Sandbox:Trusha

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

1. Bowel endometriosis vs Hemorrhoids vs Diverticular diseases vs Anal fissure vs Ulcerative colitis vs Crohn's disease
2. Colorectal carcinoma (Adenocarcinoma) vs Peutz-Jeghers syndrome vs Juvenile Polyposis Coli vs Gastrointestinal Stromal Tumors vs Hamartoma vs Colorectal Lymphoma
3. Strangulated hernia vs Appendicitis vs Crohn's disease
4. Irritable bowel syndrome vs Crohn's disease vs Ulcerative colitis vs Infectious colitis vs Carcinoids

Diseases	Clinical manifestations					Para-clinical findings					Gold standard	Additional findings
	Symptoms				Physical exam
						Lab Findings	Radiology			Histopathology
	Productive cough	Hemoptysis	Weight loss	Other	Auscultation	Sputum analysis	Nodule	Nodule content	Other findings
Pulmonary Nodule(benign)	-	-	-	Asymptomatic	Normal Present pleural friction rub Present egophony Crackling or bubbling noises Present whispered pectoriloquy Decreased/absent breath sounds	Normal	Single Round, oval <5 mm nodule Ground glass	Fat Calcification Central dense nidus Diffuse solid Laminated Popcorn	well-defined smooth border Growth rate over 18 months Cavity wall thickness of 1 mm	N/A	N/A	↓ O2 Sat
Pulmonary Nodule (malignant)	++	++	++	Dyspnea Non resolving pneumonia Wheezing Chest pain Cachexia Fatigue Loss of appetite Dysphonia Dysphagia	Normal Present pleural friction rub Present egophony Crackling or bubbling noises Present whispered pectoriloquy Decreased/absent breath sounds	Tumor cells	Multiple small Single > 2 cm of size	Calcification Amorphous Punctate Reticular Stippled or eccentric Cavity Ulceration	Spiculated border Rapid growth rate (Doubling time 1-18 months) Cavity wall thickness over 15 mm	central necrosis Cavity lined by viable cancer cells without necrosis	Biopsy and histopathological analysis	↓ O2 Sat
Diseases	Productive cough	Hemoptysis	Weight loss	Other symptoms	Auscultation	Sputum analysis	Nodule	Content	Other findings	Histopathology	Gold standard	Additional findings
Abscess	++	-	-	High fever (> 101' F) Pleuritic chest pain Foul smelling sputum Night sweats Dyspnea Weight loss Fatigue	Decreased breath sound Bronchial breath sound Inspiratory crackles Localised crepitations	Causative agents	Vary in size Round in shape	Fluid/gas-fluid level Surrounding area consolidation Cavity persists longer than consolidation	. The wall of the abscess is typically thick and the luminal surface irregular Bronchial vessels and bronchi are truncated	In central parts of abscess there are necrotic tissue mixed with necrotic granulocytes and bacteria Neutrophillic granulocytes with dilated blood vessels and inflammatory oedema	Histopathological analysis	Clubbing of finger
Septic pulmonary emboli	-	-	-	High fever Dyspnea Chest pain Focus of primary infection (Most common, right heart endocarditis)	Prominent P2 component of second heart sound Decreased breath sound Rales Crackles Pleural friction rub	N/A	Multiple peripheral nodules Size 0.5– 3.5 cm Variable shapes	Central low attenuation Feeding vessels Pleura based wedge-shaped lesions	air bronchograms Abscess or infection related changes at the primary focus	N/A	Culture and sensitivity	N/A
Fungal infection	+/-	+	-	Fever Dyspnea Chest pain Hypersensitivity or allergic reactions History of travel	Decreased breath sound Rales Crackles Pleural friction rub	KOH stain: Fungi	Multiple nodules Size 0.5– 3 cm nodules surrounded by ground-glass opacity/halo	Cavity	Halo sign in aspergillosis Patchy infiltrate Consolidation Mediastinal adenopathy	Specific causative agent	Culture and sensitivity	N/A
Parasites	+/-	+/-	+/-	Asymptomatic Chest pain Pneumothorax Fever Wheeze Urticaria Rarely, anaphylaxis	Decreased breath sound Rales Crackles	N/A	Cysts: Single or multiple well-defined homogenous Coin lesion: 1–3 cm	Cyst: Fluid or gas Worm Coin lesion: Central necrotic area surrounded by granulomatous reaction and fibrous wall	Calcified cyst wall Consolidation Pleural effusion Worm	Presence of larvae or eggs	Visualization of parasite	N/A
Diseases	Productive cough	Hemoptysis	Weight loss	Other symptoms	Auscultation	Sputum analysis	Nodule	Content	Other findings	Histopathology	Gold standard	Additional findings
Mycobacterial infections	+	+	+	Chronic cough Fever Night sweats Dyspnea Wheezing Chest pain Cachexia Fatigue Loss of appetite	Decreased breath sounds Rales Rhonchi Bronchial breath sounds	AFB+	Micronodules in the subpleural region and peribronchovascular interstitium Fluffy upper zone shadowing Cavity	Superinfected cavities shows air-fluid level	Fluffy upper zone shadowing Interlobular septal thickening Homogeneous and dense consolidation	Granulomas: necrotizing or non-necrotizing Langhans giant cells Caseous necrosis	Culture and sensitivity	N/A
Chronic inflammatory conditions (Granulomatosis with polyangiitis)	+/-	+	-	Hoarseness Chest pain Dyspnea Stridor	Pleural friction rub Absent breath sound Crackles	N/A	Multiple round lesions Size 0.5 to 10 cm	Patchy or diffuse ground-glass opacities, or both	Cavity Thick wall Irregular inner contour Atelectasis	Pathologic triad of granulomatous inflammation, vasculitis, and necrosis	Biopsy	c-ANCA p-ANCA
Diseases	Productive cough	Hemoptysis	Weight loss	Other symptoms	Auscultation	Sputum analysis	Nodule	Content	Other findings	Histopathology	Gold standard	Additional findings
Pulmonary AVMs	-	+/-	-	Dyspnoea Epistaxis Palpitation Chest pain GI bleeding Mucocutaneous telangiectasia	Bruit	RBCs	Solitary or multiple nodules Round, oval, or polycyclic Size 1 to 5 cm	Feeding pulmonary arteries and draining pulmonary veins	Well-defined borders Lower and middle third of the lung	Not recommended	Pulmonary angiography	N/A
Pneumoconiosis	+	-	+	Dyspnoea Chest pain	Fine crackles Rhonchi Bronchial breath sounds Expiratory wheezing Egophony Bronchophony	Inorganic particle	Solitary or multiple nodules Size 1 - 10 cm In the upper lobes	N/A	Massive fibrosis or conglomerate masses Small nodular opacities lymphadenopathy eggshell calcification	Calcification Central necrosis Dense collagen Malignant cells	CT scan	N/A