Sandbox:Karina

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

Overview

Pathophysiology

Gross Pathophysiology

Macroscopic Pathology

Microscopic Pathology

Causes/Etiology			Onset	Clinical manifestations					Diagnosis					Other features
				Symptoms				Physical exam	Lab findings	Imaging		PFT	Gold standard
				Cough	Dyspnea	Fever	Slurred speech	Physical exam	Lab findings	X-Ray	Other imaging	PFT	Gold standard
Upper airway	Extrathoracic	Anaphylaxis	Acute	-	✔	-	✔	Tachycardia Hypotension Hoarseness Altered mental status	High levels of serum tryptase ^[1] Incrieased levels of plasma histamine ^[2] Sking test	Not required	Not required	Not specific	Acute onset with one of them: Respiratory compromised Reduced blood pressure (BP) Two or more after the exposure to a likely allergern Respiratory compromised Reduced BP Gastrointestinal symptoms Skin-mucosal involment BP reduced after exposure of a known allergen Adult BP systolic <90 mmHg Children: Low systolic BP ^[3]	Nasal discharge, redness and hives of the skin Common allergens: food, insect stings, biologic materials, natural rubber latex, etc
		Paralysis of vocal cord
		Laryngeal stenosis
		Postnasal drip syndrome
	Intrathoracic	Tracheomalacia
		Mediastinal mass
		Tracheal stenosis
		Goiter
		Foreign body aspiration
Lower airway	Intrathoracic	Bronchiolitis
		Asthma
		Bronchiectasis
		Cystic fibrosis
		Pulmonary edema
		Chronic obstructive pulmonary disease
		Pulmonary embolism
		Diffuse idiopathic pulmonary neuroendocrina cell hyperplasia (DPNECH)

Type of respiratory failure	Causes/Etiology		Onset	Clinical manifestations		Investigations	Gold standard	Other features
Type of respiratory failure	Causes/Etiology		Onset	Symptoms	Physical exam	Investigations	Gold standard	Other features
Hypoxic respiratory failure (Type 1 respiratory failure)	Cardiogenic pulmonary edema	Acute decompensated heart failure	Acute	Cough with pink frothy expectoration Dyspnea Increased pulse rate	Wheezing Crackles Leg edema in both legs Obtundation	Cardiomegaly and interstitial edema in chest radiograph ST and T waves abnormalities in ECG SaO2 <90% ^[4]	Clinical diagnosis (test results are supportive)	High levels of BNP and pro-BNP^[5]
	Non cardiogenic pulmonary edema	Adult respiratory distress syndrome(ARDS)	Acute	Dyspnea Cyanosis	Diffuse crackles	Hypoxemia in arterial blood gases Alveolar infiltrates in chest X-Ray Bilateral opacities in CT	According to Berlin definition^[6]: One week of new or worse respiratory symptoms or clinical insult Symptoms can not be explain by cardiac disease Bilateral opacities in chest X-Ray or CT Compromised oxygenation	Exlcusion of cardiogenic pulmonary edema
		High-Altitude Pulmonary edema (HAPE)^[7]	Acute	Dyspnea Cough with pink frothy sputum Chest tightness Decreased exercise performance	Wheezing	High levels of white blood cell count Decreased of oxygen saturation Bilateral infiltration in chest X-Ray	Clinical diagnosis	Occurrs over 2500 m Descent is mandatory in >4000 m ^[7]
		Neurogenic pulmonary edema	Acute	Dyspnea Hemoptysis	Rales Bilateral crackles	Leukocytosis Bilateral hyperdense infiltration in chest X-Ray PaO2/FiO2 ratio <200	PaO2/FiO2 ratio <200^[8] Bilateral infiltration No left atrial hypertension CNS injury No evidence of other causes of ARDS	Major causes of NPE are epileptic seizures, cerebral hemorrhages and brain injury
		Pulmonary embolism	Acute, subacute, Chronic	Dyspnea Chest pain Cough Orthopnea	Wheezing Tachypnea Edema Decreased breath sounds Tachycardia	Leukocytosis, elevated erythrocyte sedimentation and lactic acid in complete blood count Hypoxemia in arterial blood gas ^[9] D-dimer to rule out other diseases Hamptom and Westermark sign in chest X-Ray Tachycardia and abnormalities in ST-segment and T waves are observed in ECG	Computed tomography pulmonary angiogram (CTPA) or catheter based pulmonary angiography ^[10]	Venous thromboembolism(VTE)
	Pneumonia^[11]		Acute	Productive cough Chest pain Fever	Egophony Crackles Tactile fremitus	Leukocytosis Infiltration in chest X-Ray Optional microbiological test	Clinical manifestations and infiltration chest X-Ray with or without microbiological test ^[12]	Community-acquired pneumonia Hospital-acquired pneumonia Healthcare-associated pneumonia Ventilator-associated pneumonia Aspiration pneumonia
	Idiopatic chronic lung fibrosis^[13]		Chronic	Dyspnea Non-productive cough	Clubbing of the digits Crackles	Reticular or nodular pattern in chest X-Ray Nodules and bilateral hiliar adenopathy in CT	Lung biopsy when Lab, imaging and PFT do not allow to do the diagnosis	Reduced FEV1 and FVC in spirometry
Hypercapnic respiratory failure (Type 2 respiratory failure)	COPD
	Sedative abuse
	Encephalitis
	Stroke
	Obesity hypoventilation
	Hypothermia
	Hypothiroidism
	Myasthenia gravis
	Guillain-Barré syndrome
Perioperative respiratory failure (Type 3 respiratory failure)	Post-operative atelectasis		Acute	Asyptomatic or increase work of breathing	Skin or lips blue Tachypnea Tachycardia	Bronchoscopy CT and chest X-Ray PaO2/FiO2 <300 mmHg ^[14]	Clinical diagnosis with supportive test	Obstructive Non Obstructive^[15]
Type 4 respiratory failure	Shock^[16]		Acute	Oliguria Abnormal mental status Clammy skin Cool extremities	Hypotension Tachycardia Tachypnea Rales Gallop rythm	Electrocardigogram with isquemic abnormalities Visible congestion in chest X-Ray High levels of nitrogen Increased levels of lactic acid Low levels of Bicarbonate Echocardiography to identify any dysfunction	Clinical diagnosis with supportive test ^[17]	Cardiac index decreased Troponin leves, chemestry screen, complete blood count ^[17] Cardiogenic shock Septic shock Hypovolemic shock

Cough

Organ system		Diseases	Clinical manifestations								Diagnosis				Other features
			Symptoms							Physical exam	Diagnosis
			Onset	Duration	Productive cough	Hemoptysis	Weight lost	Fever	Dyspnea	Ascultation	Lab findings	Imaging	PFT	Gold standard
Respiratory	Upper airway	Epiglottitis^[18]^[19]	Abrupt or acute	12-24 hours	-	-	-	✔	✔	Stridor Hoarseness	Complete blood count (CBC) Blood culture Epiglottal culture in intubated patients	Enlarge epiglottis (>8 mm), loss of vallecular air space and distended hypopharynx in neck X-ray	Normal function	Direct visualization of erythematous and edematous epiglottis	Tripod posture Drooling Tenderness of the anterior part of the neck Etiology: Haemophilus influenzae
		Croup^[20]	Acute	3-5 days	✔	-	-	-	✔	Stridor Crackles	Low White blood cell count (WBC) in blood test	Subglottic narrowing (steeple sign) in postero-anterior radiograph chest	Decresed tidal volume	Clinical diagnosis. Laboratory findings and imaging are not necessary for diagnosis	Barking cough Etiology: Parainfluenza virus type 1 (most common)
		Pertussis^[21]^[22]	Acute	Two weeks	✔ Whooping sound	-	✔	-	✔	Clear chest	Polymerase chain reaction (PCR) Serologic testing	Atelectasis Lymphadenopathy	Normal function	Culture	Etiology: Bordetella pertussis Phases: Catarrhal, paroxysmal and convalescent
		Laryngopharyngeal reflux^[23]^[24]	Chronic	Variable	✔	-	-	-	✔	Hoarseness Stridor	Decreased levels of salivary epidermal growth factor (EGF) Increased levels of NKTR Biopsy	X-Ray Endoscopy examination	Normal function	24 hour-dual sensor pH probe	Throat clearing Globus sensation
		Common Cold^[25]	Acute	3-10 days	✔	-	-	✔	-	Rales Wheezing	Bacterial culture is not indicated	Chest X-Ray in patients with signs of consolidation	Normal function	Clinical diagnosis	Conjunctival injection Nasal congestion
		Seasonal Influenza ^[26]	Acute	5-10 days				✔	✔	Shorteness of breath	RT-PCR Antigen detection test	Reticular or reticulonodular opacities in chest X-Ray	Normal function	Clinical diagnosis	Etiology: A or B Influenza virus
		Rhinosinusitis^[27]^[28]	Acute, subacute, chronic, recurrent	Acute: Less than 4 weeks Subacute: 4-12 weeks Chronic: More than 12 weeks Recurrent: 4 or more episodes or acute rhinosinusitis per year	✔	-	-	✔	✔	Clear chest	In complicated acute bacterial rhinosinusitis, endoscopic cultures or sinus aspirate is indicated Nasal culture	Air-fluid level, mucosal edema and bony erosion of sinus on CT MRI for distinguish the etiology	Normal function	Clinical diagnosis: Nasal congestion, obstruction, and purulent rhinorrhea	Erythema in periorbital area
	Lower airway	Asthma^[29]	Chronic	Years	✔ Clear mucoid or yellow sputum	-	-	-	✔	Wheezing (expiratory) Rales Rhonchi	Eosinophilia is observed in complete blood count (CBC) Total serum IgE in test for allergy	Normal airways in chest X-ray CT if there any abnormality in chest X-Ray	FEV1/FVC ratio <70% and FEV1 >15% increase after 15 minutes of 2 puffs of beta 2 sympathomimetic drug After physical active FEV1 decreases by >15% After inhaled corticosteroid (ICS)FEV1 increased by >15%	Airflow limitation on spirometry	Family history Seasonal variation
		Acute Bronchitis^[30]	Acute	From 5 days to 1 or 3 weeks	✔	-	-	-	✔	Wheezing Rhonchi	Sputum culture is not indicated PCR in bacterial infection	Chest X-ray to exclude other diseases	FEV1 < 80%	Clinical diagnosis	Majority of cases are caused by respiratory viruses
		Chronic Bronchitis^[31]^[32]	Chronic	Most of the days for three months in the las two years.	✔ Clear sputum	-	-	✔	✔	Wheezing Rhonchi	Blood test Arterial blood gas (ABG)	Chest X-Ray to exclude other diseases CT	FEV1/FVC ratio < 70% Post bronchodilatador FEV1 > 80% Reduced FVC after bronchodilatador administration Decread vital capacity Increased total lung capacity	Demostration of airflow limitation on spirometry	Smoker's cough Cigarette smoking Pollution
		Non-asthmatic eosinophilic bronchitis^[33]^[34]	Chronic	More than 8 weeks	✔ Eosinophilic sputum		-	-	✔	Wheezing Shortness of breath	High levels of IgE Airway eosinophilia in sputum induction or bronchial wash fluid from bronchoscopy (bronchoalveolar lavage)	Normal chest X-Ray	FEV1/FVC >70% No response of short acting bronchodilator	Bronchial biopsy eosinophilia	Exposure to an occupational cause
		Bronchiectasis^[35]^[36]	Chronic	Months to years	✔ Mucopurulent sputum	✔		-	✔	Crackles Wheezing Shortness of breath	Complete blood count (CBC) IgG, IgM and IgA Sputum culture for fungi, bacteria and mycobacteria	Linear atelectasis and dilated airways in chest X-Ray	FEV1/FVC <70% Normal FVC Low levels of FEV1	CT of chest	Digital clubbing Recurrent pleurisy
		Emphysema ^[37]	Chronic	Months to years	✔ Mucoid or purulent sputum	-	-	✔	✔	Shortness of breath Wheezing Prolonged expiration Crackles	Blood test Testing for alpha 1-antitrypsin	Chest X-Ray to exclude other diseases CT	FEV1/FVC <70% Post bronchodilator FEV1 >80	Detection of early emphysema in CT of chest	Exposure of tobacco and air pollution
		Foreing body aspiration^[38]^[39]	Acute	Variable	✔	✔	-	✔	✔	Wheezing Decreased breath sounds	No specific	Hyperinflated lungs, atelectasis, and mediastinitis Shift in chest radiograph when the object is radio-opaque CT	Not specific	Bronchoscopy	In children <1 year and adults >75 years Organic materials in children Inorganic materials in adults
		Bronchiolitis^[40]^[41]	Acute	8-15 days	✔	-		✔	✔	Wheezing Crackles Increased respiratory rate	Complete blood count (CBC) Urinalysis (in infants) Urine culture ( in infants)	Chest X-Ray	Normal function or obstructive changes (FEV1/FVC <70%) Air trapping in Lung volumes Reduced Diffusing capacity of carbon monoxide ( DLCO)	Clinical diagnosis	Etiology: Respiratory syncytial virus, Rhinovirus Children <2 years
	Parenchyma	Pneumonia^[42]^[43]	Acute	Variable	✔ Mucopurulent sputum	-	-	✔	✔	Crackles Egophony Decreased bronchial sounds	Leftward shift leukocytosis Blood culture in hospitalized patients Sputum culture in hospitalized patients	Consolidation, cavitation, and infiltrated interstitial in chest X-ray Anatomical changes observed in chest CT	Not specific	Infiltration observed in chest X-ray	Community-acquired pneumonia Healthcare-associated pneumonia
		Pneumoconioses^[44]^[45]	Acute, Chronic	Years	-	-	✔	✔	✔	Wheezing Rhonchi Crackles	Arterial blood gas Complete blood count (CBC)	Small oppacities and fibrosis observed in chest X-ray CT FDG-PET	FEV1/FVC <70% FEV1 <80%	Exposure history and chest radiograph	Fibrogenic: Silica, asbestos Inert: Iron, barium Granulomatous: Beryllium Giant cell pneumonia: Cobalt
		Lung cancer^[46]^[47]	Chronic	Years	✔	✔	✔	-	✔	Hoarseness	Complete blood count (CBC) ALT, AST Calcium Alkaline phosphatase LDH Creatinine	Contrast-enhanced CT of chest and upper abdomen	Not specific	Tissue biopsy (sample should be sufficient for molecular testing)	Risk factor: Cigarette smoking Types Small cell lung cancer (SCLC) Non-small cell lung cancer (NSCLC)
		Interstitial lung disease^[48]^[49]	Chronic	Variable	-	✔	✔	-	✔	Wheezing Crackles or velcro rales Inspiratory high-pitched rhonchi	Test for hepatic and renal function Hematologic test in differential CBC Serological testing	Nodular, reticular or both pattern in chest X-ray CT in patients with diffuse pulmonary lung disease	Reduction in FVC, RV, FRC, TLC and FEV1 on spirometry FEV1/FVC normal or increase Lung volumes Diffusion capacity (DLCO reduced)	Lung biopsy when lab, imaging, and PFT has indeterminate result	Clubbing is common in asbestosis and idiopathic pulmonary fibrosis
		Tuberculosis (TB)^[50]^[51]	Chronic	More than 2 or 3 weeks	✔	✔	✔	✔	✔	Pleural effusion Crackles Whispered pectoriloquy Decreased fremitus Rhonchi	Sputum acid-fast bacilli (AFB) smear Mycobacterial culture Molecular testing	Reactivation of TB is observed as infiltration in the upper lobe in chest X-Ray In patients with HIV, Tb is observed as lobar infiltration, adenopathy, lung mass named tuberculoma, small fibronodular lesions, and/or pleural effusion chest X-Ray CT can detect early nodal process	Decreased FEV1 Reduced FVC	Isolation of Mycobacterium tuberculosis from some secretion	Etiology: Mycobacterium tuberculosis Complications: Pneumothorax, bronchiectasis, pulmonary destruction and chronic pulmonary aspergillosis
		Cystic fibrosis (CF)^[52]^[53]	Chronic	Variable	✔	-	✔		✔	Barrel-shaped chest Wheezing Tachypnea	Respiratory tract culture for CF Bronchoalveolar lavage for cytology ≥ 60 mmol/L Sweat chloride test CFTR mutation in molecular testing	Hyperinflation, atelectasis, and infiltrates on chest X-Ray Severe patients present bronchietasis, "tram tracks" peribronchial cuffing in chest X-Ray The extension of bronchietasis can be defined by CT	RV/TLC ratio increased FEV1/FVC ratio <70% Low levels of FEV1 High levels of TLC RV increased	Sweat chloride test	Evidence of CFTR dysfunction
Cardiac		Cardiogenic pulmonary edema^[54]^[55]	Acute	Days to weeks	✔ Pink frothy, liquid	-	✔	-	✔	Crackles Increased respiratory rate Wheezing Rhonchi Gurgling sounds	Arterial blood gas BUN Serum creatinin Serum troponin Electrolytes Lactic acid Complete blood count	Cardiomegaly, pleural effusion, interstitial edema, alveolar edema and blood redistribution in lower lobes in chest X-ray	Not specific	Clinical diagnosis Tests are supportive	12-lead ECG Plasma BNP and NT-proBNP Echocardiography
		Mitral Stenosis^[56]^[57]	Chronic	Variable	✔ Pink frothy	✔	-	-	✔	Crackles Hoarseness	Not specifc	Electrocardiogram Enlargement of left atrium and appendage in chest radiograph	FVC reduced	Resting transthoracic echocardiography	Stress testing Cardiac catheterization
		Pulmonary hypertension^[58]^[59]	Chronic	More than 2 years	-	✔	✔	-	✔	Hoarseness	HIV serology Antinuclear antibody (ANA) Rheumatoid factor (RF) Anti-neutrophil cytoplasmic antibody (ANCA)	Enlargement of the central pulmonary artery and right heart in chest X-Ray Pulmonary artery systolic pressure can be estimated in echocardiography	Low levels of FEV1 Decreased FVC DLCO reduced	Mean pulmonary artery pressure more than 25 mmHg at rest	Chest pain Ascites Syncope Peripherial edema
Gastrointestinal		Gastroesophageal reflux^[60]^[61]	Chronic	Variable	✔	-	✔	-	✔	Wheezing Hoarseness	Not specific	Upper endoscopy Barium esophagram	Normal function	PH testing	--
Autoinmune		Goodpasture syndrome^[62]^[63]	Chronic	Variable	-	✔	-	-	✔	Shortness of breath	Complete blood count (CBC) ANCA positive Anti-GBM in ELISA or western blot	Pulmonary infiltratation in chest X-Ray CT parenchimal envolment	Increased DLCO Decreased TLC Decreased FVC	Renal biopsy	Hematuria Proteinuria
		Wegener's disease (GPA) ^[64]^[65]	Chronic	Months	✔	✔	✔	✔	✔	Hoarseness Stridor Wheezing	ANCA, P-ANCA, C-ANCA BUN Creatinine Complete blood count Urinalysis Lung biopsy	Nodules, pulmonary infiltrates, reticular margins, pleural opacities and cavities in chest X-Ray Nodules, cavities and stellate-shaped peripherial pulmonary in chest CT Bronchoscopy	Low levels of DLCO Reduce lung volumes	Tissue biopsy	Nasal crusting, sinus pain, chronic rhinosinusitis, nasal obstruction and discharge in upper airway Saddle nose deformity Purpura in lower extremities
		Sarcoidosis^[66]^[67]	Chronic	Years	-	-	✔	✔	✔	Wheezing Squeaky sounds	Complete blood count (CBC) Urinalysis BUN Liver function test Calcium Alkaline phosphatase levels Electrolytes Histopathologic detection	On chest X-Ray: Stage 1: Bilateral hiliar adenopathy Stage 2: Reticular opacities and hiliar adenopathy Stage 3: Shrink hiliar nodules and reticular opacities Stage 4: Lost of volume	Reduced FVC Decreased of TLC	Clinical diagnosis, histopathologic detection of noncaseating granulomas and exclusion of other diseases	Young adults Skin, joint and eye lesions
		Microscopic polyangitis (MPA)^[68]^[69]	Chronic	Variable	✔	✔	✔	✔	✔	Hoarseness Stridor Wheezing	ANCA positive BUN Creatinine Complete blood count Urinalysis	Cavitation, nodules, and alveolar opacities in chest X-ray Head and chest CT Electromyography/nerve conduction study	Reduced lung volumes	Tissue biopsy	Nerve damage Rhinosinusitis Purpura involving lower extremities
		Churg-Strauss^[70]^[71]	Chronic	Variable	✔	✔	✔	✔	✔	Wheezing Rales Rhonchi Expiratory sounds(related to asthma)	Peripherial eosinophilia In active phase CRP and erytrocyte sedimentation rate high High levels of IgE ANCA positive	Infiltrates in chest X-Ray Ground glass opacities, tree-in-bud sign and small nodules in chest CT	Lung volumes decreased FVC reduced FEV1/FVC ratio <70%	Tissue biopsy	Asthma Eosinophilia Rhinosinusitis
Medication		ACE inhibitors^[72]^[73]	Acute (depend on the medication)	From 2 weeks to 6 months	-	-	-	-	✔	Wheezing	Not required	No required	Normal function	Clinical diagnosis	Resolves in four to five days of stopping the medication

Microscopic Pathology

Transmission:^[74]
1. Multiplication
2. asjdh

Associated Conditions

Pathophysiology
	Pathophysiology	Gross Pathophysiology
Macroscopic	a	c
Microscopic	b	d

GASTROINTESTINAL

Condition	Onset	Duration	Type of pain	Location	Exacerbating factors	Alleviating factors	Radiation	Associated features	Labs	Imaging
GERD, Peptic Ulcer	Acute	Minutes to hours (gastroesophageal reflux) Prolonged (peptic ulcer)	Burning	Substernal Epigastric	Alcohol Aspirin Post meal Lying down Morning Empty stomach	Antiacid Food	Not specific	Not specific	Ambulatory reflux monitoring	Not specific
Esophageal Spasm	Acute	Minutes to hours	Burning Pressure	Retrosternal	Not specific	Sublingual nitroglycerine	Not specific	Not specific (closely mimic angina)	Esophageal manometry is more than 20% premature contractions	Not specific
Esophagitis^[75]	Acute	Variable	Burning	Epigastric	Immunosuppression alcohol smoking Excessive vomiting Radiation	Acid supression therapy Proton pump inhibitors Topical pain medication	Back	Not specific	Elevated IgE Elevated peripherial eosinophil Biopsies	Endoscopy
Eosinophilic esophagitis^[76]	Chronic	Variable	Burning	Retrosternal Abdominal	Cold and dry climates European ancestry	Proton pum inhibitors Corticosteroids Biologicals Amino acid-based diet	Not specific	Alergic diseases Asthma Rinithis Eczema	More than 15 eosinophils per high-power field	Not specific
Esophageal perforation^[77]	Acute	Minutes to hours	Burning	Upper abdominal	Excessive vomiting Weightlifing alcohol	Intravenos fluids Antibiotics Nasogastric suction NPO	Back Left shoulder	Eating disorders such as bulimia	Not specific	Confirmed by water-soluble contrast esophagram
Mediastinitis^[78]	Acute, Chronic	Variable	Irritation	Retrosternal	Recent chest surgery Smoking obesity endoscopy	Not specific	Not specific	Histoplasmosis tuberculosis Radiation	Postive organisms in sternal culture	CT X-Ray
Cholelithiasis^[79]	Acute, subacute	Minutes to hours	Burning Colicky	Right upper abdomen Substernal epigastric	Post meal Fatty foodd	Analgesics	Not specific	Not specific	Liver biochemical test Amylase levels Llipase levels	Transabdominal ultrasound (TAUS) X-ray
Pancreatitis^[80]	Acute, Chronic	Variable	Pressure	Epigastric Upper left side of the abdomen	Lying flat on the back After eating Drinking	Analgesics	Back Below the left shoulder	Primary cirrhosis Primary sclerosing colangitis	Amylase levels Lipase levels	CT MRI Transabdominal ultrasound ((TAUS)
Sliding hiatal hernia^[81]	Acute	Variable	Burning	Epigastric	Recumbent position Inspiration	Proton pump inhibitors H-2 blokers	Back	Obstruction Cameron ulcers	Not specific	Radiographic Endoscopy Manometry

Rheumatic diseases:

Condition	Onset	Duration	Type of pain	Location	Exacerbating factors	Alleviating factors	Radiation	Associated features	Labs	Imaging
Fibromyalgia^[82]	Chronic	Variable	Deep ache Burning	Shoulders Back of the Neck Chest Lower Back Elbows Hips Shin Knees	Stressful or traumatic events Post-traumatic stress disorder (PTSD) Worst at night During activity	During the day Physical therapy Stress-relief methods Exercise and fitness program	Spreads out the tender points	Somatization Depression	Normal Blood and urine test (mandatory to rule out other diseases)	Normal (mandatory to rule out other diseases)
Rheumatoid arthritis^[83]^[84]	Chronic	Years	Both sides in the same joint	Wrist Fingers Knees Feet Ankles	Increases at mornings Occupational activities related to silica and asbestos Smoking	Physical therapy Combination of three drugs DMARD Biologic medication Anti-inflammatory medication	Wildespread	Not specific	Positive Rheumatic Factor Anti-CCP body	Joint X-ray Joint ultrasound or MRI
Ankylosing spondylitis^[85]	Chronic	Years	Interminent	Spine joint Sacroiliac joint	Increases at morning and nights Less activity	NSAIDs Physical therapy Excersices DMARD TNF alpha	Not specific	Patients with HLA-27 variant	Complete blood count (CBC) Erythrocyte sedimetation rate (ESR) Antigen HLA-27 Negative Rheumatic Factor	X-Ray of Spine and Pelvis MRI of Spine and Pelvis
Psoriatic arthritis^[86]	Chronic	Years	Asymmetrical Intermitent (Comes and goes)	Interphalangeal joints Nails Wrist Knees Ankles Lower Back	Less activity	NSAIDs TNF inhibitors Physical therapy Glucocorticoids Heat therapy Splint Braces	Not specific	Psoriasis	Serum complement Levels of Long Prentaxin 3 protein (PTX3) Increased levels of CRP	X-Ray Utrasonography CT scan MRI
Sternocostoclavicular hyperostosis (SAPHO syndrome)^[87]	Chronic	Years	Recurrent Multifocal	Sternoclavicular joint	Shrugging or retractin the ipsilateral shoulder	NSAIDs Corticosteroid	Shoulder Neck Upper anterior wall chest	Palmoplantar pustulosis (PPP)	Serologic testing for exclude other diseases High levels of alcalin phosphatase	Hyperostosis, sclerosis and bone hypertrophy in X-Ray
Systemic lupus erythematosus ^[88]	Chronic	Years	Not specific	Skin Joints (fingers, wrist, knees) Kidneys	Sun exposure Sleep quality	Hydroxychloroquine NSAIDs Glucocorticoids Immunosuppressive therapy	Throught the body	HLA-genetic mutations Female gender Being younger than 50	Elevation of autoantibodies (ANA, anti-dsDNA, anti-SM, antiphospholipid) Complement levels decreased	Chest X-Ray
Relapsing polychondritis^[89]	Chronic	Years	Intermitent	Tissues that cover the end of the joints Cartilage of costal rib	Not specific	Corticosteroid	Nervous system Vascular system Kidneys	Hodkin's lymphoma Myelodysplastic syndromes Gastrointestinal disorders Type 1 Diabetes mellitus	Negative rheumatoid factor Biopsy	Not specific

MUSCULOSKELETAL

Condition	Onset	Duration	Type of pain	Location	Exacerbating factors	Alleviating factors	Radiation	Associated features	Diagnostic Tests
Musculo-skeletal Pain	Acute, subacute	Variable	Pressure, aching	Localized to involved area	Increases by movement and pressure on involved area	Analgesics	Not specific	Not specific	MRI
Rib pain	Acute, Chronic	Variable	Aching	Depend on the area involved	Movements during breathing Specific position that increases the pressure	Analgesics Compressive wraps Resting	Not specific	Broken ribs	X-Ray MRI
Isolated musculoskeletal chest pain syndromes^[90]	Acute, Chronic	Variable	Pressure	Ribs Sternum Joints	Overused Stress fractures Sporting activities	Analgesics	Not specific	Athlets injuries Costosternal pain syndromes Costochondral pain syndromes	CT X-Ray
Rheumatic diseases	Chronic	Variable	Intermitent	Depend on the area involve	Depend on the disease	Physical therapy NSAIDs Corticosteroids	Wildspread	Not specific	CT X-Ray
Traumatic	Acute	Variable	Aching	Localized to the area involved	Physicological distress	Pain management	Not specific	Tissue adjacent	X-Ray CT

Isolated musculoskeletal chest pain syndromes:

Condition	Onset	Duration	Type of pain	Location	Exacerbating factors	Alleviating factors	Radiation	Associated features	Diagnostic Tests
Costosternal syndromes (costochondritis)^[91]	Acute, subacute	Days to weeks	Pressure	Anterior part of chest wall	Deep breath Cough	Analgesics Lie down Breath quietly Lightly massage Hot or cold compresses	Back Stomach	Not specific	Palpation of tender areas Chest X-ray
Lower rib pain syndromes^[92]	Chronic	Variable	Aching	Lower chest Upper abdomen	Pressing in the spot Hypermobility of the anterior end of the costal cartilage	Analgesics	Not specific	Not specifc	Hooking maneuver
Sternalis syndrome^[93]	Chronic	Variable	Pressure	Over the body of sternum Sternalis muscle Left or middle side of the chest wall	Daily activities Emotional distress Anxiety	Not specific	Both arms	Cardiac diseases	X-ray
Tietze's syndrome^[94]	Acute	Weeks	Pressure	Costosternal joint Sternoclavicular joint Costochondral joint Second and thrid ribs	Exacerbated with respiration	Minimal physical activity NSAIDs Heat or ice	Arms Shoulders	Sneezing Exercise Cough Quick movements	Test are for rule out other diseases
Xiphoidalgia^[95]	Acute	Variable	Pressure	Over the xiphoid process Sternum Xiphosternal joint	Heavy meals Twisting movements Bending	Analgesics Topical heat and cold Elastic rib belt	Back	Cough Heavy work	Provocative test
Spontaneous sternoclavicular subluxation^[96]	Acute, Chronic	Variable	Aching	Sternoclavicular joint	Moderate to heavy repetitive tasks	Analgesics	Not specific	Abnormal contraction of pectoralis major	CT Esclerosis in X-ray
Posterior chest wall pain syndromes^[97]	Chronic	Variable	Band-like chest pain	Costovertebral joint Scapulothoracic articulation Posterior chest wall	Cough Deep breath Throwing activities	Physical therapy Muscular strengthening NSAIDs Corticosteroid injections	Not specific	Ankylosing spondylitis	Imaging test Pain by palpation

OTHER

Condition	Onset	Duration	Type of pain	Location	Exacerbating factors	Alleviating factors	Radiation	Associated features	Diagnostic Tests
Substance abuse (Cocaine)^[98]	Acute	Hours	Pressure	Chest	Beta Blockers (Not recommended)	Aspirin Calcium channels blockers Nitroglycerin Cessation of cocaine use	Not specific	Anxiety Dyspnea Nausea Palpitations	Frontal chest radiography Serum biomarkers (Troponin I, Troponin T) Electrocardiogram
Referred pain^[99]	Acute, Chronic	Variable	Visceral Somatic	Corresponding dermatomes Corresponding myotomes	Spurling maneuver	Shoulders abduction	Not specific	Pain in abdominal organs Disease in cervical discs	Neuroimaging Electrodiagnostic test
Herpes Zoster^[100]^[101]	Acute, Chronic	Variable	Burning	Chest Upper back Lower back	Light touch (in Postherpetic neuralgia PHN)	Pain medications (Tricyclic antidepressants) Physical therapy Relaxation therapy Massage Cold or heat pad	Dermatomal distribution	People who had chickenpox	Nerve test Blood test
Domestic abuse^[102]	Acute, chronic	Variable	Depend on the injury	Head Chest Neck Genital area Breast	Not specific	Pain medications	Not specific	Depression Anxiety Panic disorder Eating disorders Abortion	Assesment for IPV (intimate partner violence) in patients wiht suggested abuse
Stress fracture^[103]	Acute	Minutes	Aching	Lumbar spine Femoral head Superior side of femoral head Ribs Sacrum Patella	Increased activity History of prior stress fracture Low levels of physical activity	Pain medication Protection of the fracture Proper nutrition Minimal physical activity	Not specific	Athlets	MRI Radiography
Sickle cell disease^[104]	Chronic	From birth	Aching	Lower back Legs Chest Abdomen Arms	Ketorolac Miperidine	Opioid analgesia Massage	Not specific	Anxiety Depression	Blood test: High performance liquid chromatography Prenatal test: DNA samples from chorionic villus from 8-10 weeks of gestation

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[pmid16931288-1] Schwartz LB (2006). "Diagnostic value of tryptase in anaphylaxis and mastocytosis". Immunol Allergy Clin North Am. 26 (3): 451–63. doi:10.1016/j.iac.2006.05.010. PMID 16931288.

[pmid17602945-2] Simons FE, Frew AJ, Ansotegui IJ, Bochner BS, Golden DB, Finkelman FD, Leung DY, Lotvall J, Marone G, Metcalfe DD, Müller U, Rosenwasser LJ, Sampson HA, Schwartz LB, van Hage M, Walls AF (2007). "Risk assessment in anaphylaxis: current and future approaches". J. Allergy Clin. Immunol. 120 (1 Suppl): S2–24. doi:10.1016/j.jaci.2007.05.001. PMID 17602945.

[pmid16461139-3] Sampson HA, Muñoz-Furlong A, Campbell RL, Adkinson NF, Bock SA, Branum A, Brown SG, Camargo CA, Cydulka R, Galli SJ, Gidudu J, Gruchalla RS, Harlor AD, Hepner DL, Lewis LM, Lieberman PL, Metcalfe DD, O'Connor R, Muraro A, Rudman A, Schmitt C, Scherrer D, Simons FE, Thomas S, Wood JP, Decker WW (2006). "Second symposium on the definition and management of anaphylaxis: summary report--Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium". J. Allergy Clin. Immunol. 117 (2): 391–7. doi:10.1016/j.jaci.2005.12.1303. PMID 16461139.

[pmid20937981-4] Weintraub NL, Collins SP, Pang PS, Levy PD, Anderson AS, Arslanian-Engoren C, Gibler WB, McCord JK, Parshall MB, Francis GS, Gheorghiade M (2010). "Acute heart failure syndromes: emergency department presentation, treatment, and disposition: current approaches and future aims: a scientific statement from the American Heart Association". Circulation. 122 (19): 1975–96. doi:10.1161/CIR.0b013e3181f9a223. PMID 20937981.

[pmid15477431-5] Doust JA, Glasziou PP, Pietrzak E, Dobson AJ (2004). "A systematic review of the diagnostic accuracy of natriuretic peptides for heart failure". Arch. Intern. Med. 164 (18): 1978–84. doi:10.1001/archinte.164.18.1978. PMID 15477431.

[pmid22797452-6] Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS (2012). "Acute respiratory distress syndrome: the Berlin Definition". JAMA. 307 (23): 2526–33. doi:10.1001/jama.2012.5669. PMID 22797452.

[urlJournal_of_Medical_Laboratory_and_Diagnosis_-_Article_Cited_by-7] 7.0 ^7.1 "Journal of Medical Laboratory and Diagnosis - Article Cited by".

[pmid22429697-8] Davison DL, Terek M, Chawla LS (2012). "Neurogenic pulmonary edema". Crit Care. 16 (2): 212. doi:10.1186/cc11226. PMC 3681357. PMID 22429697.

[pmid8549223-9] Stein PD, Goldhaber SZ, Henry JW, Miller AC (1996). "Arterial blood gas analysis in the assessment of suspected acute pulmonary embolism". Chest. 109 (1): 78–81. PMID 8549223.

[pmid17848685-10] Remy-Jardin M, Pistolesi M, Goodman LR, Gefter WB, Gottschalk A, Mayo JR, Sostman HD (2007). "Management of suspected acute pulmonary embolism in the era of CT angiography: a statement from the Fleischner Society". Radiology. 245 (2): 315–29. doi:10.1148/radiol.2452070397. PMID 17848685.

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Sandbox:Karina

Overview

Cough

Microscopic Pathology

Associated Conditions

GASTROINTESTINAL

Rheumatic diseases:

MUSCULOSKELETAL

Isolated musculoskeletal chest pain syndromes:

OTHER

References

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