Chest pain, cough and fever

	Chest pain Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Chest pain from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Chest Pain in Pregnancy
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Interventions
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Chest pain, cough and fever On the Web
Most recent articles
cited articles
Review articles
CME Programs
Powerpoint slides
Images
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Chest pain, cough and fever
CDC on Chest pain, cough and fever
Chest pain, cough and fever in the news
Blogs on Chest pain, cough and fever
to Hospitals Treating Chest pain, cough and fever
Risk calculators and risk factors for Chest pain, cough and fever

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

Abbreviations: ABG (arterial blood gas); ACE (angiotensin converting enzyme); BMI (body mass index); CBC (complete blood count); CSF (cerebrospinal fluid); CXR (chest X-ray); ECG (electrocardiogram); FEF (forced expiratory flow rate); FEV1 (forced expiratory volume); FVC (forced vital capacity); JVD (jugular vein distention); MCV (mean corpuscular volume); Plt (platelet); RV (residual volume); SIADH (syndrome of inappropriate antidiuretic hormone); TSH (thyroid stimulating hormone); Vt (tidal volume); WBC (white blood cell); Coronary CT angiography (CCTA); multidetector row scanners (MDCT); Cardiovascular magnetic resonance — CMRI; Myocardial perfusion imaging (MPI); single-photon emission CT (SPECT); Positron emission tomography (PET) scanning; Magnetic resonance (MR) angiography, Computed tomographic (CT) angiography, and Transesophageal echocardiography (TEE), late gadolinium enhancement (LGE); right ventricular hypertrophy (RVH), right atrial enlargement (RAE), functional tricuspid regurgitation (TR), Pulmonary artery systolic pressure (PASP; adenosine deaminase (ADA); Serum amyloid A (SAA), soluble interleukin-2 receptor (sIL2R); High-resolution CT (HRCT) scanning

Differentials on the basis of Etiology	Disease	Clinical manifestations										Diagnosis
		Symptoms								Risk factors	Physical exam	Lab Findings	EKG	Imaging	Gold standard
		Onset	Duration	Quality of Pain	Cough	Fever	Dyspnea	Weight loss	Associated Features	Risk factors	Physical exam	Lab Findings	EKG	Imaging	Gold standard
Cardiac	Pericarditis^[1]^[2]^[3]	Acute or subacute	May last for hours to days	Sharp & localized retrosternal pain	+	+	+	-	Pericardial friction rub	HIV TB Immunosuppression Acute trauma	Pericardial friction rub heard with the diaphragm of stethoscope	Leukocytosis ↑Troponin level ↑Erythrocyte sedimentation rate ↑C-reactive protein level	EKG changes (typically widespread ST segment elevation or PR depressions)	Chest x-ray typically normal Echocardiogram: normal or pericardial effusion CT scan: Noncalcified pericardial thickening with pericardial effusion CMR: inflamed pericardium and myocarditis	Pericardiocentesis Pericardial biopsy
	Pericardial Tamponade^[4]^[5]	Acute or subacute	May last for hours to days	Sharp and stabbing retrosternal pain	+/-	+	+	-	Pulsus paradoxus Pericardial rub	HIV TB Immunosuppression Acute trauma	Kussmaul sign Beck triad Pulsus paradoxus	Creatine kinase and isoenzymes Abnormal LFTs Antinuclear antibody assay, erythrocyte sedimentation rate and rheumatoid factor HIV testing	EKG findings: Sinus tachycardia Low QRS voltage Electrical alternans	CXR: enlarged cardiac silhouette with clear lung fields Echocardiography: Chamber collapse, Respiratory variation in volumes and flows, IVC plethora Swan-Ganz Catheterization: Equilibration of average intracardiac diastolic pressures (usually between 10 and 30 mmHg)	Echocardiography
	Myocarditis^[6]^[7]^[8]	Acute or subacute	Variable	Sharp & localized retrosternal pain reflects associated pericarditis	+/-	+	+	-	Heart failure Sudden cardiac death Arrythmias	Ischemic heart disease Valvular heart disease	S3 and S4 gallop Cardiac murmurs Pericardial friction rub	Serum cardiac troponin levels ↑ BNP or NT-proBNP level	Nonspecific ST changes, single atrial or ventricular ectopic beats, complex ventricular arrhythmias	CXR: Normal to enlarged with or without pulmonary vascular congestion and pleural effusions Echo: Left ventricular dilation, changes in left ventricular geometry (eg, development of a more spheroid shape), and wall motion abnormalities CMR: T1 and T2 signal intensity consistent with edema, presence of LGE consistent with necrosis or scar Radionuclide ventriculography: ↓ EF Cardiac catheterization: Assessment of hemodynamic status	Endomyocardial biopsy
Differentials on the basis of Etiology	Disease	Clinical manifestations										Diagnosis
		Symptoms								Risk factors	Physical exam	Lab Findings	EKG	Imaging	Gold standard
		Onset	Duration	Quality of Pain	Cough	Fever	Dyspnea	Weight loss	Associated Features	Risk factors	Physical exam	Lab Findings	EKG	Imaging	Gold standard
Pulmonary	Pulmonary Embolism^[9]^[10]	Acute	May last minutes to hours	Sharp or knifelike or pleuritic pain Localized to side of lesion	+	+/-	+	-	Hemoptysis History of venous thromboembolism or coagulation abnormalities.	Hormone replacement therapy Cancer Oral contraceptive pills Stroke Pregnancy Postpartum Prior history of VTE Thrombophilia	S3 or S4 gallop Low grade fever Tachycardia Tachypnea Hypoxia	↑D-dimer ≥500 ng/mL Arterial blood gases (Respiratory alkalosis) ↑Troponin levels Hypercoagulation workup	Tachycardia and nonspecific ST-segment and T-wave changes (70 percent) S1Q3T3 pattern New right bundle branch block Inferior Q-waves (leads II, III, and aVF)	Duplex Ultrasonography: DVT CXR: Westermark sign, Hampton hump, Palla's sign Echocardiography: RV dilation (ratio of apical 4-chamber RV diameter to left ventricle (LV) diameter > 0.9) RV systolic dysfunction Ventilation-Perfusion Scanning: High probability	CT pulmonary angiography
	Pneumonia^[11]^[12]^[13]	Acute or chronic	Variable	Dull Localized to side of lesion	+	+	+	+/-	Altered mental status Tachycardia Rust-colored sputum Green sputum Red currant-jelly sputum Central cyanosis	Long hospital stay Ill contact exposure Aspiration	Wheezing Rhonchi Rales Decreased breath sounds Pleural friction rub	Arterial blood gas : Hypoxia, hypoxemia ↑ Procalcitonin Leukocytosis Sputum evaluation Positive blood cultures	Sinus tachycardia Nonspecific ST-segment or T-wave changes	CXR: Interstitial infiltrates, lobar consolidation, cavitation	CXR
	Tracheitis/ Bronchitis^[14]^[15]^[16]^[17]	Acute	Variable	Dull Substernal	+	+	+	-	Tachypnea Respiratory distress Hoarseness Dyspnea Cyanosis Sore throat Odynophagia Dysphonia	Aspiration Pneumonia	Inspiratory stridor (with or without expiratory stridor) Nasal flaring Wheezing	Gram stain of exudates: Neutrophils	Peaked P-wave	Radiography of the neck: Steeple sign Laryngotracheobronchoscopy: a normal epiglottis with subglottic narrowing, thick and purulent secretions in the trachea, pseudomembranes	Endoscopy
	Pleuritis	Acute or subacute or chronic	May last minutes to hours	Sharp Localized pleuritic	+	+	+	-	Sharp chest pain with breathing Itching in sites on the back Dizziness	Autoimmune conditions Infections	Tachypnea Tachycardia Pleural Rubs Decreased breath sounds	Leukocytosis Arterial blood gas (ABG): Hypoxia Thoracocentesis	EKG done to rule out other causes in differential diagnoses	Chest X Ray: Pleural fluid on one or both sides Computerized tomography (CT) scan: Pleural effusions	CXR
	Pleural Effusion^[18]^[19]^[20]	Acute or subacute or chronic	Variable	Dull Pleuritic pain	+	+/-	+	+/-	Increasing lower extremity edema Orthopnea Paroxysmal nocturnal dyspnea Night sweats Hemoptysis	Pneumonia	Diminished or inaudible breath sounds Pleural friction rub Egophony (known as "E-to-A" changes)	Pleural fluid LDH levels above 1000 IU/L Nucleated cells - Lymphocytosis - Eosinophilia - Mesothelial cells Pleural fluid culture and cytology Pleural fluid antinuclear antibody and rheumatoid factor	Typically not indicated	Chest X Ray: Pleural fluid on one or both sides Computerized tomography (CT) scan: Detects small pleural effusions, ie, less than 10 mL and possibly as little as 2 mL of liquid in the pleural space, Thickening of the visceral and parietal pleura MRI: Characterize the content of pleural effusions	Computed tomography
	Asthma & COPD^[21]^[22]^[23]^[24]	Acute or subacute or chronic	Variable	Tightness	+	+/-	+	+/-	Cyanosis	Smoking HF HTN	Elevated jugular venous pulse (JVP) Hyperinflation (barrel chest) Peripheral edema Clubbing Wheezing Rhonchi Diffusely decreased breath sounds Coarse crackles beginning with inspiration	Leukocytosis Eosinophilia Respiratory alkalosis	Peaked P-wave Reduced amplitude of the QRS complexes Multifocal atrial tachycardia (MAT)	CXR: Hyperinflation Spirometry: ↓ FEV1, PEF, ↓ FEV1/FVC	Spirometry
	Pulmonary Malignancy^[25]^[26]^[27]^[28]	Chronic	Variable	Dull aching	+	+/-	+	+	Bone pain Fatigue Neurologic dysfunction Superior vena cava (SVC) obstruction Hoarseness Hemidiaphragm paralysis Dysphagia Paraneoplastic syndromes Hypercalcemia	Smoking Metastasis	Wheeze Crackles Depending upon complications caused by the spread of cancer	Hypercalcemia	EKG may be performed before cancer treatment to identify any pre-existing conditions, or during treatment to check for possible heart damage	CXR and CT scan: Mass lesion, hilar lymphadenopathy Spirometry: ↓Vt, ↑RV Bronchoscopy: Biopsy	Bronchoscopy
	Acute chest syndrome (Sickle cell anemia)^[29]^[30]^[31]	Acute	May last minutes to hours	Chest tightness	+	+/-	+	-	Sickle cell anemia Vaso-occlusive crisis Pain crises	↑ WBC ↑ Hb levels ↓ fetal hemoglobin levels Smoking Vaso-occlusive pain events	Systolic murmur may be heard over the entire precordium	↑Erythrocyte sedimentation rate Peripheral blood smears: Schistiocytes ↑ Reticulocyte count	EKG typically not indicated	Plain radiography of the extremities: Avascular necrosis	---
Differentials on the basis of Etiology	Disease	Clinical manifestations										Diagnosis
		Symptoms								Risk factors	Physical exam	Lab Findings	EKG	Imaging	Gold standard
		Onset	Duration	Quality of Pain	Cough	Fever	Dyspnea	Weight loss	Associated Features	Risk factors	Physical exam	Lab Findings	EKG	Imaging	Gold standard
Gastrointestinal	GERD, Peptic Ulcer^[32]^[33]^[34]	Acute	Minutes to hours (gastroesophageal reflux) Prolonged (peptic ulcer) 5 to 60 minutes	Burning Substernal Epigastric	+/-	+/-	-	+/-	Visceral, substernal, worse with recumbency, no radiation, relief with food, antacids Hematemesis or melena resulting from gastrointestinal bleeding Dyspepsia	Prolonged NSAIDs intake Smoking Alcohol abuse Spicy foods H-pylori infection	Not any auscultatory findings associated with this disease Enamel erosion or other dental manifestations	↑Serum Gastrin Level Secretin Stimulation Test H-Pylori testing	EKG usually normal but may show T wave inversions in leads V2 through V4 consistent with myocardial ischemia in patients with peptic ulcer perforation	Upper Gastrointestinal Endoscopy: Biopsy Esophageal Manometry: To exclude an esophageal motility disorder Esophageal impedance pH testing: Monitors esophageal pH	Upper Gastrointestinal Endoscopy
	Esophagitis^[35]^[36]^[37]	Acute	Variable	Burning Epigastric	+	+	-	+/-	Heartburn Abdominal pain	HIV Immunosuppression	No auscultatory finding	Troponin or other cardiac markers Leukopenia ↓CD4 count Human immunodeficiency virus (HIV) test	ECG is done to rule out acute coronary syndrome	Double-contrast esophageal barium study (esophagography) Endoscopy: Biopsy	Endoscopy
	Mediastinitis^[38]^[39]^[40]^[41]	Acute, Chronic	Variable	Retrosternal irritation	+/-	+	+	-	Nonspecific	Infection Esophageal perforation Post operative complication	Dysphagia Dysphonia Stridor Hamman sign	Positive organisms in sternal culture Leukocytosis Positive blood cultures	Diffuse ST elevation	CT: Localize the infection and extent of spread MRI: Assesses vascular involvement and complications	CT scan
Differentials on the basis of Etiology	Disease	Clinical manifestations										Diagnosis
		Symptoms								Risk factors	Physical exam	Lab workup	EKG	Imaging	Gold standard
		Onset	Duration	Quality of Pain	Cough	Fever	Dyspnea	Weight loss	Associated Features	Risk factors	Physical exam	Lab workup	EKG	Imaging	Gold standard
Rheumatic	Rheumatoid arthritis^[42]	Chronic	Years	Symmetrical joint pain in Wrist Fingers Knees Feet Ankles	+/-	+	-	+	Extra-articular involvement of other organ systems Carpal tunnel syndrome Tarsal tunnel syndrome	Old age Smoking Autoimmune conditions	Reduced grip strength Rheumatoid nodules	Positive Rheumatic Factor Anti-CCP body Synovial fluid analysis: WBC between 1500 and 25,000/cubicmm, low glucose, low C3 and C4 complement level. Thrombocytosis Anemia Mild leukocytosis	ECG is done rule out the heart failure as RA is one of the causes of heart failure	Plain film radiography: periarticular osteopenia, joint space narrowing, and bone erosions MRI: Bone erosions Ultrasonography: Degree of inflammation and the volume of inflamed tissue	---
	Systemic lupus erythematosus^[43] ^[44]^[45]	Chronic	Years	Skin Joints (fingers, wrist, knees) Kidneys SLE can affect any organ of the body	+/-	+	+	+	HLA-genetic mutations Female gender Being younger than 50	Autoimmune conditions Genetic predisposition Positive family history	Malar rash Photosensitive rash Discoid rash Arthritis of the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints of the hands Pleuro-pericardial friction rubs Systolic murmurs	Elevation of autoantibodies (ANA, anti-dsDNA, anti-SM, antiphospholipid) Complement levels decreased Anemia	Sinus tachycardia, ST segment changes, and ventricular conduction disturbances	Related to specific organ involvent	Anti-dsDNA antibody test
	Relapsing polychondritis^[46]	Chronic	Years	Intermittent pain in: Tissues that cover the end of the joints Cartilage of costal rib	+	+	+	+	Hodkin's lymphoma Myelodysplastic syndromes Gastrointestinal disorders Type 1 Diabetes mellitus Auricular chondritis	Autoimmune diseases	Physical examinations findings are seen related to nasal chondritis, ocular inflammation, cardiovascular disease, skin disease, CNS and pulmonary system	Negative rheumatoid factor Anti-type II collagen antibodies Antineutrophil cytoplasmic antibodies	ECG is done to rule out the cardiovascular complications of this disease	Non specific Related to specific organ involvent	No gold standard test for this disease
Others	Substance abuse (Cocaine)^[47]^[48]^[49]	Acute (hours)	Minutes to hours	Pressure like pain in the center of chest	+	+	+	+	Anxiety Dyspnea Nausea Palpitations	Psychiatric disorders	Signs of injection drug use Signs of drug inhalation Poor personal hygiene	Serum biomarkers (Troponin I, Troponin T) Toxicologic tests or drug screens of bodily fluids (blood, urine, saliva) and hairs	QT prolongation Sinus Tachycardia Arrhythmias Cardiac conduction abnormalities	---	Gold standard test depends on the type of substance is abuse

References

↑ Imazio M, Demichelis B, Parrini I, Giuggia M, Cecchi E, Gaschino G, Demarie D, Ghisio A, Trinchero R (March 2004). "Day-hospital treatment of acute pericarditis: a management program for outpatient therapy". J. Am. Coll. Cardiol. 43 (6): 1042–6. doi:10.1016/j.jacc.2003.09.055. PMID 15028364.
↑ Troughton RW, Asher CR, Klein AL (February 2004). "Pericarditis". Lancet. 363 (9410): 717–27. doi:10.1016/S0140-6736(04)15648-1. PMID 15001332.
↑ Spodick DH (March 2003). "Acute pericarditis: current concepts and practice". JAMA. 289 (9): 1150–3. PMID 12622586.
↑ Ewart W (March 1896). "Practical Aids in the Diagnosis of Pericardial Effusion, in Connection with the Question as to Surgical Treatment". Br Med J. 1 (1838): 717–21. PMC 2406464. PMID 20756103.
↑ Adler Y, Charron P, Imazio M, Badano L, Barón-Esquivias G, Bogaert J, Brucato A, Gueret P, Klingel K, Lionis C, Maisch B, Mayosi B, Pavie A, Ristić AD, Sabaté Tenas M, Seferovic P, Swedberg K, Tomkowski W, Achenbach S, Agewall S, Al-Attar N, Angel Ferrer J, Arad M, Asteggiano R, Bueno H, Caforio AL, Carerj S, Ceconi C, Evangelista A, Flachskampf F, Giannakoulas G, Gielen S, Habib G, Kolh P, Lambrinou E, Lancellotti P, Lazaros G, Linhart A, Meurin P, Nieman K, Piepoli MF, Price S, Roos-Hesselink J, Roubille F, Ruschitzka F, Sagristà Sauleda J, Sousa-Uva M, Uwe Voigt J, Luis Zamorano J (November 2015). "2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS)". Eur. Heart J. 36 (42): 2921–64. doi:10.1093/eurheartj/ehv318. PMID 26320112.
↑ Dec GW, Palacios IF, Fallon JT, Aretz HT, Mills J, Lee DC, Johnson RA (April 1985). "Active myocarditis in the spectrum of acute dilated cardiomyopathies. Clinical features, histologic correlates, and clinical outcome". N. Engl. J. Med. 312 (14): 885–90. doi:10.1056/NEJM198504043121404. PMID 3974674.
↑ Caforio AL, Calabrese F, Angelini A, Tona F, Vinci A, Bottaro S, Ramondo A, Carturan E, Iliceto S, Thiene G, Daliento L (June 2007). "A prospective study of biopsy-proven myocarditis: prognostic relevance of clinical and aetiopathogenetic features at diagnosis". Eur. Heart J. 28 (11): 1326–33. doi:10.1093/eurheartj/ehm076. PMID 17493945.
↑ Ukena C, Mahfoud F, Kindermann I, Kandolf R, Kindermann M, Böhm M (April 2011). "Prognostic electrocardiographic parameters in patients with suspected myocarditis". Eur. J. Heart Fail. 13 (4): 398–405. doi:10.1093/eurjhf/hfq229. PMID 21239404.
↑ Stein PD, Beemath A, Matta F, Weg JG, Yusen RD, Hales CA, Hull RD, Leeper KV, Sostman HD, Tapson VF, Buckley JD, Gottschalk A, Goodman LR, Wakefied TW, Woodard PK (October 2007). "Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II". Am. J. Med. 120 (10): 871–9. doi:10.1016/j.amjmed.2007.03.024. PMC 2071924. PMID 17904458.
↑ "Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED)". JAMA. 263 (20): 2753–9. 1990. PMID 2332918.
↑ File TM (December 2003). "Community-acquired pneumonia". Lancet. 362 (9400): 1991–2001. doi:10.1016/S0140-6736(03)15021-0. PMID 14683661.
↑ Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG (March 2007). "Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults". Clin. Infect. Dis. 44 Suppl 2: S27–72. doi:10.1086/511159. PMID 17278083.
↑ Musher DM, Thorner AR (October 2014). "Community-acquired pneumonia". N. Engl. J. Med. 371 (17): 1619–28. doi:10.1056/NEJMra1312885. PMID 25337751.
↑ Conley SF, Beste DJ, Hoffmann RG (May 1993). "Measles-associated bacterial tracheitis". Pediatr. Infect. Dis. J. 12 (5): 414–5. PMID 8327305.
↑ Salamone FN, Bobbitt DB, Myer CM, Rutter MJ, Greinwald JH (December 2004). "Bacterial tracheitis reexamined: is there a less severe manifestation?". Otolaryngol Head Neck Surg. 131 (6): 871–6. doi:10.1016/j.otohns.2004.06.708. PMID 15577783.
↑ Hopkins A, Lahiri T, Salerno R, Heath B (October 2006). "Changing epidemiology of life-threatening upper airway infections: the reemergence of bacterial tracheitis". Pediatrics. 118 (4): 1418–21. doi:10.1542/peds.2006-0692. PMID 17015531.
↑ Liston SL, Gehrz RC, Siegel LG, Tilelli J (August 1983). "Bacterial tracheitis". Am. J. Dis. Child. 137 (8): 764–7. PMID 6869336.
↑ Feinsilver SH, Barrows AA, Braman SS (October 1986). "Fiberoptic bronchoscopy and pleural effusion of unknown origin". Chest. 90 (4): 516–9. PMID 3757561.
↑ Collins TR, Sahn SA (June 1987). "Thoracocentesis. Clinical value, complications, technical problems, and patient experience". Chest. 91 (6): 817–22. PMID 3581930.
↑ Venekamp LN, Velkeniers B, Noppen M (2005). "Does 'idiopathic pleuritis' exist? Natural history of non-specific pleuritis diagnosed after thoracoscopy". Respiration. 72 (1): 74–8. doi:10.1159/000083404. PMID 15753638.
↑ Kuempel ED, Wheeler MW, Smith RJ, Vallyathan V, Green FH (August 2009). "Contributions of dust exposure and cigarette smoking to emphysema severity in coal miners in the United States". Am. J. Respir. Crit. Care Med. 180 (3): 257–64. doi:10.1164/rccm.200806-840OC. PMID 19423717.
↑ Lamprecht B, McBurnie MA, Vollmer WM, Gudmundsson G, Welte T, Nizankowska-Mogilnicka E, Studnicka M, Bateman E, Anto JM, Burney P, Mannino DM, Buist SA (April 2011). "COPD in never smokers: results from the population-based burden of obstructive lung disease study". Chest. 139 (4): 752–763. doi:10.1378/chest.10-1253. PMC 3168866. PMID 20884729.
↑ Rennard S, Decramer M, Calverley PM, Pride NB, Soriano JB, Vermeire PA, Vestbo J (October 2002). "Impact of COPD in North America and Europe in 2000: subjects' perspective of Confronting COPD International Survey". Eur. Respir. J. 20 (4): 799–805. PMID 12412667.
↑ Badgett RG, Tanaka DJ, Hunt DK, Jelley MJ, Feinberg LE, Steiner JF, Petty TL (February 1993). "Can moderate chronic obstructive pulmonary disease be diagnosed by historical and physical findings alone?". Am. J. Med. 94 (2): 188–96. PMID 8430714.
↑ Kocher F, Hilbe W, Seeber A, Pircher A, Schmid T, Greil R, Auberger J, Nevinny-Stickel M, Sterlacci W, Tzankov A, Jamnig H, Kohler K, Zabernigg A, Frötscher J, Oberaigner W, Fiegl M (February 2015). "Longitudinal analysis of 2293 NSCLC patients: a comprehensive study from the TYROL registry". Lung Cancer. 87 (2): 193–200. doi:10.1016/j.lungcan.2014.12.006. PMID 25564398.
↑ Hyde L, Hyde CI (March 1974). "Clinical manifestations of lung cancer". Chest. 65 (3): 299–306. PMID 4813837.
↑ Chute CG, Greenberg ER, Baron J, Korson R, Baker J, Yates J (October 1985). "Presenting conditions of 1539 population-based lung cancer patients by cell type and stage in New Hampshire and Vermont". Cancer. 56 (8): 2107–11. PMID 2992757.
↑ Hiraki A, Ueoka H, Takata I, Gemba K, Bessho A, Segawa Y, Kiura K, Eguchi K, Yoneda T, Tanimoto M, Harada M (March 2004). "Hypercalcemia-leukocytosis syndrome associated with lung cancer". Lung Cancer. 43 (3): 301–7. doi:10.1016/j.lungcan.2003.09.006. PMID 15165088.
↑ Vichinsky EP, Styles LA, Colangelo LH, Wright EC, Castro O, Nickerson B (March 1997). "Acute chest syndrome in sickle cell disease: clinical presentation and course. Cooperative Study of Sickle Cell Disease". Blood. 89 (5): 1787–92. PMID 9057664.
↑ Castro O, Brambilla DJ, Thorington B, Reindorf CA, Scott RB, Gillette P, Vera JC, Levy PS (July 1994). "The acute chest syndrome in sickle cell disease: incidence and risk factors. The Cooperative Study of Sickle Cell Disease". Blood. 84 (2): 643–9. PMID 7517723.
↑ Vichinsky EP, Neumayr LD, Earles AN, Williams R, Lennette ET, Dean D, Nickerson B, Orringer E, McKie V, Bellevue R, Daeschner C, Manci EA (June 2000). "Causes and outcomes of the acute chest syndrome in sickle cell disease. National Acute Chest Syndrome Study Group". N. Engl. J. Med. 342 (25): 1855–65. doi:10.1056/NEJM200006223422502. PMID 10861320.
↑ Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R (August 2006). "The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus". Am. J. Gastroenterol. 101 (8): 1900–20, quiz 1943. doi:10.1111/j.1572-0241.2006.00630.x. PMID 16928254.
↑ Vakil NB, Traxler B, Levine D (August 2004). "Dysphagia in patients with erosive esophagitis: prevalence, severity, and response to proton pump inhibitor treatment". Clin. Gastroenterol. Hepatol. 2 (8): 665–8. PMID 15290658.
↑ Giannini EG, Zentilin P, Dulbecco P, Vigneri S, Scarlata P, Savarino V (February 2008). "Management strategy for patients with gastroesophageal reflux disease: a comparison between empirical treatment with esomeprazole and endoscopy-oriented treatment". Am. J. Gastroenterol. 103 (2): 267–75. doi:10.1111/j.1572-0241.2007.01659.x. PMID 18289194.
↑ Bott S, Prakash C, McCallum RW (August 1987). "Medication-induced esophageal injury: survey of the literature". Am. J. Gastroenterol. 82 (8): 758–63. PMID 3605035.
↑ Parfitt JR, Jayakumar S, Driman DK (September 2008). "Mycophenolate mofetil-related gastrointestinal mucosal injury: variable injury patterns, including graft-versus-host disease-like changes". Am. J. Surg. Pathol. 32 (9): 1367–72. PMID 18763324.
↑ Jaspersen D (March 2000). "Drug-induced oesophageal disorders: pathogenesis, incidence, prevention and management". Drug Saf. 22 (3): 237–49. PMID 10738847.
↑ Loyd JE, Tillman BF, Atkinson JB, Des Prez RM (September 1988). "Mediastinal fibrosis complicating histoplasmosis". Medicine (Baltimore). 67 (5): 295–310. PMID 3045478.
↑ Feigin DS, Eggleston JC, Siegelman SS (January 1979). "The multiple roentgen manifestations of sclerosing mediastinitis". Johns Hopkins Med J. 144 (1): 1–8. PMID 762913.
↑ Garrett HE, Roper CL (December 1986). "Surgical intervention in histoplasmosis". Ann. Thorac. Surg. 42 (6): 711–22. PMID 3539049.
↑ Sherrick AD, Brown LR, Harms GF, Myers JL (August 1994). "The radiographic findings of fibrosing mediastinitis". Chest. 106 (2): 484–9. PMID 7774324.
↑ Rodríguez-Henríquez P, Solano C, Peña A, León-Hernández S, Hernández-Díaz C, Gutiérrez M, Pineda C (July 2013). "Sternoclavicular joint involvement in rheumatoid arthritis: clinical and ultrasound findings of a neglected joint". Arthritis Care Res (Hoboken). 65 (7): 1177–82. doi:10.1002/acr.21958. PMID 23335586.
↑ Turner-Stokes L, Turner-Warwick M (April 1982). "Intrathoracic manifestations of SLE". Clin Rheum Dis. 8 (1): 229–42. PMID 6749397.
↑ Hunder GG, McDuffie FC, Hepper NG (March 1972). "Pleural fluid complement in systemic lupus erythematosus and rheumatoid arthritis". Ann. Intern. Med. 76 (3): 357–63. PMID 5015911.
↑ Porcel JM, Ordi-Ros J, Esquerda A, Vives M, Madroñero AB, Bielsa S, Vilardell-Tarrés M, Light RW (2007). "Antinuclear antibody testing in pleural fluid for the diagnosis of lupus pleuritis". Lupus. 16 (1): 25–7. doi:10.1177/0961203306074470. PMID 17283581.
↑ Chopra R, Chaudhary N, Kay J (May 2013). "Relapsing polychondritis". Rheum. Dis. Clin. North Am. 39 (2): 263–76. doi:10.1016/j.rdc.2013.03.002. PMID 23597963.
↑ Grant BF, Goldstein RB, Saha TD, Chou SP, Jung J, Zhang H, Pickering RP, Ruan WJ, Smith SM, Huang B, Hasin DS (August 2015). "Epidemiology of DSM-5 Alcohol Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions III". JAMA Psychiatry. 72 (8): 757–66. doi:10.1001/jamapsychiatry.2015.0584. PMC 5240584. PMID 26039070.
↑ Cosci F, Schruers KR, Abrams K, Griez EJ (June 2007). "Alcohol use disorders and panic disorder: a review of the evidence of a direct relationship". J Clin Psychiatry. 68 (6): 874–80. PMID 17592911.
↑ George DT, Nutt DJ, Dwyer BA, Linnoila M (February 1990). "Alcoholism and panic disorder: is the comorbidity more than coincidence?". Acta Psychiatr Scand. 81 (2): 97–107. PMID 2183544.

[pmid15028364-1] Imazio M, Demichelis B, Parrini I, Giuggia M, Cecchi E, Gaschino G, Demarie D, Ghisio A, Trinchero R (March 2004). "Day-hospital treatment of acute pericarditis: a management program for outpatient therapy". J. Am. Coll. Cardiol. 43 (6): 1042–6. doi:10.1016/j.jacc.2003.09.055. PMID 15028364.

[pmid15001332-2] Troughton RW, Asher CR, Klein AL (February 2004). "Pericarditis". Lancet. 363 (9410): 717–27. doi:10.1016/S0140-6736(04)15648-1. PMID 15001332.

[pmid12622586-3] Spodick DH (March 2003). "Acute pericarditis: current concepts and practice". JAMA. 289 (9): 1150–3. PMID 12622586.

[pmid20756103-4] Ewart W (March 1896). "Practical Aids in the Diagnosis of Pericardial Effusion, in Connection with the Question as to Surgical Treatment". Br Med J. 1 (1838): 717–21. PMC 2406464. PMID 20756103.

[pmid26320112-5] Adler Y, Charron P, Imazio M, Badano L, Barón-Esquivias G, Bogaert J, Brucato A, Gueret P, Klingel K, Lionis C, Maisch B, Mayosi B, Pavie A, Ristić AD, Sabaté Tenas M, Seferovic P, Swedberg K, Tomkowski W, Achenbach S, Agewall S, Al-Attar N, Angel Ferrer J, Arad M, Asteggiano R, Bueno H, Caforio AL, Carerj S, Ceconi C, Evangelista A, Flachskampf F, Giannakoulas G, Gielen S, Habib G, Kolh P, Lambrinou E, Lancellotti P, Lazaros G, Linhart A, Meurin P, Nieman K, Piepoli MF, Price S, Roos-Hesselink J, Roubille F, Ruschitzka F, Sagristà Sauleda J, Sousa-Uva M, Uwe Voigt J, Luis Zamorano J (November 2015). "2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS)". Eur. Heart J. 36 (42): 2921–64. doi:10.1093/eurheartj/ehv318. PMID 26320112.

[pmid3974674-6] Dec GW, Palacios IF, Fallon JT, Aretz HT, Mills J, Lee DC, Johnson RA (April 1985). "Active myocarditis in the spectrum of acute dilated cardiomyopathies. Clinical features, histologic correlates, and clinical outcome". N. Engl. J. Med. 312 (14): 885–90. doi:10.1056/NEJM198504043121404. PMID 3974674.

[pmid17493945-7] Caforio AL, Calabrese F, Angelini A, Tona F, Vinci A, Bottaro S, Ramondo A, Carturan E, Iliceto S, Thiene G, Daliento L (June 2007). "A prospective study of biopsy-proven myocarditis: prognostic relevance of clinical and aetiopathogenetic features at diagnosis". Eur. Heart J. 28 (11): 1326–33. doi:10.1093/eurheartj/ehm076. PMID 17493945.

[pmid21239404-8] Ukena C, Mahfoud F, Kindermann I, Kandolf R, Kindermann M, Böhm M (April 2011). "Prognostic electrocardiographic parameters in patients with suspected myocarditis". Eur. J. Heart Fail. 13 (4): 398–405. doi:10.1093/eurjhf/hfq229. PMID 21239404.

[pmid17904458-9] Stein PD, Beemath A, Matta F, Weg JG, Yusen RD, Hales CA, Hull RD, Leeper KV, Sostman HD, Tapson VF, Buckley JD, Gottschalk A, Goodman LR, Wakefied TW, Woodard PK (October 2007). "Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II". Am. J. Med. 120 (10): 871–9. doi:10.1016/j.amjmed.2007.03.024. PMC 2071924. PMID 17904458.

[pmid2332918-10] "Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED)". JAMA. 263 (20): 2753–9. 1990. PMID 2332918.

[pmid14683661-11] File TM (December 2003). "Community-acquired pneumonia". Lancet. 362 (9400): 1991–2001. doi:10.1016/S0140-6736(03)15021-0. PMID 14683661.

[pmid17278083-12] Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG (March 2007). "Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults". Clin. Infect. Dis. 44 Suppl 2: S27–72. doi:10.1086/511159. PMID 17278083.

[pmid25337751-13] Musher DM, Thorner AR (October 2014). "Community-acquired pneumonia". N. Engl. J. Med. 371 (17): 1619–28. doi:10.1056/NEJMra1312885. PMID 25337751.

[pmid8327305-14] Conley SF, Beste DJ, Hoffmann RG (May 1993). "Measles-associated bacterial tracheitis". Pediatr. Infect. Dis. J. 12 (5): 414–5. PMID 8327305.

[pmid15577783-15] Salamone FN, Bobbitt DB, Myer CM, Rutter MJ, Greinwald JH (December 2004). "Bacterial tracheitis reexamined: is there a less severe manifestation?". Otolaryngol Head Neck Surg. 131 (6): 871–6. doi:10.1016/j.otohns.2004.06.708. PMID 15577783.

[pmid17015531-16] Hopkins A, Lahiri T, Salerno R, Heath B (October 2006). "Changing epidemiology of life-threatening upper airway infections: the reemergence of bacterial tracheitis". Pediatrics. 118 (4): 1418–21. doi:10.1542/peds.2006-0692. PMID 17015531.

[pmid6869336-17] Liston SL, Gehrz RC, Siegel LG, Tilelli J (August 1983). "Bacterial tracheitis". Am. J. Dis. Child. 137 (8): 764–7. PMID 6869336.

[pmid3757561-18] Feinsilver SH, Barrows AA, Braman SS (October 1986). "Fiberoptic bronchoscopy and pleural effusion of unknown origin". Chest. 90 (4): 516–9. PMID 3757561.

[pmid3581930-19] Collins TR, Sahn SA (June 1987). "Thoracocentesis. Clinical value, complications, technical problems, and patient experience". Chest. 91 (6): 817–22. PMID 3581930.

[pmid15753638-20] Venekamp LN, Velkeniers B, Noppen M (2005). "Does 'idiopathic pleuritis' exist? Natural history of non-specific pleuritis diagnosed after thoracoscopy". Respiration. 72 (1): 74–8. doi:10.1159/000083404. PMID 15753638.

[pmid19423717-21] Kuempel ED, Wheeler MW, Smith RJ, Vallyathan V, Green FH (August 2009). "Contributions of dust exposure and cigarette smoking to emphysema severity in coal miners in the United States". Am. J. Respir. Crit. Care Med. 180 (3): 257–64. doi:10.1164/rccm.200806-840OC. PMID 19423717.

[pmid20884729-22] Lamprecht B, McBurnie MA, Vollmer WM, Gudmundsson G, Welte T, Nizankowska-Mogilnicka E, Studnicka M, Bateman E, Anto JM, Burney P, Mannino DM, Buist SA (April 2011). "COPD in never smokers: results from the population-based burden of obstructive lung disease study". Chest. 139 (4): 752–763. doi:10.1378/chest.10-1253. PMC 3168866. PMID 20884729.

[pmid12412667-23] Rennard S, Decramer M, Calverley PM, Pride NB, Soriano JB, Vermeire PA, Vestbo J (October 2002). "Impact of COPD in North America and Europe in 2000: subjects' perspective of Confronting COPD International Survey". Eur. Respir. J. 20 (4): 799–805. PMID 12412667.

[pmid8430714-24] Badgett RG, Tanaka DJ, Hunt DK, Jelley MJ, Feinberg LE, Steiner JF, Petty TL (February 1993). "Can moderate chronic obstructive pulmonary disease be diagnosed by historical and physical findings alone?". Am. J. Med. 94 (2): 188–96. PMID 8430714.

[pmid25564398-25] Kocher F, Hilbe W, Seeber A, Pircher A, Schmid T, Greil R, Auberger J, Nevinny-Stickel M, Sterlacci W, Tzankov A, Jamnig H, Kohler K, Zabernigg A, Frötscher J, Oberaigner W, Fiegl M (February 2015). "Longitudinal analysis of 2293 NSCLC patients: a comprehensive study from the TYROL registry". Lung Cancer. 87 (2): 193–200. doi:10.1016/j.lungcan.2014.12.006. PMID 25564398.

[pmid4813837-26] Hyde L, Hyde CI (March 1974). "Clinical manifestations of lung cancer". Chest. 65 (3): 299–306. PMID 4813837.

[pmid2992757-27] Chute CG, Greenberg ER, Baron J, Korson R, Baker J, Yates J (October 1985). "Presenting conditions of 1539 population-based lung cancer patients by cell type and stage in New Hampshire and Vermont". Cancer. 56 (8): 2107–11. PMID 2992757.

[pmid15165088-28] Hiraki A, Ueoka H, Takata I, Gemba K, Bessho A, Segawa Y, Kiura K, Eguchi K, Yoneda T, Tanimoto M, Harada M (March 2004). "Hypercalcemia-leukocytosis syndrome associated with lung cancer". Lung Cancer. 43 (3): 301–7. doi:10.1016/j.lungcan.2003.09.006. PMID 15165088.

[pmid9057664-29] Vichinsky EP, Styles LA, Colangelo LH, Wright EC, Castro O, Nickerson B (March 1997). "Acute chest syndrome in sickle cell disease: clinical presentation and course. Cooperative Study of Sickle Cell Disease". Blood. 89 (5): 1787–92. PMID 9057664.

[pmid7517723-30] Castro O, Brambilla DJ, Thorington B, Reindorf CA, Scott RB, Gillette P, Vera JC, Levy PS (July 1994). "The acute chest syndrome in sickle cell disease: incidence and risk factors. The Cooperative Study of Sickle Cell Disease". Blood. 84 (2): 643–9. PMID 7517723.

[pmid10861320-31] Vichinsky EP, Neumayr LD, Earles AN, Williams R, Lennette ET, Dean D, Nickerson B, Orringer E, McKie V, Bellevue R, Daeschner C, Manci EA (June 2000). "Causes and outcomes of the acute chest syndrome in sickle cell disease. National Acute Chest Syndrome Study Group". N. Engl. J. Med. 342 (25): 1855–65. doi:10.1056/NEJM200006223422502. PMID 10861320.

[pmid16928254-32] Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R (August 2006). "The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus". Am. J. Gastroenterol. 101 (8): 1900–20, quiz 1943. doi:10.1111/j.1572-0241.2006.00630.x. PMID 16928254.

[pmid15290658-33] Vakil NB, Traxler B, Levine D (August 2004). "Dysphagia in patients with erosive esophagitis: prevalence, severity, and response to proton pump inhibitor treatment". Clin. Gastroenterol. Hepatol. 2 (8): 665–8. PMID 15290658.

[pmid18289194-34] Giannini EG, Zentilin P, Dulbecco P, Vigneri S, Scarlata P, Savarino V (February 2008). "Management strategy for patients with gastroesophageal reflux disease: a comparison between empirical treatment with esomeprazole and endoscopy-oriented treatment". Am. J. Gastroenterol. 103 (2): 267–75. doi:10.1111/j.1572-0241.2007.01659.x. PMID 18289194.

[pmid3605035-35] Bott S, Prakash C, McCallum RW (August 1987). "Medication-induced esophageal injury: survey of the literature". Am. J. Gastroenterol. 82 (8): 758–63. PMID 3605035.

[pmid18763324-36] Parfitt JR, Jayakumar S, Driman DK (September 2008). "Mycophenolate mofetil-related gastrointestinal mucosal injury: variable injury patterns, including graft-versus-host disease-like changes". Am. J. Surg. Pathol. 32 (9): 1367–72. PMID 18763324.

[pmid10738847-37] Jaspersen D (March 2000). "Drug-induced oesophageal disorders: pathogenesis, incidence, prevention and management". Drug Saf. 22 (3): 237–49. PMID 10738847.

[pmid3045478-38] Loyd JE, Tillman BF, Atkinson JB, Des Prez RM (September 1988). "Mediastinal fibrosis complicating histoplasmosis". Medicine (Baltimore). 67 (5): 295–310. PMID 3045478.

[pmid762913-39] Feigin DS, Eggleston JC, Siegelman SS (January 1979). "The multiple roentgen manifestations of sclerosing mediastinitis". Johns Hopkins Med J. 144 (1): 1–8. PMID 762913.

[pmid3539049-40] Garrett HE, Roper CL (December 1986). "Surgical intervention in histoplasmosis". Ann. Thorac. Surg. 42 (6): 711–22. PMID 3539049.

[pmid7774324-41] Sherrick AD, Brown LR, Harms GF, Myers JL (August 1994). "The radiographic findings of fibrosing mediastinitis". Chest. 106 (2): 484–9. PMID 7774324.

[pmid23335586-42] Rodríguez-Henríquez P, Solano C, Peña A, León-Hernández S, Hernández-Díaz C, Gutiérrez M, Pineda C (July 2013). "Sternoclavicular joint involvement in rheumatoid arthritis: clinical and ultrasound findings of a neglected joint". Arthritis Care Res (Hoboken). 65 (7): 1177–82. doi:10.1002/acr.21958. PMID 23335586.

[pmid6749397-43] Turner-Stokes L, Turner-Warwick M (April 1982). "Intrathoracic manifestations of SLE". Clin Rheum Dis. 8 (1): 229–42. PMID 6749397.

[pmid5015911-44] Hunder GG, McDuffie FC, Hepper NG (March 1972). "Pleural fluid complement in systemic lupus erythematosus and rheumatoid arthritis". Ann. Intern. Med. 76 (3): 357–63. PMID 5015911.

[pmid17283581-45] Porcel JM, Ordi-Ros J, Esquerda A, Vives M, Madroñero AB, Bielsa S, Vilardell-Tarrés M, Light RW (2007). "Antinuclear antibody testing in pleural fluid for the diagnosis of lupus pleuritis". Lupus. 16 (1): 25–7. doi:10.1177/0961203306074470. PMID 17283581.

[pmid23597963-46] Chopra R, Chaudhary N, Kay J (May 2013). "Relapsing polychondritis". Rheum. Dis. Clin. North Am. 39 (2): 263–76. doi:10.1016/j.rdc.2013.03.002. PMID 23597963.

[pmid26039070-47] Grant BF, Goldstein RB, Saha TD, Chou SP, Jung J, Zhang H, Pickering RP, Ruan WJ, Smith SM, Huang B, Hasin DS (August 2015). "Epidemiology of DSM-5 Alcohol Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions III". JAMA Psychiatry. 72 (8): 757–66. doi:10.1001/jamapsychiatry.2015.0584. PMC 5240584. PMID 26039070.

[pmid17592911-48] Cosci F, Schruers KR, Abrams K, Griez EJ (June 2007). "Alcohol use disorders and panic disorder: a review of the evidence of a direct relationship". J Clin Psychiatry. 68 (6): 874–80. PMID 17592911.

[pmid2183544-49] George DT, Nutt DJ, Dwyer BA, Linnoila M (February 1990). "Alcoholism and panic disorder: is the comorbidity more than coincidence?". Acta Psychiatr Scand. 81 (2): 97–107. PMID 2183544.

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[9]

[10]

[11]

[12]

[13]

[14]

[15]

[16]

[17]

[18]

[19]

[20]

[21]

[22]

[23]

[24]

[25]

[26]

[27]

[28]

[29]

[30]

[31]

[32]

[33]

[34]

[35]

[36]

[37]

[38]

[39]

[40]

[41]

[42]

[43]

[44]

[45]

[46]

[47]

[48]

[49]

Chest pain, cough and fever

References

Navigation menu