIC LYMPHOMA" (COMMON)
The following clinical manifestations (if present) would support this disease: mental nerve neuropathy dermatitis, exfoliative extremity paralysis, lower gout esophageal candidiasis abdominal mass biliary tract obstruction breast mass epitrochlear lymph node enlargement erythema multiforme erythema nodosum esophageal obstruction facial edema gastric obstruction thyroid nodule hepatosplenomegaly intestinal obstruction intussusception liver mass mesenteric lymph node enlargement mucous membrane bleeding night sweats paraplegia pruritus anergy spinal cord compression stool clay color stool color yellow superior vena cava obstruction supraclavicular lymph node enlargement testicular mass urinary tract obstruction inferior vena cava obstruction generalized diffuse lymph node enlargement splenomegaly, massive femoral lymph node enlargement popliteal lymph node enlargement airway compression or obstruction cryptococcosis recurrent infection lymph node, fixed neck mass spleen enlargement fever unknown origin regional lymph node enlargement painless lymphadenopathy cancer lymphoma non-Hodgkin lymphoma
The following lab data (if present) would be useful in establishing the presence of the disease: IVP bladder mass or abnormal shape hypercalcemia, extreme (>14 mg/dl) bone destruction kidney mass mediastinal lymph node enlargement prolonged bleeding time ESR markedly increased retroperitoneal lymph node enlargement hypogammaglobulinemia bone lesion pancytopenia lymphocytes decreased chest xray mediastinal mass, adenopathy, or widening chest xray mediastinal mass anterior pleural effusion, exudate bone marrow plasma cells increased cryoglobulinemia abdominal ultrasound, biliary tract dilatation pleural effusion, lymphocytes increased pleural effusion, chylous malignant ascites gallium scan increased uptake, mediastinum gallium scan, increased uptake, abdomen vitamin D, 1,25-dihydroxy, increased
The following clinical manifestations (if present) would support this disease: prison inmate retinal granuloma erythema nodosum Haiti immunosuppressive therapy weight loss, severe corticosteroid use chest pain, pleuritic dyspnea, progressive fever unknown origin retinitis tuberculosis exposure
The following lab data (if present) would be useful in establishing the presence of the disease: pancytopenia PPD positive nucleated red cells gallium scan, increased uptake, abdomen abdominal CT: multiple hypodense liver lesions bone marrow granulomas AFB smear positive chest xray multiple pulmonary nodules, non-calcified granulomas on biopsy
Evidence of "INFECTIOUS MONONUCLEOSIS" (COMMON) The following clinical manifestations (if present) would support this disease:
optic neuritis epitrochlear lymph node enlargement periorbital edema pharyngeal petechia spleen enlargement spleen palpable tonsillitis abdominal tenderness, left upper quadrant axillary lymph node enlargement inguinal lymph node enlargement mesenteric lymph node enlargement pharyngeal exudate pharyngeal erythema spleen tenderness tonsillar exudate generalized diffuse lymph node enlargement cervical lymph node enlargement pharyngeal swelling sore throat
The following lab data (if present) would be useful in establishing the presence of the disease:
SGPT (ALT), marked elevation SGPT (ALT), elevated lymphocytes increased atypical lymphocytes increased heterophile antibody positive monocytes, increased Epstein-Barr virus titre positive
Evidence of "THORACIC AORTIC ANEURYSM" (RARE)
The following clinical manifestations (if present) would support this disease: cocaine use Turner syndrome Pemberton sign positive marfan syndrome aortic valve regurgitation superior vena cava obstruction aortic dilation, ascending
The following lab data (if present) would be useful in establishing the presence of the disease: chest xray mediastinal mass middle chest xray mediastinal mass posterior mediastinal widening chest xray aorta prominent or enlarged chest xray mediastinal mass anterior chest xray mediastinal mass, adenopathy, or widening
Evidence of "SUBSTERNAL GOITER" (RARE)
The following clinical manifestations (if present) would support this disease: upper extremity edema chest mass neck mass thyroid enlargement tracheal compression Pemberton sign positive
The following lab data (if present) would be useful in establishing the presence of the disease: TSH elevated chest xray mediastinal mass, adenopathy, or widening chest xray mediastinal mass anterior
Evidence of "THYMOMA" (RARE)
The following clinical manifestations (if present) would support this disease: bulbar palsy facial candida infection facial cyanosis jugular venous distention mouth candida infection superior vena cava obstruction diplopia Pemberton sign positive
The following lab data (if present) would be useful in establishing the presence of the disease: pancytopenia antistriational antibodies chest xray mediastinal mass, adenopathy, or widening chest xray mediastinal mass anterior
Evidence of "ACTINOMYCOSIS" (RARE)
The following clinical manifestations (if present) would support this disease:
tongue mass trismus pericardial constriction pharyngeal swelling pharyngeal tenderness abdominal fistula bronchial fistula empyema lung abscess abdominal mass, right lower quadrant chest wall suppuration gingival fistula chest wall fistula gingival swelling gingival tenderness jaw induration mandibular swelling
The following lab data (if present) would be useful in establishing the presence of the disease:
echocardiogram: intracardiac mass hepatic cyst(s) mediastinal lymph node enlargement chest xray mediastinal mass, adenopathy, or widening Gram stain: branching Gram-positive bacilli sulfur granule
Evidence of "CHRONIC LYMPHOCYTIC LEUKEMIA" (RARE)
The following clinical manifestations (if present) would support this disease: skin infiltration sternal tenderness lymph node firmness
The following lab data (if present) would be useful in establishing the presence of the disease: hemolysis mediastinal lymph node enlargement prolonged bleeding time chest xray mediastinal mass, adenopathy, or widening monoclonal gammopathy cryoglobulinemia leukocytes, marked increase flow cytometry: clonal B-lymphocytes lymphocytes increased
The following findings (if present) would make this disease less likely: left shift metamyelocytes increased
Evidence of "SUPERIOR VENA CAVA SYNDROME" (RARE - Urgent action required) The following clinical manifestations (if present) would support this disease:
stridor facial erythema forehead vein distention lymphoma tracheal displacement chest vein distention facial cyanosis collateral circulation increase conjunctival edema conjunctival vein distention upper extremity edema upper extremity erythema head edema jugular venous distention with inspiration lung tumor extremity cyanosis upper extremity vein distention facial edema neck edema jugular venous distention lung cancer upper extremity cyanosis facial vein distention superior vena cava obstruction
The following lab data (if present) would be useful in establishing the presence of the disease:
mediastinal lymph node enlargement chest xray pulmonary nodule (< 4 cm), non-calcified chest xray mediastinal mass, adenopathy, or widening
The following findings (if present) would exclude this disease:
hepatojugular reflux
Evidence of "UNICENTRIC CASTLEMAN DISEASE" (RARE)
The following lab data (if present) would be useful in establishing the presence of the disease: mediastinal lymph node enlargement chest xray mediastinal mass, adenopathy, or widening
Evidence of "ADULT STILL DISEASE" (RARE)
The following clinical manifestations (if present) would support this disease: ankylosis hepatosplenomegaly weight loss, severe fever, recurrent night sweats wrist pain generalized diffuse lymph node enlargement fever unknown origin fever, remittent fever, high grade polyarticular rash, evanescent
The following lab data (if present) would be useful in establishing the presence of the disease: leukocytes, marked increase ESR markedly increased serum ferritin greatly increased
The following findings (if present) would make this disease less likely: monoarticular
The following findings (if present) would exclude this disease: asymptomatic
Evidence of "SMALL CELL LUNG CARCINOMA" (COMMON)
The following clinical manifestations (if present) would support this disease: acanthosis nigricans axillary lymph node enlargement axillary lymph node pain dysphagia esophageal obstruction heart tamponade pericardial effusion rib tenderness, lower tracheal displacement hoarseness digital clubbing airway compression or obstruction Pemberton sign positive palms, velvet Horner syndrome superior vena cava obstruction bone pain spinal cord compression supraclavicular lymph node enlargement intracranial metastatic tumor acute symmetrical peripheral neuropathy hemoptysis right supraclavicular lymph node enlargement tobacco smoking
The following lab data (if present) would be useful in establishing the presence of the disease: bone destruction chest xray unilateral diaphragm elevation chest xray pulmonary nodule (< 4 cm), non-calcified chest xray mediastinal mass, adenopathy, or widening pleural effusion pleural effusion, bloody chest xray pulmonary mass (>= 4 cm), non-calcified hyponatremia bone marrow tumor cells serum calcitonin, increased chest xray hilar lymph node enlargement
The following findings (if present) would make this disease less likely: chest xray normal chest CT (contrast enhanced) normal
Evidence of "MALIGNANT HISTIOCYTOSIS" (RARE)
The following clinical manifestations (if present) would support this disease: tendon xanthoma xanthoma tuberous xanthoma planar xanthoma palmar planar xanthoma hepatosplenomegaly spleen enlargement panniculitis generalized diffuse lymph node enlargement
The following lab data (if present) would be useful in establishing the presence of the disease: ESR markedly increased serum ferritin greatly increased ESR mildly or moderately increased C-reactive protein elevated
- ↑ Ferri, Fred (2011). Ferri's differential diagnosis: a practical guide to the differential diagnosis of symptoms, signs, and clinical disorders. Philadelphia, PA: Elsevier/Mosby. ISBN 978-0323076999.
- ↑ Siegenthaler, Walter (2007). Differential diagnosis in internal medicine: from symptom to diagnosis. Stuttgart New York: Thieme. ISBN 978-1588905512.
- ↑ Mesko, Dusan (2002). Differential diagnosis by laboratory medicine: a quick reference for physicians. Berlin New York: Springer-Verlag. ISBN 978-3540430575.
- ↑ Reeder and Felson's gamuts in radiology: comprehensive lists of roentgen differential diagnosis. Place of publication not identified: Springer. 2014. ISBN 978-1475781229.
- ↑ Burgener, Francis (2008). Differential diagnosis in conventional radiology. Stuttgart New York: Thieme. ISBN 978-1588902757.
- ↑ Gattuso, Paolo (2015). Differential diagnosis in surgical pathology. Philadelphia, PA: Saunders/Elsevier. ISBN 978-1455770137.
- ↑ "DXplain".