Difference between revisions of "Tuberculous pericarditis differential diagnosis"

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{|
 
{|
 
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
 
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases
+
! rowspan="2" |<small>Diseases</small>
| colspan="6" rowspan="1"  style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Clinical manifestations'''
+
! colspan="3" |<small>Diagnostic tests</small>
! colspan="7" rowspan="2"  style="background: #4479BA; color: #FFFFFF; text-align: center;|Para-clinical findings
+
! colspan="3" |<small>Physical Examination</small>
| colspan="1" rowspan="4"  style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Gold standard'''
+
| colspan="7" |<small>Symptoms
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Additional findings
+
! colspan="1" rowspan="2" |<small>Past medical history</small>
 +
! rowspan="2" |<small>Other Findings</small>
 +
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
 +
!<small>CT scan and MRI</small>
 +
!<small>EKG</small>
 +
!<small>Chest X-ray</small> 
 +
!<small>Tachypnea</small>
 +
!<small>Tachycardia</small>
 +
!<small>Fever</small>
 +
!<small>Chest Pain</small>
 +
!<small>Hemoptysis</small>
 +
!<small>Dyspnea on Exertion</small>
 +
!<small>Wheezing</small>
 +
!<small>Chest Tenderness</small>
 +
!<small>Nasalopharyngeal Ulceration</small>
 +
!<small>Carotid Bruit</small>
 
|-
 
|-
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Symptoms'''
+
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pulmonary embolism]]
! colspan="3" rowspan="2"  style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical examination
+
| style="background: #F5F5F5; padding: 5px; text-align:center" |
|-
+
* On [[CT angiography]]:
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;|Lab Findings
+
** Intra-luminal filling defect
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging
+
*On [[MRI]]:
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Histopathology
+
** Narrowing of involved [[Blood vessel|vessel]]
|-  
+
** No contrast seen distal to [[obstruction]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptom 1
+
** Polo-mint sign (partial filling defect surrounded by contrast)
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptom 2
 
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptom 3
 
! 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
 
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical exam 3
 
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Lab 1
 
! 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;" |
 
| style="background: #F5F5F5; padding: 5px;" |
 
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| 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: #F5F5F5; padding: 5px;" |
 
 
| style="background: #F5F5F5; padding: 5px;" |
 
| style="background: #F5F5F5; padding: 5px;" |
 +
* [[Pulmonary embolism electrocardiogram|S1Q3T3]] pattern representing acute [[right heart]] strain
 
| style="background: #F5F5F5; padding: 5px;" |
 
| style="background: #F5F5F5; padding: 5px;" |
 +
* [[Fleischner sign]] (enlarged pulmonary artery), [[Hampton's hump|Hampton hump]], [[Westermark's sign]]
 +
| style="background: #F5F5F5; padding: 5px;" |✔
 +
| style="background: #F5F5F5; padding: 5px;" |✔
 +
| style="background: #F5F5F5; padding: 5px;" |✔ (Low grade)
 +
| style="background: #F5F5F5; padding: 5px;" |✔
 +
| style="background: #F5F5F5; padding: 5px;" |✔ (In case of massive PE)
 +
| 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: #F5F5F5; padding: 5px;" |
 +
*Hypercoagulating conditions ([[Factor V Leiden]], [[thrombophilia]], [[deep vein thrombosis]], immobilization, [[malignancy]], [[pregnancy]])
 
| style="background: #F5F5F5; padding: 5px;" |
 
| style="background: #F5F5F5; padding: 5px;" |
 +
* May be associated with [[metabolic alkalosis]] and [[syncope]]
 
|-
 
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 2
+
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Congestive heart failure]]
| style="background: #F5F5F5; padding: 5px;" |
 
| style="background: #F5F5F5; padding: 5px;" |
 
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| style="background: #F5F5F5; padding: 5px;" |
 
| style="background: #F5F5F5; padding: 5px;" |
 
 
| style="background: #F5F5F5; padding: 5px;" |
 
| style="background: #F5F5F5; padding: 5px;" |
 +
*On [[Computed tomography|CT scan]]:
 +
** [[Mediastinal lymphadenopathy]]
 +
** Hazy [[mediastinal]] fat
 +
*On [[Magnetic resonance imaging|MRI]]:
 +
** Abnormality of [[cardiac]] chambers ([[Hypertrophy (medical)|hypertrophy]], dilation)
 +
** Delayed enhancement [[MRI]] may help characterize the [[myocardial]] [[Tissue (biology)|tissue]] ([[fibrosis]])
 +
** Late enhancement of contrast in conditions such as [[myocarditis]], [[sarcoidosis]], [[amyloidosis]], [[Anderson-Fabry disease|Anderson-Fabry]]'s disease, [[Chagas disease]])
 
| style="background: #F5F5F5; padding: 5px;" |
 
| style="background: #F5F5F5; padding: 5px;" |
 +
*Goldberg's criteria may aid in diagnosis of left ventricular dysfunction: (High specificity)
 +
**[[S wave|S]]V1 or [[S wave|S]]V2 + [[R wave|R]]V5 or [[R wave|R]]V6 ≥3.5 mV
 +
**Total [[QRS complex|QRS]] amplitude in each of the limb leads ≤0.8 mV
 +
** [[R wave|R]]/[[S wave|S]] ratio <1 in lead V4
 
| style="background: #F5F5F5; padding: 5px;" |
 
| style="background: #F5F5F5; padding: 5px;" |
 +
*[[Cardiomegaly]]
 +
| 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: #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;" |
 +
*Previous [[myocardial infarction]]
 +
*[[Hypertension]] ([[Systemic hypertension|systemic]] and [[Pulmonary hypertension|pulmonary]])
 +
*[[Cardiac arrhythmia|Cardiac arrythmias]]
 +
*[[Viral]] infections ([[myocarditis]])
 +
*[[Congenital heart disease|Congenital heart defects]]
 
| style="background: #F5F5F5; padding: 5px;" |
 
| style="background: #F5F5F5; padding: 5px;" |
 +
*[[Right heart failure]] associated with:
 +
**[[Hepatomegaly]]
 +
**Positive hepato-jugular reflex
 +
**Increased [[jugular venous pressure]]
 +
**[[Peripheral edema]]
 +
*[[Left heart failure]] associated with:
 +
**[[Pulmonary edema]]
 +
**Eventual [[right heart failure]]
 
|-
 
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 3
+
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Percarditis]]
| style="background: #F5F5F5; padding: 5px;" |
+
| style="background: #F5F5F5; padding: 5px;" |  
 +
*On contrast enhanced [[Computed tomography|CT scan]]:
 +
**Enhancement of the [[pericardium]] (due to [[inflammation]])
 +
**[[Pericardial effusion]]
 +
**[[Pericardial calcification]]
 +
*On [[gadolinium]]-enhanced fat-saturated [[Magnetic resonance imaging|T1-weighted MRI]]:
 +
**[[Pericardial]] enhancement (due to [[inflammation]])
 +
**[[Pericardial effusion]]
 +
| style="background: #F5F5F5; padding: 5px;" |
 +
*ST elevation
 +
*PR depression
 
| style="background: #F5F5F5; padding: 5px;" |
 
| style="background: #F5F5F5; padding: 5px;" |
 +
*Large collection of fluid inside the pericardial sac (pericardial effusion)
 +
*Calcification of pericardial sac
 +
| style="background: #F5F5F5; padding: 5px;" |✔
 +
| style="background: #F5F5F5; padding: 5px;" |✔
 +
| style="background: #F5F5F5; padding: 5px;" |✔ (Low grade)
 +
| style="background: #F5F5F5; padding: 5px;" |✔ (Relieved by sitting up and leaning forward)
 +
| 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: #F5F5F5; padding: 5px;" |
 
| style="background: #F5F5F5; padding: 5px;" |
 +
*Infections:
 +
**[[Viral]] (Coxsackie virus, [[Herpes simplex virus|Herpes virus]], [[Mumps virus]], [[Human Immunodeficiency Virus (HIV)|HIV]])
 +
**[[Bacteria]] ([[Mycobacterium tuberculosis]]-common in developing countries)
 +
**[[Fungal]] ([[Histoplasmosis]])
 +
*Idiopathic in a large number of cases
 +
*[[Autoimmune]]
 +
*[[Uremia]]
 +
*[[Malignancy]]
 +
*Previous [[myocardial infarction]]
 
| style="background: #F5F5F5; padding: 5px;" |
 
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
+
*May be clinically classified into:
| style="background: #F5F5F5; padding: 5px;" |
+
**Acute (< 6 weeks)
| style="background: #F5F5F5; padding: 5px;" |
+
**Sub-acute (6 weeks - 6 months)
| style="background: #F5F5F5; padding: 5px;" |
+
**Chronic (> 6 months)
| 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: #F5F5F5; padding: 5px;" |
 
|- 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: #DCDCDC; padding: 5px; text-align: center;" |[[Pneumonia]]
| 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: #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;" |
 +
*On [[Computed tomography|CT scan]]: (not generally indicated)
 +
**[[Consolidation (medicine)|Consolidation]] ([[alveolar]]/lobar pneumonia)
 +
**Peribronchial [[nodules]] ([[bronchopneumonia]])
 +
**[[Ground glass opacification on CT|Ground-glass opacity]] (GGO)
 +
**[[Abscess]]
 +
**[[Pleural effusion]]
 +
**On [[MRI]]:
 +
*Not indicated
 
| style="background: #F5F5F5; padding: 5px;" |
 
| style="background: #F5F5F5; padding: 5px;" |
 +
*Prolonged [[PR interval]]
 +
*Transient [[T wave]] inversions
 
| style="background: #F5F5F5; padding: 5px;" |
 
| style="background: #F5F5F5; padding: 5px;" |
 +
*[[Consolidation (medicine)|Consolidation]] ([[alveolar]]/lobar [[pneumonia]])
 +
*Peribronchial [[nodules]] (bronchopneumonia)
 +
*Ground-glass opacity (GGO)
 +
| 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: #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;" |
 +
*Ill-contact
 +
*Travelling
 +
*[[Smoking]]
 +
*[[Diabetes mellitus|Diabetic]]
 +
*Recent hospitalization
 +
*[[Chronic obstructive pulmonary disease]]
 
| style="background: #F5F5F5; padding: 5px;" |
 
| style="background: #F5F5F5; padding: 5px;" |
 +
*Requires [[Sputum|sputum stain]] and culture for diagnosis
 +
*[[Empiric therapy|Empiric management]] usually started before [[Culture collection|culture]] results
 
|-
 
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 5
+
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Vasculitis]]
| 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: #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;" |
 +
*On [[Computed tomography|CT scan]]: ([[Takayasu's arteritis|Takayasu arteritis]])
 +
**[[Blood vessel|Vessel]] wall thickening
 +
**Luminal narrowing of [[pulmonary artery]]
 +
**Masses or nodules ([[Anti-neutrophil cytoplasmic antibody|ANCA]]-associated granulomatous vasculitis)
 +
*On [[Magnetic resonance imaging|MRI]]:
 +
Homogeneous, circumferential [[Blood vessel|vessel]] wall [[swelling]]
 
| style="background: #F5F5F5; padding: 5px;" |
 
| style="background: #F5F5F5; padding: 5px;" |
 +
*[[Bundle branch block|Right or left bundle-branch block]] ([[Churg-Strauss syndrome]])
 +
*[[Atrial fibrillation]] ([[Churg-Strauss syndrome]])
 +
*Non-specific [[ST interval|ST segment]] and [[T wave]] changes
 
| style="background: #F5F5F5; padding: 5px;" |
 
| style="background: #F5F5F5; padding: 5px;" |
 +
*[[Nodule (medicine)|Nodules]]
 +
*[[Cavitation]]
 +
| 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: #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;" |
 +
*[[Takayasu's arteritis|Takayasu arteritis]] usually found in persons aged 4-60 years with a mean of 30
 +
*[[Giant-cell arteritis]] usually occurrs in persons aged > 60 years
 +
*[[Churg-Strauss syndrome]] may present with [[asthma]], [[sinusitis]], transient [[pulmonary]] infiltrates and neuropathy alongwith [[cardiac]] involvement
 +
*Granulomatous vasculitides may present with [[nephritis]] and [[upper airway]] ([[nasopharyngeal]]) destruction
 
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| style="background: #F5F5F5; padding: 5px;" |
 
|-
 
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 6
+
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Chronic obstructive pulmonary disease]] (COPD)
| 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: #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;" |
 +
*On [[Computed tomography|CT scan]]:
 +
**[[Chronic bronchitis]] may show [[bronchial]] wall thickening, scarring with bronchovascular irregularity, [[fibrosis]]
 +
**[[Emphysema]] may show [[alveolar]] septal destruction and airspace enlargement (Centrilobular- upper lobe, panlobular- lower lobe)
 +
**Giant bubbles
 +
*On [[MRI]]:
 +
**Increased diameter of [[pulmonary arteries]]
 +
**Peripheral [[pulmonary]] [[vasculature]] attentuation
 +
**Loss of retrosternal airspace due to right ventricular enlargement
 +
**Hyperpolarized Helium MRI may show progressively poor ventilation and destruction of lung
 
| style="background: #F5F5F5; padding: 5px;" |
 
| style="background: #F5F5F5; padding: 5px;" |
 +
*[[Multifocal atrial tachycardia]] (atleast 3 distinct [[P waves|P wave]] morphologies)
 
| style="background: #F5F5F5; padding: 5px;" |
 
| style="background: #F5F5F5; padding: 5px;" |
 +
*Enlarged [[lung]] shadows ([[emphysema]])
 +
*Flattening of [[diaphragm]] ([[emphysema]])
 +
| 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: #F5F5F5; padding: 5px;" |✔
 +
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Revision as of 17:42, 4 December 2019

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Tuberculous pericarditis Microchapters

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Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Tuberculous pericarditis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

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Echocardiography and Ultrasound

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MRI

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Case #1

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

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].

OR

[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].

Differentiating [Disease name] from other Diseases

[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].

OR

[Disease name] must be differentiated from [differential dx1], [differential dx2], and [differential dx3].

OR

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].

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].

Diseases Diagnostic tests Physical Examination Symptoms Past medical history Other Findings
CT scan and MRI EKG Chest X-ray Tachypnea Tachycardia Fever Chest Pain Hemoptysis Dyspnea on Exertion Wheezing Chest Tenderness Nasalopharyngeal Ulceration Carotid Bruit
Pulmonary embolism
  • On CT angiography:
    • Intra-luminal filling defect
  • On MRI:
    • Narrowing of involved vessel
    • No contrast seen distal to obstruction
    • Polo-mint sign (partial filling defect surrounded by contrast)
✔ (Low grade) ✔ (In case of massive PE) - - - -
Congestive heart failure
  • Goldberg's criteria may aid in diagnosis of left ventricular dysfunction: (High specificity)
    • SV1 or SV2 + RV5 or RV6 ≥3.5 mV
    • Total QRS amplitude in each of the limb leads ≤0.8 mV
    • R/S ratio <1 in lead V4
- - - - - -
Percarditis
  • ST elevation
  • PR depression
  • Large collection of fluid inside the pericardial sac (pericardial effusion)
  • Calcification of pericardial sac
✔ (Low grade) ✔ (Relieved by sitting up and leaning forward) - - - - -
  • May be clinically classified into:
    • Acute (< 6 weeks)
    • Sub-acute (6 weeks - 6 months)
    • Chronic (> 6 months)
Pneumonia - - - -
Vasculitis

Homogeneous, circumferential vessel wall swelling

-
Chronic obstructive pulmonary disease (COPD)
  • On CT scan:
  • On MRI:
    • Increased diameter of pulmonary arteries
    • Peripheral pulmonary vasculature attentuation
    • Loss of retrosternal airspace due to right ventricular enlargement
    • Hyperpolarized Helium MRI may show progressively poor ventilation and destruction of lung
- - - - - -

References


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