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 |
Pneumothorax[1] | - | - | - | - | + | - | - | - | +/- | - | Diminished breath sounds | Normal | ↓O2, ↑CO2 | Radiolucency without lung marking | ↓Vt | CXR and Chest CT scan | Tracheal deviation |
| Aspiration[2] | - | + | - | - | +/- | + | + | - | - | - | Diminished breath sounds | Normal | Normal | Atelectasis | ↓Vt, ↑RV | Bronchoscopy | Choking | |||
| Chest and Pleura,
Lower airway |
Asthma attack[3] | - | + | - | - | +/- | + | + | - | - | - | Wheeze | ↑ Eosinophil | Respiratory alkalosis | Normal | ↓ FEV1, PEF | Physical exam and | 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
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Molis MA, Molis WE (2010). "Exercise-induced bronchospasm". Sports Health. 2 (4): 311–7. doi:10.1177/1941738110373735. PMC 3445098. PMID 23015953.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.