Pulmonary edema differential diagnosis

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

Overview

Pulmonary edema should be distinguished from other conditions that cause dyspnea, orthopneacough.

Differentiating Pulmonary edema from Other Diseases

Pulmonary edema should be differentiated from other diseases presenting with dyspnea, orthopneacough.

The differentials include the following:

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

Upper airway

Angioedema[1] - - - - - +/- + - - +/- - + Normal Normal O2, ↑CO2 Normal N/A Physical exam Generalized edema
Anaphylaxis[2] +/- + - +/- - - - - +/- - - - Scattered wheezing Normal Normal Normal N/A Vital sign Type 1 hypersensitivity
Aspiration[3] - + - - +/- + - - + - - - Diminished breath sounds Normal Normal Atelectasis Vt, ↑RV Bronchoscopy Choking
Croup[4] - + - +/- - + - - + - - - Stridor WBC Normal Steeple sign Normal Physical exam Barking cough
Epiglottitis[5] - + - + - + - - - - - - Stridor WBC Normal Thumb sign Normal Laryngoscopy Drooling
Rhinosinusitis[6] - - - + - +/- - - - - - - Normal WBC Normal Air fluid level Normal Physical exam Headache
Vocal cord dysfunction[7] - - - - - +/- - - - - - - Stridor Normal Normal Normal FVC Laryngoscopy Choking sensation
Chest and Pleura,

Lower airway

Asthma attack[8] - + - - +/- + - - + - - - Wheeze Eosinophil Respiratory alkalosis Normal FEV1, PEF Physical exam and

Spirometry

Chest pain
Atelectasis - - - +/- +/- +/- - - +/- - - - Diminished breath sounds, Wheeze Normal O2, Normal/↓CO2 Collapsed lung lobe, fissuresdisplacement FVC Chest CT scan Surgical procedure, Aspiration,

Mechanical ventilation

Bronchitis[9] - - - + + + - - - - - - Rhonchi  WBC Normal Normal Normal Physical exam Rhonchi relieved by cough
Bronchospasm[10] +/- + - - + +/- - - + - - - Wheeze Normal O2, ↑CO2 Normal Vt, ↑RV Physical exam Allergic reaction
Bronchiolitis[11] - - - + +/- + - - - - - - Wheeze and Crackles WBC Normal Bronchovascular markings Vt Clinical assessment Respiratory syncytial virus (RSV)
COPD exacerbation[12] - + - + + + + - + +/- +/- +/- Wheeze, Rhonchi, and Crackles WBC, ↑RBC Respiratory alkalosis Hyperexpansion FEV1/FVC Clinical assessment Acute exacerbations of chronic bronchitis (AECB)
Lung carcinoma[13] - - + - - + - - + + - - Wheeze and Crackles Normal Normal Mass lesion, hilar lymphadenopathy Vt, ↑RV Bronchoscopy  Paraneoplastic syndromes, such as SIADH and lambert-Eaton
Pneumonia[14] - - - + + + - - - - - - Wheeze, Rhonchi, and Crackles WBC, neutrophilia Normal Lobar consolidation Normal Chest X-ray and CT Scan productive cough
Pneumothorax[15] - - - - + - - - - - +/- - Diminished breath sounds Normal O2, ↑CO2 Radiolucency without lung marking Vt CXR and Chest CT scan Tracheal deviation
Pulmonary embolism[16] - - - - + - - +/- - - - - Normal Normal Respiratory alkalosis Normal Normal Pulmonary CT angiography Pleuritic chest pain
Rib fractures (flail chest)[17] - + - - + - - - - - - - Normal Normal Respiratory acidosis Fracture marks Normal Chest X-ray Pneumothorax
Cardiovascular system Acute myocardial ischemia[18] +/- + - +/- + - + + - - - - Normal Normal Normal Normal Normal Cardiac troponin I Nausea and vomiting, Positive pertinent risk factors, such as hypertension, diabetes, and smoking
Acute heart failure[19] +/- + - - +/- + +/- + + - + + S3 Normal Respiratory alkalosis Cardiothoracic ratio Vt B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) Excessive sweating, high blood pressure
Pericardial tamponade[20] +/- - - - + - +/- +/- - - + - Muffled heart sounds Normal Normal Water bottle appearance enlarged heart Normal Echocardiography Fluid accumulation in pericardium
Tachyarrhythmia[18] +/- + - - +/- - - - - - - - High pulse rate Normal Normal Normal Normal ECG Palpitation
Pulmonary edema[21] +/- + - + + + + + + + + + Basal crackle Normal Respiratory alkalosis Bat wing pattern, air bronchograms Vt, ↑RV Cardiac Catheterization Tachypnea
Toxic/Metabolic Organophosphate poisoning[22] + - - + - - - - - - - - Wheeze Normal O2, ↑CO2 Normal Normal Blood test Salivation, Lacrimation, Emesis, Miosis
Salicylate poisoning[23] + - - - - - - - + - - - Normal Normal Metabolic acidosis, Respiratory alkalosis Normal Normal Blood test Vomiting, Tinnitus, Confusion, Hyperthermia
Carbon monoxide poisoning[24] + - - - + + - - + - - - Wheeze Carboxyhemoglobin O2, ↑CO2 Normal N/A Carboxyhemoglobin (HbCO) level Headache, Dizziness, Weakness, Vomiting, Confusion
Diabetic ketoacidosis[25] + +/- - - - - - - - - - - Scattered wheeze, Kussmaul's respiration WBC Metabolic acidosis Normal Normal Blood test (acidosis, hyperglycemia, ketonemia) Vomiting, Abdominal pain, Weakness, Confusion

Abbreviations: ABG (arterial blood gas); ACE (angiotensin converting enzyme); BMI (body mass index); CBC (complete blood count); CSF (cerebrospinal fluid); CXR (chest X-ray); DOE (dyspnea on exercise); 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);

References

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