Squamous cell carcinoma of the lung differential diagnosis: Difference between revisions

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Revision as of 16:30, 25 April 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shanshan Cen, M.D. [2], Maria Fernanda Villarreal, M.D. [3]

Overview

Squamous cell carcinoma of the lung must be differentiated from other diseases that cause chronic cough, weight loss, hemoptysis, and dyspnea among adults such as pulmonary tuberculosis, sarcoidosis, pneumonia, pulmonary fungal infection, and secondary metastases.

Differential Diagnosis

The table below summarizes the findings that differentiate squamous cell carcinoma of the lung from other conditions that cause chronic cough, weight loss, hemoptysis, and dyspnea.^[1]^[2]

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	Parenchyma	Lung cancer^[3]^[4]	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^[5]^[6]	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)^[7]^[8]	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
Cardiac		Pulmonary hypertension^[9]^[10]	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
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
Autoimmune		Wegener's disease (GPA) ^[11]^[12]	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
		Microscopic polyangitis (MPA)^[13]	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^[14]^[15]	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

References

↑ Bhatt M, Kant S, Bhaskar R (2012). "Pulmonary tuberculosis as differential diagnosis of lung cancer". South Asian J Cancer. 1 (1): 36–42. doi:10.4103/2278-330X.96507. PMC 3876596. PMID 24455507.
↑ Kamiya K, Yoshizu A, Misumi Y, Hida N, Okamoto H, Yoshida S (2011). "[Lung abscess which needed to be distinguished from lung cancer; report of a case]". Kyobu Geka. 64 (13): 1204–7. PMID 22242302.
↑ Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D (2011). "Global cancer statistics". CA Cancer J Clin. 61 (2): 69–90. doi:10.3322/caac.20107. PMID 21296855.
↑ Ost DE, Jim Yeung SC, Tanoue LT, Gould MK (2013). "Clinical and organizational factors in the initial evaluation of patients with lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines". Chest. 143 (5 Suppl): e121S–e141S. doi:10.1378/chest.12-2352. PMC 4694609. PMID 23649435.
↑ Lama VN, Martinez FJ (2004). "Resting and exercise physiology in interstitial lung diseases". Clin. Chest Med. 25 (3): 435–53, v. doi:10.1016/j.ccm.2004.05.005. PMID 15331185.
↑ Chetta A, Marangio E, Olivieri D (2004). "Pulmonary function testing in interstitial lung diseases". Respiration. 71 (3): 209–13. doi:10.1159/000077416. PMID 15133338.
↑ Perlman DC, el-Sadr WM, Nelson ET, Matts JP, Telzak EE, Salomon N, Chirgwin K, Hafner R (1997). "Variation of chest radiographic patterns in pulmonary tuberculosis by degree of human immunodeficiency virus-related immunosuppression. The Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA). The AIDS Clinical Trials Group (ACTG)". Clin. Infect. Dis. 25 (2): 242–6. PMID 9332519.
↑ Barnes PF, Verdegem TD, Vachon LA, Leedom JM, Overturf GD (1988). "Chest roentgenogram in pulmonary tuberculosis. New data on an old test". Chest. 94 (2): 316–20. PMID 2456183.
↑ Brown LM, Chen H, Halpern S, Taichman D, McGoon MD, Farber HW, Frost AE, Liou TG, Turner M, Feldkircher K, Miller DP, Elliott CG (2011). "Delay in recognition of pulmonary arterial hypertension: factors identified from the REVEAL Registry". Chest. 140 (1): 19–26. doi:10.1378/chest.10-1166. PMC 3198486. PMID 21393391.
↑ Sun XG, Hansen JE, Oudiz RJ, Wasserman K (2003). "Pulmonary function in primary pulmonary hypertension". J Am Coll Cardiol. 41 (6): 1028–35. PMID 12651053.
↑ 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.
↑ 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.

Template:WikiDoc Sources

[pmid24455507-1] Bhatt M, Kant S, Bhaskar R (2012). "Pulmonary tuberculosis as differential diagnosis of lung cancer". South Asian J Cancer. 1 (1): 36–42. doi:10.4103/2278-330X.96507. PMC 3876596. PMID 24455507.

[pmid22242302-2] Kamiya K, Yoshizu A, Misumi Y, Hida N, Okamoto H, Yoshida S (2011). "[Lung abscess which needed to be distinguished from lung cancer; report of a case]". Kyobu Geka. 64 (13): 1204–7. PMID 22242302.

[pmid21296855-3] Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D (2011). "Global cancer statistics". CA Cancer J Clin. 61 (2): 69–90. doi:10.3322/caac.20107. PMID 21296855.

[pmid23649435-4] Ost DE, Jim Yeung SC, Tanoue LT, Gould MK (2013). "Clinical and organizational factors in the initial evaluation of patients with lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines". Chest. 143 (5 Suppl): e121S–e141S. doi:10.1378/chest.12-2352. PMC 4694609. PMID 23649435.

[pmid15331185-5] Lama VN, Martinez FJ (2004). "Resting and exercise physiology in interstitial lung diseases". Clin. Chest Med. 25 (3): 435–53, v. doi:10.1016/j.ccm.2004.05.005. PMID 15331185.

[pmid15133338-6] Chetta A, Marangio E, Olivieri D (2004). "Pulmonary function testing in interstitial lung diseases". Respiration. 71 (3): 209–13. doi:10.1159/000077416. PMID 15133338.

[pmid9332519-7] Perlman DC, el-Sadr WM, Nelson ET, Matts JP, Telzak EE, Salomon N, Chirgwin K, Hafner R (1997). "Variation of chest radiographic patterns in pulmonary tuberculosis by degree of human immunodeficiency virus-related immunosuppression. The Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA). The AIDS Clinical Trials Group (ACTG)". Clin. Infect. Dis. 25 (2): 242–6. PMID 9332519.

[pmid2456183-8] Barnes PF, Verdegem TD, Vachon LA, Leedom JM, Overturf GD (1988). "Chest roentgenogram in pulmonary tuberculosis. New data on an old test". Chest. 94 (2): 316–20. PMID 2456183.

[pmid21393391-9] Brown LM, Chen H, Halpern S, Taichman D, McGoon MD, Farber HW, Frost AE, Liou TG, Turner M, Feldkircher K, Miller DP, Elliott CG (2011). "Delay in recognition of pulmonary arterial hypertension: factors identified from the REVEAL Registry". Chest. 140 (1): 19–26. doi:10.1378/chest.10-1166. PMC 3198486. PMID 21393391.

[pmid12651053-10] Sun XG, Hansen JE, Oudiz RJ, Wasserman K (2003). "Pulmonary function in primary pulmonary hypertension". J Am Coll Cardiol. 41 (6): 1028–35. PMID 12651053.

[pmid1739240-11] 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.

[pmid21374588-12] 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.

[JennetteFalk1997-13] 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.

[pmid23330816-14] 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.

[pmid6366453-15] 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.

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@@ Line 9: / Line 9: @@
 *The table below summarizes the findings that differentiate squamous cell carcinoma of the lung from other conditions that cause  chronic [[cough]], [[weight loss]], [[hemoptysis]], and [[dyspnea]].<ref name="pmid24455507">{{cite journal| author=Bhatt M, Kant S, Bhaskar R| title=Pulmonary tuberculosis as differential diagnosis of lung cancer. | journal=South Asian J Cancer | year= 2012 | volume= 1 | issue= 1 | pages= 36-42 | pmid=24455507 | doi=10.4103/2278-330X.96507 | pmc=PMC3876596 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24455507  }} </ref><ref name="pmid22242302">{{cite journal| author=Kamiya K, Yoshizu A, Misumi Y, Hida N, Okamoto H, Yoshida S| title=[Lung abscess which needed to be distinguished from lung cancer; report of a case]. | journal=Kyobu Geka | year= 2011 | volume= 64 | issue= 13 | pages= 1204-7 | pmid=22242302 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22242302  }} </ref>
-{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
+{|
-| valign="top" |
+! align="center" style="background:#4479BA; color: #FFFFFF;" rowspan="3" colspan="2" + |Organ system
-|+
+! align="center" style="background:#4479BA; color: #FFFFFF;" rowspan="3" + |Diseases
-! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differential Diagnosis}}
+! align="center" style="background:#4479BA; color: #FFFFFF;" colspan="8" + |Clinical manifestations
-! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Similar Features}}
+! align="center" style="background:#4479BA; color: #FFFFFF;" rowspan="2" colspan="4" + |Diagnosis
-! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Differentiating Features}}
+! align="center" style="background:#4479BA; color: #FFFFFF;" rowspan="3" + |Other features
 |-
-| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |''' [[Pulmonary tuberculosis]]'''
+! align="center" style="background:#4479BA; color: #FFFFFF;" colspan="7" + |Symptoms
-| style="padding: 5px 5px; background: #F5F5F5;" |
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Physical exam
-*Chronic [[cough]], [[weight loss]], [[hemoptysis]], nocturnal diaphoresis, [[dyspnea]]
-| style="padding: 5px 5px; background: #F5F5F5;" |
-*In pulmonary tuberculosis, clinical features include: increase in diameter despite optimal medical therapy, patients age is usually younger, hemoptisis is an early feature,  and CXR anatomical predilection for upper lobes
 |-
-| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |''' [[Sarcoidosis]]'''
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Onset
-| style="padding: 5px 5px; background: #F5F5F5;" |
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Duration
-*Chronic [[cough]], [[weight loss]], and [[dyspnea]]
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Productive cough
-| style="padding: 5px 5px; background: #F5F5F5;" |
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hemoptysis
-*In sarcoidosis, clinical features include:  acute or subacute onset, CXR anatomical predilection for upper lobes,  and  usually resolve with antibiotic
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Weight lost
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Fever
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Dyspnea
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Ascultation
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Lab findings
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Imaging
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |PFT
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Gold standard
 |-
-| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Pneumonia]]'''
+| rowspan="3" align="center" style="background:#DCDCDC;" + |[[Respiratory system|'''Respiratory''']]
-| style="padding: 5px 5px; background: #F5F5F5;" |
+| rowspan="3" align="center" style="background:#DCDCDC;" + |[[Parenchyma|'''Parenchyma''']]
-*Cough, fatigue, and dyspnea
+| align="center" style="background:#DCDCDC;" + |[[Lung cancer|'''Lung cancer''']]<ref name="pmid21296855">{{cite journal |vauthors=Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D |title=Global cancer statistics |journal=CA Cancer J Clin |volume=61 |issue=2 |pages=69–90 |year=2011 |pmid=21296855 |doi=10.3322/caac.20107 |url=}}</ref><ref name="pmid23649435">{{cite journal |vauthors=Ost DE, Jim Yeung SC, Tanoue LT, Gould MK |title=Clinical and organizational factors in the initial evaluation of patients with lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines |journal=Chest |volume=143 |issue=5 Suppl |pages=e121S–e141S |year=2013 |pmid=23649435 |pmc=4694609 |doi=10.1378/chest.12-2352 |url=}}</ref>
-| style="padding: 5px 5px; background: #F5F5F5;" |
+| align="center" style="background:#F5F5F5;" + |Chronic
-*In pneumonia, clinical features include: good response to antibiotics, acute onset, predilection on CXR is consolidation, laboratory markers indicate infection
+| style="background:#F5F5F5;" + |
+*Years
+| align="center" style="background:#F5F5F5;" + | +
+| align="center" style="background:#F5F5F5;" + | +
+| align="center" style="background:#F5F5F5;" + | +
+| align="center" style="background:#F5F5F5;" + | +/−
+| align="center" style="background:#F5F5F5;" + | +
+| style="background:#F5F5F5;" + |
+*[[Hoarseness]]
+| style="background:#F5F5F5;" + |The following investigations may be helpful:
+*[[Complete blood count]] ([[Complete blood count|CBC]])
+*[[Alanine transaminase|ALT]], [[Aspartate transaminase|AST]]
+*[[Calcium]]
+*[[Alkaline phosphatase]]
+*[[Lactate dehydrogenase|LDH]]
+*[[Creatinine]]
+| style="background:#F5F5F5;" + |
+*[[Contrast enhanced CT|Contrast−enhanced CT]] of chest and upper abdomen
+| style="background:#F5F5F5;" + |
+*Not specific
+| style="background:#F5F5F5;" + |
+*Tissue [[biopsy]]  (sample should be sufficient for [[Molecule|molecular]] testing)
+| style="background:#F5F5F5;" + |
+*Risk factor:
+**Cigarette smoking
+*Types
+**[[Small cell lung cancer|Small cell lung cance]]<nowiki/>r ([[Small cell lung cancer|SCLC]])
+**[[Non small cell lung cancer|Non−small cell lung cance]]<nowiki/>r ([[Non small cell lung cancer|NSCLC]])
 |-
-| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | '''[[Fungal infection|Pulmonary fungal infection]]'''
+| align="center" style="background:#DCDCDC;" + |'''[[Interstitial lung disease]]'''<ref name="pmid15331185">{{cite journal |vauthors=Lama VN, Martinez FJ |title=Resting and exercise physiology in interstitial lung diseases |journal=Clin. Chest Med. |volume=25 |issue=3 |pages=435–53, v |year=2004 |pmid=15331185 |doi=10.1016/j.ccm.2004.05.005 |url=}}</ref><ref name="pmid15133338">{{cite journal |vauthors=Chetta A, Marangio E, Olivieri D |title=Pulmonary function testing in interstitial lung diseases |journal=Respiration |volume=71 |issue=3 |pages=209–13 |year=2004 |pmid=15133338 |doi=10.1159/000077416 |url=}}</ref>
-| style="padding: 5px 5px; background: #F5F5F5;" |
+| align="center" style="background:#F5F5F5;" + |Chronic
-*Chronic [[cough]], [[weight loss]], [[hemoptysis]], and [[dyspnea]]
+| style="background:#F5F5F5;" + |
-| style="padding: 5px 5px; background: #F5F5F5;" |
+*Variable
-*In primary fungal infection, clinical features include: CXR findings: air-cresecent sign, no response to antibioitcs, and  mimcs tuberculosis
+| align="center" style="background:#F5F5F5;" + |−
+| align="center" style="background:#F5F5F5;" + | +
+| align="center" style="background:#F5F5F5;" + | +
+| align="center" style="background:#F5F5F5;" + |−
+| align="center" style="background:#F5F5F5;" + | +
+| style="background:#F5F5F5;" + |
+*[[Wheeze|Wheezing]]
+*[[Rales|Crackles]] or velcro rales
+*[[Lung volumes|Inspiratory]] high−pitched [[rhonchi]]
+| style="background:#F5F5F5;" + |The following investigations may be helpful:
+*[[Hepatic function test]]
+*[[Renal function tests|Renal function test]]
+*[[Complete blood count|CBC]]
+*[[Serology|Serological testing]]
+| style="background:#F5F5F5;" + |
+*[[Nodular]], [[reticular]] or both pattern in [[Chest X-ray|chest X−ray]]
+*[[Computed tomography|CT]] in patients with diffuse pulmonary lung disease
+| style="background:#F5F5F5;" + |
+*Reduction in [[Vital capacity|FVC]], [[Residual volume|RV]], [[Functional residual capacity|FRC]], [[Total lung capacity|TLC]] and [[FEV1]] on spirometry
+*[[FEV1/FVC ratio|FEV1/FVC]] normal or increase
+*[[Lung volumes]]
+*Diffusion capacity ([[DLCO]] reduced)
+| style="background:#F5F5F5;" + |
+*Lung [[biopsy]] when lab, imaging, and PFT has indeterminate result
+| style="background:#F5F5F5;" + |
+*Clubbing is common in [[asbestosis]] and [[idiopathic pulmonary fibrosis]]
 |-
-| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Metastases]]'''
+| align="center" style="background:#DCDCDC;" + |'''[[Tuberculosis]] ([[Tuberculosis|TB]])'''<ref name="pmid9332519">{{cite journal |vauthors=Perlman DC, el-Sadr WM, Nelson ET, Matts JP, Telzak EE, Salomon N, Chirgwin K, Hafner R |title=Variation of chest radiographic patterns in pulmonary tuberculosis by degree of human immunodeficiency virus-related immunosuppression. The Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA). The AIDS Clinical Trials Group (ACTG) |journal=Clin. Infect. Dis. |volume=25 |issue=2 |pages=242–6 |year=1997 |pmid=9332519 |doi= |url=}}</ref><ref name="pmid2456183">{{cite journal |vauthors=Barnes PF, Verdegem TD, Vachon LA, Leedom JM, Overturf GD |title=Chest roentgenogram in pulmonary tuberculosis. New data on an old test |journal=Chest |volume=94 |issue=2 |pages=316–20 |year=1988 |pmid=2456183 |doi= |url=}}</ref>
-| style="padding: 5px 5px; background: #F5F5F5;" |
+| align="center" style="background:#F5F5F5;" + |Chronic
-*Chronic [[cough]], [[weight loss]], [[hemoptysis]], and [[dyspnea]]
+| style="background:#F5F5F5;" + |
-| style="padding: 5px 5px; background: #F5F5F5;" |
+*More than 2 or 3 weeks
-*In metastases, clinical features include: multicentricity, involvement of the contralateral hemitorax, and usually the location of the primary cancer is known
+| align="center" style="background:#F5F5F5;" + | +
+| align="center" style="background:#F5F5F5;" + | +
+| align="center" style="background:#F5F5F5;" + | +
+| align="center" style="background:#F5F5F5;" + | +
+| align="center" style="background:#F5F5F5;" + | +
+| style="background:#F5F5F5;" + |
+*[[Pleural effusion]]
+*[[Crackles]]
+*[[Whispered pectoriloquy]]
+*Decreased fremitus
+*[[Rhonchi]]
+| style="background:#F5F5F5;" + |
+*Sputum [[Acid-fast|acid−fast]] bacilli ([[Acid-fast|AFB]]) smear may be positive
+*[[Mycobacterium|Mycobacterial]] [[Culture media|culture]] may be positive
+*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]] on [[Chest X-ray|chest X−Ray]]
+*[[Computed tomography|CT]] can detect early nodal process
+| style="background:#F5F5F5;" + |
+*Decreased [[FEV1]]
+*Reduced  [[Vital capacity|FVC]]
+| style="background:#F5F5F5;" + |
+*Isolation of ''[[Mycobacterium tuberculosis]]'' from some [[secretion]]
+| style="background:#F5F5F5;" + |
+*Etiology: ''[[Mycobacterium tuberculosis]]''
+*Complications: [[Pneumothorax]], [[bronchiectasis]], pulmonary destruction and [[chronic pulmonary aspergillosis]]
+|-
+| colspan="2" align="center" style="background:#DCDCDC;" + |[[Heart|'''Cardiac''']]
+| align="center" style="background:#DCDCDC;" + |[[Pulmonary hypertension|'''Pulmonary hypertension''']]<ref name="pmid21393391">{{cite journal |vauthors=Brown LM, Chen H, Halpern S, Taichman D, McGoon MD, Farber HW, Frost AE, Liou TG, Turner M, Feldkircher K, Miller DP, Elliott CG |title=Delay in recognition of pulmonary arterial hypertension: factors identified from the REVEAL Registry |journal=Chest |volume=140 |issue=1 |pages=19–26 |year=2011 |pmid=21393391 |pmc=3198486 |doi=10.1378/chest.10-1166 |url=}}</ref><ref name="pmid12651053">{{cite journal| author=Sun XG, Hansen JE, Oudiz RJ, Wasserman K| title=Pulmonary function in primary pulmonary hypertension. | journal=J Am Coll Cardiol | year= 2003 | volume= 41 | issue= 6 | pages= 1028-35 | pmid=12651053 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12651053  }}</ref>
+| align="center" style="background:#F5F5F5;" + |Chronic
+| style="background:#F5F5F5;" + |
+*More than 2 years
+| align="center" style="background:#F5F5F5;" + |−
+| align="center" style="background:#F5F5F5;" + | +
+| align="center" style="background:#F5F5F5;" + | +
+| align="center" style="background:#F5F5F5;" + |−
+| align="center" style="background:#F5F5F5;" + | +
+| style="background:#F5F5F5;" + |
+*[[Dysphonia|Hoarseness]]
+| style="background:#F5F5F5;" + |The following investigations may be helpful:
+*[[Human Immunodeficiency Virus (HIV)|HIV]] serology
+*[[Anti-nuclear antibody|Antinuclear antibody]] ([[Antinuclear antibodies|ANA]])
+*[[Rheumatoid factor]] ([[RF]])
+*[[Anti-neutrophil cytoplasmic antibody|Anti−neutrophil  cytoplasmic antibody]] ([[Anti-neutrophil cytoplasmic antibody|ANCA]])
+| style="background:#F5F5F5;" + |
+*Enlargement of the central [[pulmonary artery]] and right heart  in [[Chest X-ray|chest X−Ray]]
+*[[Pulmonary  artery]] systolic pressure can be estimated in [[echocardiography]]
+| style="background:#F5F5F5;" + |
+*Low levels of [[FEV1]]
+*Decreased [[Vital capacity|FVC]]
+*[[DLCO]] reduced
+| style="background:#F5F5F5;" + |
+*Mean [[pulmonary artery]] pressure more than 25 [[mmHg]] at rest
+| style="background:#F5F5F5;" + |
+*[[Chest pain]]
+*[[Ascites]]
+*[[Syncope]]
+*Peripherial [[edema]]
+|-
+! align="center" style="background:#4479BA; color: #FFFFFF;" rowspan="3" colspan="2" + |Organ system
+! align="center" style="background:#4479BA; color: #FFFFFF;" rowspan="3" + |Diseases
+! align="center" style="background:#4479BA; color: #FFFFFF;" colspan="8" + |Clinical manifestations
+! align="center" style="background:#4479BA; color: #FFFFFF;" rowspan="2" colspan="4" + |Diagnosis
+! align="center" style="background:#4479BA; color: #FFFFFF;" rowspan="3" + |Other features
+|-
+! align="center" style="background:#4479BA; color: #FFFFFF;" colspan="7" + |Symptoms
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Physical exam
+|-
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Onset
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Duration
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Productive cough
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hemoptysis
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Weight lost
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Fever
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Dyspnea
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Ascultation
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Lab findings
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Imaging
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |PFT
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Gold standard
+|-
+| align="center" style="background:#DCDCDC;" rowspan="3" colspan="2" + |'''[[Autoimmune]]'''
+| align="center" style="background:#DCDCDC;" + |[[Granulomatosis with polyangiitis|'''Wegener's disease''']] ([[Granulomatosis with polyangiitis|'''GPA''']]) <ref name="pmid1739240">{{cite journal |vauthors=Hoffman GS, Kerr GS, Leavitt RY, Hallahan CW, Lebovics RS, Travis WD, Rottem M, Fauci AS |title=Wegener granulomatosis: an analysis of 158 patients |journal=Ann. Intern. Med. |volume=116 |issue=6 |pages=488–98 |year=1992 |pmid=1739240 |doi= |url=}}</ref><ref name="pmid21374588">{{cite journal |vauthors=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 |title=Granulomatosis with polyangiitis (Wegener's): an alternative name for Wegener's granulomatosis |journal=Arthritis Rheum. |volume=63 |issue=4 |pages=863–4 |year=2011 |pmid=21374588 |doi=10.1002/art.30286 |url=}}</ref>
+| align="center" style="background:#F5F5F5;" + |Chronic
+| style="background:#F5F5F5;" + |
+*Months
+| align="center" style="background:#F5F5F5;" + | +
+| align="center" style="background:#F5F5F5;" + | +
+| align="center" style="background:#F5F5F5;" + | +
+| align="center" style="background:#F5F5F5;" + | +
+| align="center" style="background:#F5F5F5;" + | +
+| style="background:#F5F5F5;" + |
+*[[Hoarseness]]
+*[[Stridor]]
+*[[Wheeze|Wheezing]]
+| style="background:#F5F5F5;" + |The following investigations may be helpful:
+*[[Anti-neutrophil cytoplasmic antibody|ANCA]], [[P-ANCA|P−ANCA]], [[C-ANCA|C−ANCA]]
+*[[Blood urea nitrogen|BUN]]
+*[[Creatinine]]
+*[[Complete blood count]]
+*[[Urinalysis]]
+*Lung [[biopsy]]
+| style="background:#F5F5F5;" + |
+*[[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]] may be helpful
+| style="background:#F5F5F5;" + |
+*Low levels of [[DLCO]]
+*Reduce [[lung volumes]]
+| style="background:#F5F5F5;" + |
+*Tissue [[biopsy]]
+| style="background:#F5F5F5;" + |
+*Nasal crusting, sinus pain, chronic [[rhinosinusitis]], nasal obstruction and discharge in [[Upper respiratory tract|upper airway]]
+*[[Saddle nose|Saddle nose deformity]]
+*[[Purpura]] in lower extremities
+|-
+| align="center" style="background:#DCDCDC;" + |'''Microscopic polyangitis ([[Microscopic polyangiitis|MPA]])'''<ref name="JennetteFalk1997">{{cite journal|last1=Jennette|first1=J. Charles|last2=Falk|first2=Ronald J.|title=Small-Vessel Vasculitis|journal=New England Journal of Medicine|volume=337|issue=21|year=1997|pages=1512–1523|issn=0028-4793|doi=10.1056/NEJM199711203372106}}</ref>
+| align="center" style="background:#F5F5F5;" + |Chronic
+| style="background:#F5F5F5;" + |
+*Variable
+| align="center" style="background:#F5F5F5;" + | +
+| align="center" style="background:#F5F5F5;" + | +
+| align="center" style="background:#F5F5F5;" + | +
+| align="center" style="background:#F5F5F5;" + | +
+| align="center" style="background:#F5F5F5;" + | +
+| style="background:#F5F5F5;" + |
+*[[Hoarseness]]
+*[[Stridor]]
+*[[Wheeze|Wheezing]]
+| style="background:#F5F5F5;" + |The following investigations may be helpful:
+*[[ANCA]] positive
+*[[Blood urea nitrogen|BUN]]
+*[[Creatinine]]
+*[[Complete blood count]]
+*[[Urinalysis]]
+| style="background:#F5F5F5;" + |
+*[[Cavitation]], [[Nodule (medicine)|nodules]], and alveolar opacities in [[Chest X-ray|chest X−ray]]
+*Head and chest [[Computed tomography|CT]] may be helpful
+*[[Electromyography]]/[[nerve conduction study]] may also be helpful
+| style="background:#F5F5F5;" + |
+*Reduced [[lung volumes]]
+| style="background:#F5F5F5;" + |
+*Tissue [[biopsy]]
+| style="background:#F5F5F5;" + |
+*[[Nerve]] damage
+*[[Rhinosinusitis]]
+*[[Purpura]] involving lower extremities
+|-
+| align="center" style="background:#DCDCDC;" + |[[Eosinophilic granulomatosis with polyangiitis|'''Churg−Strauss''']]<ref name="pmid23330816">{{cite journal |vauthors=Vaglio A, Buzio C, Zwerina J |title=Eosinophilic granulomatosis with polyangiitis (Churg-Strauss): state of the art |journal=Allergy |volume=68 |issue=3 |pages=261–73 |year=2013 |pmid=23330816 |doi=10.1111/all.12088 |url=}}</ref><ref name="pmid6366453">{{cite journal |vauthors=Lanham JG, Elkon KB, Pusey CD, Hughes GR |title=Systemic vasculitis with asthma and eosinophilia: a clinical approach to the Churg-Strauss syndrome |journal=Medicine (Baltimore) |volume=63 |issue=2 |pages=65–81 |year=1984 |pmid=6366453 |doi= |url=}}</ref>
+| align="center" style="background:#F5F5F5;" + |Chronic
+| style="background:#F5F5F5;" + |
+*Variable
+| align="center" style="background:#F5F5F5;" + | +
+| align="center" style="background:#F5F5F5;" + | +
+| align="center" style="background:#F5F5F5;" + | +
+| align="center" style="background:#F5F5F5;" + | +
+| align="center" style="background:#F5F5F5;" + | +
+| style="background:#F5F5F5;" + |
+*[[Wheeze|Wheezing]]
+*[[Rales]]
+*[[Rhonchi]]
+*Expiratory sounds(related to [[asthma]])
+| style="background:#F5F5F5;" + |
+*Peripherial [[eosinophilia]]
+*In active phase [[C-reactive protein|CRP]] and [[Red blood cell|erytrocyte]] [[sedimentation]] rate high
+*Elevated [[Immunoglobulin E|IgE]]
+*[[Anti-neutrophil cytoplasmic antibody|ANCA]] positive
+| style="background:#F5F5F5;" + |
+*Infiltrates in [[Chest X-ray|chest X−Ray]]
+*Ground glass opacities, tree−in−bud sign and small nodules  in chest [[Computed tomography|CT]]
+| style="background:#F5F5F5;" + |
+*[[Lung volumes]] decreased
+*[[Vital capacity|FVC]] reduced
+*[[FEV1/FVC ratio]] <70%
+| style="background:#F5F5F5;" + |
+*Tissue [[biopsy]]
+| style="background:#F5F5F5;" + |
+*[[Asthma]]
+*[[Eosinophilia]]
+*[[Rhinosinusitis]]
 |}

Squamous cell carcinoma of the lung differential diagnosis: Difference between revisions

Revision as of 16:30, 25 April 2018

Overview

Differential Diagnosis

References

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