Differential diagnosis of new-onset wheezing in adult
- Assess by anatomy:
- Extrathoracic upper airway obstruction: postnasal drip syndrome, paroxysmal vocal cord motion, hypertrophied tonsils, supraglottitis, laryngeal edem
- Intrathoracic upper airway obstruction: tracheal stenosis, foreign body aspiration, benign airway tumor, malignancie
- Lower airway obstruction: asthma/COPD, chronic obstructive pulmonary disease, pulmonary edema, aspiration, pulmonary embolism, bronchiolitis
Posted 09/22/16 09:25:32 AM by Matthew Cummings
Classic PFT patterns
- Obstruction: decreased/normal FVC, decreased FEV1, decreased FEV1/FVC ratio (<70%), normal/increase RV, TLC
- Restriction: decreased FVC, decreased/normal FEV1, normal FEV1/FVC, decreased TLC
Posted 09/22/16 09:30:14 AM by Matthew Cummings
Eosinophilic pulmonary diseases
- Infections (helminthic infections)
- Drug-induced pneumonitis (antibiotics, phenytoin, or l-tryptophan)
- Inhaled toxins (cocaine)
- Systemic disorders (eosinophilic granulomatosis with polyangiitis aka Churg-Strauss)
- Allergic bronchopulmonary aspergillosis
Posted 09/22/16 09:32:08 AM by Matthew Cummings
Strongyloidiasis (S. stercoralis)
- Endemic in tropics and subtropics (prevalence ~25%) , also occurs sporadically in temperate areas.
- Commonly asymptomatic, eosinophilia insensitive for diagnosis
- Symptoms often waxing, waning
- GI: Abd pain, bloating (70%)
- Pulm: SOB, wheeze (50-60%)
- Skin: pruritis (35%)
Posted 09/22/16 09:33:19 AM by Matthew Cummings
- Migratory phase
- Microfilariae migrate from pulmonary capillaries into the alveoli.
- Peripheral eosinophilia, elevated serum IgE levels.
- Pulmonary infiltrates with eosinophilia syndrome, asthma without infiltrates.
- Hyperinfection syndrome
- Accelerated autoinfection leading to wide-spread dissemination, typically in setting of immunosuppression.
- ARDS, cavitary lesions, interstitial infiltrates, and fibrotic disease.
- Management: PO vs. IV ivermectin depending on severity
Posted 09/22/16 09:35:37 AM by Matthew Cummings
For further reading...
Posted 09/22/16 09:40:30 AM by Matthew Cummings
Created by Christopher Kelly
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It is not meant to replace the advice of a health professional.