Differential Diagnosis
In
Pulmonary Disease
© William Herring, MD, FACR
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How This Works
Eachdifferentialstarts with aphoto of thefindings (in thiscase it’s theesophagus, butdisregard that)
How This Works
The next slidegives the title ofthe differentialand the numberof items on thelist
How This Works
The next slidein each setgives thedifferential
How This Works
The last slidein each setgives the“answer”
Start
Start
For what is this a differential diagnosis?
Anterior Mediastinal Masses
1.
2.
3.
4.
Anterior Mediastinal Masses
1.Thymoma
2.Teratoma
3.Substernal thyroid
4.Lymphoma
Teratoma
Day 1
Two days later
For what is this a differential diagnosis?
Acute Airspace Disease
1.
2.
3.
4.
Acute Airspace Disease
1.Pulmonary edema
2.Pneumonia
3.Aspiration
4.Hemorrhage
Non-cardiogenic pulmonary edema
Day 1
Two days later
Opacified Hemithorax
1.
2.
3.
4.
Opacified Hemithorax
1.Atelectasis
2.Pleural effusion
3.Pneumonia
4.Post-pneumonectomy
Pneumonectomy
Large Cavitary Lung Lesions
1.
2.
3.
Large Cavitary Lung Lesions
1.Abscess
2.Carcinoma
3.TB
Carcinoma of the Lung
Pneumomediastinum
1.
2.
3.
4.
Pneumomediastinum
1. Ruptured esophagus
2. Ruptured trachea/bronchus
3. Iatrogenic/trauma
4. Asthma
Asthmatic with pneumomediastinum
July ’65
June ‘72
Chronic Alveolar Disease
1.
2.
3.
4.
Chronic Alveolar Disease
1.Alveolar cell ca
2.Alveolar sarcoid
3.Lymphoma
4.Alveolar proteinosis
Alveolar Sarcoid
July ’65
June ‘72
Upper Lobe Disease
1.
2.
3.
4.
Upper Lobe Disease
1. TB (2° TB)
2. Silicosis
3. Eosinophilic granuloma
4. Ankylosing spondylitis
Progressive Massive Fibrosis in Silicosis
Bibasilar Interstitial Disease
1.
2.
3.
4.
5.
6.
Bibasilar Interstitial Disease
1.B
2.A
3.D
4.A
5.S
6.S
Bibasilar Interstitial Disease
1.Bronchiectasis
2.Aspiration (Chronic)
3.DIP
4.Asbestosis
5.Sickle Cell Disease
6.Scleroderma
Scleroderma
Micronodular Lung Disease
1.
2.
3.
4.
Micronodular Lung Disease
1.Mets
2.Sarcoid
3.Pneumoconiosis
4.Miliary TB
Sarcoid
Small Cavitary Lung Lesions
1.
2.
3.
4.
Small Cavitary Lung Lesions
1.Septic emboli
2.Rheumatoid nodules
3.Squamous or transitional cell mets
4.Wegener’s Granulomatosis
Septic emboli
Lymphangitic Spread to the Lungs
1.
2.
3.
4.
5.
6.
Lymphangitic Spread to the Lungs
1.Lung ca
2.Breast ca
3.Stomach ca
4.Pancreas ca
5.Laryngeal ca
6.Cervical ca
Lymphangitic Spread of Lung Cancer
Multiple Lung Nodules
1.
2.
3.
4.
5.
Multiple Lung Nodules
1.Metastases
2.Metastases
3.Metastases
4.Metastases
5.Metastases
Multiple Lung Nodules
2.Wegener’s granulomatosis
3.Rheumatoid nodules
4.AVMs
5.Septic emboli
Metastases from colon carcinoma
Pulmonary Interstitial Edema
1.
2.
3.
Pulmonary Interstitial Edema
1.CHF
2.Lymphangitic spread
3.Allergic reaction
Congestive Heart Failure
Day 3
Day 0
Shifting Infiltrates
1.
2.
3.
4.
5.
6.
Any 3
Shifting Infiltrates
1. Aspiration
2.Loeffler’s syndrome
3.ABPA
4.Asthma
5.Polyarteritis
6.Viral pneumonia
Recurrent Aspiration
Day 3
Day 0
Unchanged in 8 mos
Chronic Interstitial DiseasePulmonary Fibrosis
1.
2.
3.
4.
5.
6.
Chronic Interstitial DiseasePulmonary Fibrosis
1.Pneumoconiosis
2.Interstitial Pneumonia
3.Granulomatous disease
4.Neoplastic disease
5.Idiopathic fibrosis
6.Collagen vascular disease
Sarcoid
Inspiration
Expiration
Unilateral Hyperlucent Lung
1.
2.
3.
4.
Any 3
Unilateral Hyperlucent Lung
1.Swyer-James syndrome
2.Pulmonary embolism
3.Pneumothorax
4.Obstructive emphysema
Obstructive Emphysema
Inspiration
Expiration
Hours later
3/29/09
Rapidly Clearing Airspace Disease
1.
2.
3.
4.
Any 3
Rapidly Clearing Airspace Disease
1.Hemorrhage
2.Pulmonary edema
3. Aspiration
4.Pneumococcal pneumonia
Pulmonary Edema
Hours later
3/29/09
Masses with Air Bronchograms
1.
2.
3.
Masses with Air Bronchograms
1.Lymphoma
2.Alveolar cell ca
3.Pseudolymphoma (Maltoma)
Lymphoma
Cavitating Pneumonia
1.
2.
3.
4.
Any 3
Cavitating Pneumonia
1.Staph
2.Strep
3.TB
4.Gram negative (Klebsiella)
Staphylococcal Pneumonia
Middle Mediastinal Masses
1.
2.
3.
4.
Any 3
Middle Mediastinal Masses
1.Lymphadenopathy
2.Aneurysms
3.Esophageal duplication
4.Bronchogenic cysts
Bronchogenic Cyst
M=2
Hilar AdenopathyBilateral or Unilateral
1.
2.
3.
4.
5.
Any 3
Hilar AdenopathyBilateral or Unilateral
1. Sarcoid (B/L)
2. TB (U/L)
3. Lymphoma (B/L)
4. Bronchogenic ca (U/L)
5. Mets (B/L)
Sarcoid
Cavities Containing Masses
1.
2.
3.
Cavities Containing Masses
1.Aspergillosis
2.Cavitating bronchogenic ca
3.Tuberculosis
Aspergilloma
Airspace Dz with Effusion
1.
2.
3.
4.
Any 3
Airspace Dz with Effusion
1.Staph pneumonia
2.Strep pneumonia
3.TB
4.Pulmonary infarct
Staph Pneumonia
“Mass”+ ipsilateral adenopathy
1.
2.
3.
“Mass”+ ipsilateral adenopathy
1.Bronchogenic ca
2.Lymphoma
3.TB
Bronchogenic Carcinoma
Bronchogenic Carcinoma
Solitary Pulmonary Nodule
1.
2.
3.
4.
5.
6.
7.
8.
Any 3
Solitary Pulmonary Nodule
1. Bronchogenic ca
2. Hamartoma
3. Histoplasmoma
4. TB granuloma
5. Carcinoid tumor
6. Solitary met
7. Round pneumonia
8. Rounded atelectasis
Hamartoma
Left-sided Pleural Effusion
1.
2.
3.
Left-sided Pleural Effusion
1. Boerhaave’s Syndrome
2. Dissecting aortic aneurysm
3. Pancreatitis
Dissecting Aortic Aneurysm
Pleural Effusion
1.
2.
3.
4.
5.
6.
7.
8.
9.
Any 3
Pleural Effusion
1.CHF
2.Mets
3.Pancreatitis
4.Pulmonary embolism
5.Trauma
6.Empyema
7.Collagen vascular
8.Ovarian tumor (Meig’s Syndrome)
9.Chylothorax
Congestive Heart Failure
Multiple Small Calcifications
1.
2.
3.
4.
5.
Any 3
Multiple Small Calcifications
1.Histoplasmosis
2.Silicosis
3.Chicken pox pneumonia
4.Pulmonary ossification 2° MS
5.Alveolar microlithiasis
Histoplasmosis
Posterior Mediastinal Masses
1.
2.
3.
Posterior Mediastinal Masses
1.Neurogenic tumors
2.Lymphadenopathy
3.Extramedullary hematopoesis
Neurofibroma
Mediastinal Adenopathy
1.
2.
3.
4.
5.
Any 3
Mediastinal Adenopathy
1.Bronchogenic ca
2.Lymphoma
3.TB
4.Mets
5.Sarcoid
Lymphoma
Lung Disease & Rib Destruction
1.
2.
3.
4.
Any 3
Lung Disease & Rib Destruction
1.Bronchogenic ca, i.e Pancoast tumor
2.Actinomycosis
3.Blastomycosis
4.Multiple myeloma
Pancoast Tumor
Pleural Calcification
1.
2.
3.
Pleural Calcification
1.Old TB empyema
2.Asbestos exposure
3.Hemothorax
Asbestos Exposure
“Masses” in Cardiophrenic Angle
1.
2.
3.
“Masses” in Cardiophrenic Angle
1.Sequestration
2.Diaphragmatic hernia
3.Pericardial cyst
Pericardial Cyst
Unilateral Pulmonary Edema
1.
2.
3.
4.
Any 3
Unilateral Pulmonary Edema
1. Rapid expansion of PTX
2. Rapid drainage of hemothorax
3. Postural
4. Disease in other lung, e.g. COPD
Re-expansion Pulmonary Edema
Reverse “Pulmonary Edema”
1.
2.
3.
Reverse “Pulmonary Edema”
1.Eosinophilic lung disease, e.g. Loeffler’s
2.Sarcoid
3.Pulmonary contusions
Loeffler’s Syndrome
The End