Pneumothorax differential diagnosis

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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]

Overview

Pneumothorax must be differentiated from other diseases that cause shortness of breath, difficulty breathing, and chest pain, such as [differential dx1], [differential dx2], and [differential dx3].

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

Upper airway

Aspiration[1] - + - - +/- + + - - - Diminished breath sounds Normal Normal Atelectasis Vt, ↑RV Bronchoscopy Choking
Chest and Pleura,

Lower airway

Pneumothorax[2] - - - - + - - - +/- - Diminished breath sounds Normal O2, ↑CO2 Radiolucency without lung marking Vt CXR and Chest CT scan Tracheal deviation
Asthma attack[3] - + - - +/- + + - - - Wheeze Eosinophil Respiratory alkalosis Normal FEV1, PEF Physical exam and

Spirometry

Chest pain
Bronchitis[4] - - - + + + - - - - Rhonchi  WBC Normal Normal Normal Physical exam Rhonchi relieved by cough
Bronchospasm[5] +/- + - - + +/- + - - - Wheeze Normal O2, ↑CO2 Normal Vt, ↑RV Physical exam Allergic reaction
Bronchiolitis[6] - - - + +/- + - - - - Wheeze and Crackles WBC Normal Bronchovascular markings Vt Clinical assessment Respiratory syncytial virus (RSV)
COPD exacerbation[7] - + - + + + + +/- +/- +/- Wheeze, Rhonchi, and Crackles WBC, ↑RBC Respiratory alkalosis Hyperexpansion FEV1/FVC Clinical assessment Acute exacerbations of chronic bronchitis (AECB)
Pneumonia[8] - - - + + + - - - - Wheeze, Rhonchi, and Crackles WBC, neutrophilia Normal Lobar consolidation Normal Chest X-ray and CT Scan productive cough
Pulmonary embolism[9] - - - - + - - - - - Normal Normal Respiratory alkalosis Normal Normal Pulmonary CT angiography Pleuritic chest pain
Rib fractures (flail chest)[10] - + - - + - - - - - Normal Normal Respiratory acidosis Fracture marks Normal Chest X-ray Pneumothorax

References

  1. 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.
  2. Currie GP, Alluri R, Christie GL, Legge JS (2007). "Pneumothorax: an update". Postgrad Med J. 83 (981): 461–5. doi:10.1136/pgmj.2007.056978. PMC 2600088. PMID 17621614.
  3. Hodder R, Lougheed MD, Rowe BH, FitzGerald JM, Kaplan AG, McIvor RA (2010). "Management of acute asthma in adults in the emergency department: nonventilatory management". CMAJ. 182 (2): E55–67. doi:10.1503/cmaj.080072. PMC 2817338. PMID 19858243.
  4. 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.
  5. Molis MA, Molis WE (2010). "Exercise-induced bronchospasm". Sports Health. 2 (4): 311–7. doi:10.1177/1941738110373735. PMC 3445098. PMID 23015953.
  6. 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.
  7. Qureshi H, Sharafkhaneh A, Hanania NA (2014). "Chronic obstructive pulmonary disease exacerbations: latest evidence and clinical implications". Ther Adv Chronic Dis. 5 (5): 212–27. doi:10.1177/2040622314532862. PMC 4131503. PMID 25177479.
  8. Simonetti AF, Viasus D, Garcia-Vidal C, Carratalà J (2014). "Management of community-acquired pneumonia in older adults". Ther Adv Infect Dis. 2 (1): 3–16. doi:10.1177/2049936113518041. PMC 4072047. PMID 25165554.
  9. Bĕlohlávek J, Dytrych V, Linhart A (2013). "Pulmonary embolism, part I: Epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism". Exp Clin Cardiol. 18 (2): 129–38. PMC 3718593. PMID 23940438.
  10. 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.



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