Cough differential diagnosis: Difference between revisions

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Revision as of 14:58, 5 March 2018

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

Overview

Cough Differential Diagnosis

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 diseases	Epiglottitis^[1]^[2]	Abrupt or acute	12-24 hours	-	-	-	✔	✔	Stridor Hoarseness	Elevated white blood count in CBC Blood culture may show bacterial growth Epiglottal culture in intubated patients may show bacterial growth	Enlarge epiglottis (>8 mm), loss of vallecular air space and distended hypopharynx in neck X-ray may be helpful	Normal function	Direct visualization of erythematous and edematous epiglottis	Tripod posture Drooling Tenderness of the anterior part of the neck Etiology: Haemophilus influenzae
		Croup^[3]	Acute	3-5 days	✔	-	-	-	✔	Stridor Crackles	Leukopenia	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^[4]^[5]	Acute	Two weeks	✔ Whooping sound	-	✔	-	✔	Clear chest	Polymerase chain reaction (PCR) shows Bordetella pertussis Serologic testing	Atelectasis may seen on chest imaging Lymphadenopathy	Normal function	Culture	Etiology: Bordetella pertussis Phases: Catarrhal, paroxysmal and convalescent
		Laryngopharyngeal reflux^[6]^[7]	Chronic	Variable	✔	-	-	-	✔	Hoarseness Stridor	Decreased levels of salivary epidermal growth factor (EGF) Increased levels of NKTR Biopsy	X-Ray may be helpful Endoscopy examination may be helpful as well	Normal function	24 hour-dual sensor pH probe	Throat clearing Globus sensation
		Common Cold^[8]	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 ^[9]	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^[10]^[11]	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 may also be helpful	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^[12]	Chronic	Years	✔ Clear mucoid or yellow sputum	-	-	-	✔	Wheezing (expiratory) Rales Rhonchi	Eosinophilia Total serum IgE in test for allergy may be helpful	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^[13]	Acute	From 5 days to 1 or 3 weeks	✔	-	-	-	✔	Wheezing Rhonchi	Sputum culture is not indicated PCR in bacterial infection may be helpful	Chest X-ray to exclude other diseases	FEV1 < 80%	Clinical diagnosis	Majority of cases are caused by respiratory viruses
		Chronic Bronchitis^[14]^[15]	Chronic	Most of the days for three months in the las two years.	✔ Clear sputum	-	-	✔	✔	Wheezing Rhonchi	CBC and ABG may be helpful	Chest X-Ray to exclude other diseases CT may also be helpful	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^[16]^[17]	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^[18]	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 ^[19]	Chronic	Months to years	✔ Mucoid or purulent sputum	-	-	✔	✔	Shortness of breath Wheezing Prolonged expiration Crackles	Testing for alpha 1-antitrypsin may be helpful	Chest X-Ray to exclude other diseases CT may also be helpful	FEV1/FVC <70% Post bronchodilator FEV1 >80	Detection of early emphysema in CT of chest	Exposure of tobacco and air pollution
		Foreing body aspiration^[20]^[21]^[22]	Acute	Variable	✔	✔	-	✔	✔	Wheezing Decreased breath sounds	No specific tests	Hyperinflated lungs, atelectasis, and mediastinitis Shift in chest radiograph when the object is radio-opaque CT may be helpful	Not specific	Bronchoscopy	In children <1 year and adults >75 years Organic materials in children Inorganic materials in adults
		Bronchiolitis^[23]^[24]	Acute	8-15 days	✔	-		✔	✔	Wheezing Crackles Increased respiratory rate	Complete blood count (CBC) may be helpful Urinalysis & urine culture ( in infants)	Chest X-Ray may be helpful	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^[25]^[26]	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^[27]^[28]	Acute, Chronic	Years	-	-	✔	✔	✔	Wheezing Rhonchi Crackles	CBC and ABG may be helpful	Small oppacities and fibrosis observed in chest X-ray CT and FDG-PET may be helpful	FEV1/FVC <70% FEV1 <80%	Exposure history and chest radiograph	Fibrogenic: Silica, asbestos Inert: Iron, barium Granulomatous: Beryllium Giant cell pneumonia: Cobalt
		Lung cancer^[29]^[30]	Chronic	Years	✔	✔	✔	-	✔	Hoarseness	The following investigations may be helpful: 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^[31]^[32]	Chronic	Variable	-	✔	✔	-	✔	Wheezing Crackles or velcro rales Inspiratory high-pitched rhonchi	The following investigations may be helpful: Hepatic function test Renal function test 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)^[33]^[34]	Chronic	More than 2 or 3 weeks	✔	✔	✔	✔	✔	Pleural effusion Crackles Whispered pectoriloquy Decreased fremitus Rhonchi	Sputum acid-fast bacilli (AFB) smear may be positive Mycobacterial culture may be positive Molecular testing may be helpful	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 on 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)^[35]^[36]	Chronic	Variable	✔	-	✔		✔	Barrel-shaped chest Wheezing Tachypnea	Respiratory tract culture may be helpful for diagnosing secondary bacterial infection Bronchoalveolar lavage for cytology may be helpful ≥ 60 mmol/L Sweat chloride test CFTR mutation in molecular testing may be positive	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^[37]^[38]	Acute	Days to weeks	✔ Pink frothy, liquid	-	✔	-	✔	Crackles Increased respiratory rate Wheezing Rhonchi Gurgling sounds	The following investigations may be helpful: 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^[39]^[40]	Chronic	Variable	✔ Pink frothy	✔	-	-	✔	Crackles Hoarseness	Not specifc	Electrocardiogram may be helpful Enlargement of left atrium and appendage in chest radiograph	FVC reduced	Resting transthoracic echocardiography	Stress testing Cardiac catheterization
		Pulmonary hypertension^[41]^[42]	Chronic	More than 2 years	-	✔	✔	-	✔	Hoarseness	The following investigations may be helpful: 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^[43]^[44]	Chronic	Variable	✔	-	✔	-	✔	Wheezing Hoarseness	Not specific	Upper endoscopy may be helpful Barium esophagram may be helpful	Normal function	PH testing	--
Autoinmune		Goodpasture syndrome^[45]^[46]	Chronic	Variable	-	✔	-	-	✔	Shortness of breath	The following investigations may be helpful: Complete blood count (CBC) ANCA positive Anti-GBM in ELISA or western blot	Pulmonary infiltratation in chest X-Ray CT scan for parenchymal involvement	Increased DLCO Decreased TLC Decreased FVC	Renal biopsy	Hematuria Proteinuria
		Wegener's disease (GPA) ^[47]^[48]	Chronic	Months	✔	✔	✔	✔	✔	Hoarseness Stridor Wheezing	The following investigations may be helpful: 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 may be helpful	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^[49]^[50]	Chronic	Years	-	-	✔	✔	✔	Wheezing Squeaky sounds	The following investigations may be helpful: 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)^[51]	Chronic	Variable	✔	✔	✔	✔	✔	Hoarseness Stridor Wheezing	The following investigations may be helpful: ANCA positive BUN Creatinine Complete blood count Urinalysis	Cavitation, nodules, and alveolar opacities in chest X-ray Head and chest CT may be helpful Electromyography/nerve conduction study may also be helpful	Reduced lung volumes	Tissue biopsy	Nerve damage Rhinosinusitis Purpura involving lower extremities
		Churg-Strauss^[52]^[53]	Chronic	Variable	✔	✔	✔	✔	✔	Wheezing Rales Rhonchi Expiratory sounds(related to asthma)	Peripherial eosinophilia In active phase CRP and erytrocyte sedimentation rate high Elevated 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^[54]^[55]	Acute (depend on the medication)	From 2 weeks to 6 months	-	-	-	-	✔	Wheezing	Not indicated	No indicated	Normal function	Clinical diagnosis	Resolves in four to five days of stopping the medication Angioedema

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↑ Foster MH (2017). "Basement membranes and autoimmune diseases". Matrix Biol. 57-58: 149–168. doi:10.1016/j.matbio.2016.07.008. PMC 5290253. PMID 27496347.
↑ Hoffman GS, Kerr GS, Leavitt RY, Hallahan CW, Lebovics RS, Travis WD, Rottem M, Fauci AS (1992). "Wegener granulomatosis: an analysis of 158 patients". Ann. Intern. Med. 116 (6): 488–98. PMID 1739240.
↑ Falk RJ, Gross WL, Guillevin L, Hoffman GS, Jayne DR, Jennette JC, Kallenberg CG, Luqmani R, Mahr AD, Matteson EL, Merkel PA, Specks U, Watts RA (2011). "Granulomatosis with polyangiitis (Wegener's): an alternative name for Wegener's granulomatosis". Arthritis Rheum. 63 (4): 863–4. doi:10.1002/art.30286. PMID 21374588.
↑ Carmona EM, Kalra S, Ryu JH (2016). "Pulmonary Sarcoidosis: Diagnosis and Treatment". Mayo Clin. Proc. 91 (7): 946–54. doi:10.1016/j.mayocp.2016.03.004. PMID 27378039.
↑ Yanardağ H, Pamuk GE, Karayel T, Demirci S (2002). "Bone marrow involvement in sarcoidosis: an analysis of 50 bone marrow samples". Haematologia (Budap). 32 (4): 419–25. PMID 12803116.
↑ Jennette, J. Charles; Falk, Ronald J. (1997). "Small-Vessel Vasculitis". New England Journal of Medicine. 337 (21): 1512–1523. doi:10.1056/NEJM199711203372106. ISSN 0028-4793.
↑ Vaglio A, Buzio C, Zwerina J (2013). "Eosinophilic granulomatosis with polyangiitis (Churg-Strauss): state of the art". Allergy. 68 (3): 261–73. doi:10.1111/all.12088. PMID 23330816.
↑ Lanham JG, Elkon KB, Pusey CD, Hughes GR (1984). "Systemic vasculitis with asthma and eosinophilia: a clinical approach to the Churg-Strauss syndrome". Medicine (Baltimore). 63 (2): 65–81. PMID 6366453.
↑ Israili ZH, Hall WD (1992). "Cough and angioneurotic edema associated with angiotensin-converting enzyme inhibitor therapy. A review of the literature and pathophysiology". Ann. Intern. Med. 117 (3): 234–42. PMID 1616218.
↑ Wood R (1995). "Bronchospasm and cough as adverse reactions to the ACE inhibitors captopril, enalapril and lisinopril. A controlled retrospective cohort study". Br J Clin Pharmacol. 39 (3): 265–70. PMC 1365002. PMID 7619667.

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@@ Line 49: / Line 49: @@
 * Epiglottal culture in intubated patients may show bacterial growth
 | style="background:#F5F5F5;" + |
-* Enlarge [[epiglottis]] (>8 mm), loss of vallecular air space and distended [[hypopharynx]] in neck [[X-rays|X-ray]]
+* Enlarge [[epiglottis]] (>8 mm), loss of vallecular air space and distended [[hypopharynx]] in neck [[X-rays|X-ray]] may be helpful
 | style="background:#F5F5F5;" + |
 * Normal function
@@ Line 73: / Line 73: @@
 * [[Rales|Crackles]]
 | style="background:#F5F5F5;" + |
-* Low [[White blood cell count|White blood cell coun]]<nowiki/>t ([[White blood cells|WBC]]) in CBC
+* [[Leukopenia]]
 | style="background:#F5F5F5;" + |
 * [[Respiratory system|Subglottic]] narrowing ([[steeple sign]]) in postero-anterior [[Radiography|radiograph]] chest
@@ Line 100: / Line 100: @@
 * Serologic testing
 | style="background:#F5F5F5;" + |
-* [[Atelectasis]]
+* [[Atelectasis]] may seen on chest imaging
 * [[Lymphadenopathy]]
 | style="background:#F5F5F5;" + |
@@ Line 127: / Line 127: @@
 * [[Biopsy]]
 | style="background:#F5F5F5;" + |
-* [[X-rays|X-Ray]]
+* [[X-rays|X-Ray]] may be helpful
-* [[Endoscopy]] examination
+* [[Endoscopy]] examination may be helpful as well
 | style="background:#F5F5F5;" + |
 * Normal function
@@ Line 200: / Line 200: @@
 | style="background:#F5F5F5;" + |
 * In complicated acute [[Rhinosinusitis|bacterial rhinosinusitis]], endoscopic cultures or [[sinus]] aspirate is indicated
-* Nasal culture
+* Nasal culture may also be helpful
 | style="background:#F5F5F5;" + |
 * Air-fluid level, mucosal [[edema]] and bony erosion of sinus on [[Computed tomography|CT]]
@@ Line 226: / Line 226: @@
 * [[Rhonchi]]
 | style="background:#F5F5F5;" + |
-* [[Eosinophilia]] is observed in [[complete blood count]] ([[Complete blood count|CBC]])
+* [[Eosinophilia]]
-* Total [[serum]] [[Immunoglobulin E|IgE]] in test for [[allergy]]
+* Total [[serum]] [[Immunoglobulin E|IgE]] in test for [[allergy]] may be helpful
 | style="background:#F5F5F5;" + |
 * Normal [[Airway|airways]] in [[chest X-ray]]
@@ Line 255: / Line 255: @@
 | style="background:#F5F5F5;" + |
 * [[Sputum culture]] is not indicated
-* [[Polymerase chain reaction|PCR]] in bacterial infection
+* [[Polymerase chain reaction|PCR]] in bacterial infection may be helpful
 | style="background:#F5F5F5;" + |
 * [[Chest X-ray]] to exclude other diseases
@@ Line 278: / Line 278: @@
 * [[Rhonchi]]
 | style="background:#F5F5F5;" + |
-* [[Blood test]]
+* [[CBC]] and [[ABG]] may be helpful
-* [[Arterial blood gas]] ([[Arterial blood gas|ABG]])
 | style="background:#F5F5F5;" + |
 * [[Chest X-ray|Chest X-Ray]] to exclude other diseases
-* [[Computed tomography|CT]]
+* [[Computed tomography|CT]] may also be helpful
 | style="background:#F5F5F5;" + |
 * [[FEV1/FVC ratio]] < 70%
@@ Line 317: / Line 316: @@
 * No response of short acting [[bronchodilator]]
 | style="background:#F5F5F5;" + |
-* [[Bronchial]] [[biopsy]] [[eosinophilia]]
+* [[Bronchial]] [[biopsy]]
+* [[Eosinophilia]]
 | style="background:#F5F5F5;" + |
 * Exposure to an occupational cause
@@ Line 365: / Line 365: @@
 * [[Rales|Crackles]]
 | style="background:#F5F5F5;" + |
-* [[Blood test]]
+* Testing for [[alpha 1-antitrypsin]] may be helpful
-* Testing for [[alpha 1-antitrypsin]]
 | style="background:#F5F5F5;" + |
 * [[Chest X-ray|Chest X-Ray]] to exclude other diseases
-* [[Computed tomography|CT]]
+* [[Computed tomography|CT]] may also be helpful
 | style="background:#F5F5F5;" + |
 * [[FEV1/FVC ratio|FEV1/FVC]] <70%
@@ Line 391: / Line 390: @@
 * Decreased [[breath sounds]]
 | style="background:#F5F5F5;" + |
-* No specific
+* No specific tests
 | style="background:#F5F5F5;" + |
 * Hyperinflated lungs, [[atelectasis]], and [[mediastinitis]]
 * Shift in [[Chest X-ray|chest radiograph]] when the object is [[radio-opaque]]
-* [[Computed tomography|CT]]
+* [[Computed tomography|CT]] may be helpful
 | style="background:#F5F5F5;" + |
 * Not specific
@@ Line 419: / Line 418: @@
 * Increased [[respiratory rate]]
 | style="background:#F5F5F5;" + |
-* [[Complete blood count]] ([[CBC]])
+* [[Complete blood count]] ([[CBC]]) may be helpful
-* [[Urinalysis]] (in infants)
+* [[Urinalysis]] & [[urine culture]] ( in infants)
-* [[Urine culture]] ( in infants)
 | style="background:#F5F5F5;" + |
-* [[Chest X-Ray]]
+* [[Chest X-Ray]] may be helpful
 | style="background:#F5F5F5;" + |
 * Normal function or obstructive changes ([[FEV1/FVC ratio|FEV1/FVC]] <70%)
@@ Line 477: / Line 475: @@
 * [[Rales|Crackles]]
 | style="background:#F5F5F5;" + |
-* [[Arterial blood gas]]
+* [[CBC]] and [[ABG]] may be helpful
-* [[Complete blood count]] ([[Complete blood count|CBC]])
 | style="background:#F5F5F5;" + |
 * Small oppacities and [[fibrosis]] observed in [[chest X-ray]]
-* [[Computed tomography|CT]]
+* [[Computed tomography|CT]] and [[Positron emission tomography|FDG-PET]] may be helpful
-* [[Positron emission tomography|FDG-PET]]
 | style="background:#F5F5F5;" + |
 * [[FEV1/FVC ratio|FEV1/FVC]] <70%
@@ Line 505: / Line 501: @@
 | style="background:#F5F5F5;" + |
 * [[Hoarseness]]
-| style="background:#F5F5F5;" + |
+| style="background:#F5F5F5;" + |The following investigations may be helpful:
 * [[Complete blood count]] ([[Complete blood count|CBC]])
 * [[Alanine transaminase|ALT]], [[Aspartate transaminase|AST]]
@@ Line 538: / Line 534: @@
 * [[Rales|Crackles]] or velcro rales
 * [[Lung volumes|Inspiratory]] high-pitched [[rhonchi]]
-| style="background:#F5F5F5;" + |
+| style="background:#F5F5F5;" + |The following investigations may be helpful:
-* Test for [[Hepatic function test|hepatic]] and [[Renal function tests|renal function]]
+* [[Hepatic function test]]
-* Hematologic test in differential [[Complete blood count|CBC]]
+* [[Renal function tests|Renal function test]]
+* [[Complete blood count|CBC]]
 * [[Serology|Serological testing]]
 | style="background:#F5F5F5;" + |
@@ Line 571: / Line 568: @@
 * [[Rhonchi]]
 | style="background:#F5F5F5;" + |
-* Sputum [[acid-fast]] bacilli ([[Acid-fast|AFB]]) smear
+* Sputum [[acid-fast]] bacilli ([[Acid-fast|AFB]]) smear may be positive
-* [[Mycobacterium|Mycobacterial]] [[Culture media|culture]]
+* [[Mycobacterium|Mycobacterial]] [[Culture media|culture]] may be positive
-* Molecular testing
+* Molecular testing may be helpful
 | style="background:#F5F5F5;" + |
 * Reactivation of [[Tuberculosis|TB]] is observed as [[Infiltration (medical)|infiltration]] in the upper [[Lobe (anatomy)|lobe]] in [[Chest X-ray|chest X-Ray]]
-* In patients with [[Human Immunodeficiency Virus (HIV)|HIV]], Tb is observed as lobar [[Infiltration (medical)|infiltration]], [[adenopathy]], lung mass named [[tuberculoma]], small fibronodular lesions, and/or [[pleural effusion]] [[Chest X-ray|chest X-Ray]]
+* In patients with [[Human Immunodeficiency Virus (HIV)|HIV]], Tb is observed as lobar [[Infiltration (medical)|infiltration]], [[adenopathy]], lung mass named [[tuberculoma]], small fibronodular lesions, and/or [[pleural effusion]] on [[Chest X-ray|chest X-Ray]]
 * [[Computed tomography|CT]] can detect early nodal process
 | style="background:#F5F5F5;" + |
@@ Line 601: / Line 598: @@
 * [[Tachypnea]]
 | style="background:#F5F5F5;" + |
-* [[Respiratory tract]] [[Culture media|culture]] for [[Cystic fibrosis|CF]]
+* [[Respiratory tract]] [[Culture media|culture]] may be helpful for diagnosing secondary bacterial infection
-* [[Bronchoalveolar lavage]] for cytology
+* [[Bronchoalveolar lavage]] for cytology may be helpful
 * ≥ 60 mmol/L [[Sweat chloride test]]
-* [[CFTR (gene)|CFTR]] [[mutation]] in molecular testing
+* [[CFTR (gene)|CFTR]] [[mutation]] in molecular testing may be positive
 | style="background:#F5F5F5;" + |
 * Hyperinflation, [[atelectasis]], and infiltrates on [[Chest X-ray|chest X-Ray]]
@@ Line 636: / Line 633: @@
 * [[Rhonchi]]
 * Gurgling sounds
-| style="background:#F5F5F5;" + |
+| style="background:#F5F5F5;" + |The following investigations may be helpful:
 * [[Arterial blood gas]]
 * [[Blood urea nitrogen|BUN]]
@@ Line 671: / Line 668: @@
 * Not specifc
 | style="background:#F5F5F5;" + |
-* [[Electrocardiogram]]
+* [[Electrocardiogram]] may be helpful
 * Enlargement of [[left atrium]] and [[appendage]] in [[Chest X-ray|chest radiograph]]
 | style="background:#F5F5F5;" + |
@@ Line 692: / Line 689: @@
 | style="background:#F5F5F5;" + |
 * [[Dysphonia|Hoarseness]]
-| style="background:#F5F5F5;" + |
+| style="background:#F5F5F5;" + |The following investigations may be helpful:
 * [[Human Immunodeficiency Virus (HIV)|HIV]] serology
 * [[Anti-nuclear antibody|Antinuclear antibody]] ([[Antinuclear antibodies|ANA]])
@@ Line 728: / Line 725: @@
 * Not specific
 | style="background:#F5F5F5;" + |
-* [[Upper endoscopy]]
+* [[Upper endoscopy]] may be helpful
-* [[Barium]] esophagram
+* [[Barium]] esophagram may be helpful
 | style="background:#F5F5F5;" + |
 * Normal function
@@ Line 748: / Line 745: @@
 | style="background:#F5F5F5;" + |
 * [[Shortness of breath]]
-| style="background:#F5F5F5;" + |
+| style="background:#F5F5F5;" + |The following investigations may be helpful:
 * [[Complete blood count]] ([[Complete blood count|CBC]])
 * [[Anti-neutrophil cytoplasmic antibody|ANCA]] positive
@@ Line 754: / Line 751: @@
 | style="background:#F5F5F5;" + |
 * Pulmonary infiltratation in [[Chest X-ray|chest X-Ray]]
-* [[Computed tomography|CT]] parenchimal envolment
+* [[Computed tomography|CT]] scan for parenchymal involvement
 | style="background:#F5F5F5;" + |
 * Increased [[DLCO]]
@@ Line 778: / Line 775: @@
 * [[Stridor]]
 * [[Wheeze|Wheezing]]
-| style="background:#F5F5F5;" + |
+| style="background:#F5F5F5;" + |The following investigations may be helpful:
 * [[Anti-neutrophil cytoplasmic antibody|ANCA]], [[P-ANCA]], [[C-ANCA]]
 * [[Blood urea nitrogen|BUN]]
@@ Line 788: / Line 785: @@
 * [[Nodules]], [[Lung|pulmonary]] infiltrates, reticular margins, pleural opacities and [[Cavity|cavities]] in [[Chest X-ray|chest X-Ray]]
 * [[Nodule (medicine)|Nodules]], [[cavities]] and stellate-shaped peripherial [[pulmonary]] in chest [[Computed tomography|CT]]
-* [[Bronchoscopy]]
+* [[Bronchoscopy]] may be helpful
 | style="background:#F5F5F5;" + |
 * Low levels of [[DLCO]]
@@ Line 811: / Line 808: @@
 * [[Wheeze|Wheezing]]
 * Squeaky sounds
-| style="background:#F5F5F5;" + |
+| style="background:#F5F5F5;" + |The following investigations may be helpful:
 * [[Complete blood count]] ([[CBC]])
 * [[Urinalysis]]
@@ Line 848: / Line 845: @@
 * [[Stridor]]
 * [[Wheeze|Wheezing]]
-| style="background:#F5F5F5;" + |
+| style="background:#F5F5F5;" + |The following investigations may be helpful:
 * [[ANCA]] positive
 * [[Blood urea nitrogen|BUN]]
@@ Line 856: / Line 853: @@
 | style="background:#F5F5F5;" + |
 * [[Cavitation]], [[Nodule (medicine)|nodules]], and alveolar opacities in [[chest X-ray]]
-* Head and chest [[Computed tomography|CT]]
+* Head and chest [[Computed tomography|CT]] may be helpful
-* [[Electromyography]]/[[nerve conduction study]]
+* [[Electromyography]]/[[nerve conduction study]] may also be helpful
 | style="background:#F5F5F5;" + |
 * Reduced [[lung volumes]]
@@ Line 884: / Line 881: @@
 * Peripherial [[eosinophilia]]
 * In active phase [[C-reactive protein|CRP]] and [[Red blood cell|erytrocyte]] [[sedimentation]] rate high
-* High levels of [[Immunoglobulin E|IgE]]
+* Elevated [[Immunoglobulin E|IgE]]
 * [[Anti-neutrophil cytoplasmic antibody|ANCA]] positive
 | style="background:#F5F5F5;" + |
@@ Line 913: / Line 910: @@
 * [[Wheeze|Wheezing]]
 | style="background:#F5F5F5;" + |
-* Not  required
+* Not  indicated
 | style="background:#F5F5F5;" + |
-* No required
+* No indicated
 | style="background:#F5F5F5;" + |
 * Normal function
@@ Line 924: / Line 921: @@
 *[[Angioedema]]
 |}
+<references />

Cough differential diagnosis: Difference between revisions

Revision as of 14:58, 5 March 2018

Overview

Cough Differential Diagnosis

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