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
Know a hypochondriac? Get them the best-selling book 'AM I DYING?!: A Complete Guide to Your Symptoms, and What to Do Next'
The information on the website does not constitute official guidelines except where explicitly stated.
It is not meant to replace the advice of a health professional.