CHEST Differentials

DIFFERENTIAL DIAGNOSES:

FOR NEONATAL LUNG DISEASES
Decreased Lung Vol – HMD
Plueral Effusion – pneumonia, meconium aspiration, TTN
Pneumothorax – HMD, mec aspiration
Normal Heart Size w edema – TAPVR III, TTN, pulmonary lymphagiectasia

CHEST WALL DENSITY
Skin – nipple, mole
Soft Tisssue Noplasm – lipoma, neural, askin
Bone Neoplasm – myeloma, chondrosarc, ewings
Trauma – hematoma, fx
Infection – actinomycosis, TB

PLUERAL DENSITIES
Loculated Effusion – CHF, infection
Mets – #1 multiple, thymoma
Mesothelioma – benign has pedicle, malig no plaques assoc
Lipoma
Splenosis – assoc w trauma

PNEUMOTHORAX
Trauma
Ventilator
Eosinophilic Granuloma
Lymphangiomyomatosis
Alveolar Protienosis
Pneumocystis Carini
Osteosarcoma Mets

PLEURAL EFFUSIONS
CHF
PE
Pneumonia – TB
Trauma – chylous, boerhaave’s, aorta
Neoplasm – meig’s
Pericarditis – dressler’s, post-pericardotomy
Abdominal Pathology – pancreatitis, post-surg
Collagen Vascular Dz – rheumatoid, SLE, wegener’s
Low Colloid Pressure

DIAPHRAGM ELEVATION
Subpulmonic
Pulmonary Volume Loss – atelectasis, venolobar
Nerve Paralysis – phrenic, ALS, myasthenia
Diaphragmatic Abnormality – hernia, eventration
Abdominal Process – abscess, chiliditi

WIDE MEDIASTINUM
Technique
Vascular – ectasia, dissection, coarctation, left SVC
Trauma
Neoplasm
Pneumomediastinum
Mediastinitis – histo
Lipomatosis
Achalasia – look for AF levels

SHIFT OF THE MEDIASTINUM
Decreased Lung Volume
Increased Lung Volume – FB, bronchogenic cyst, CAM, swyer-james
Plueral Space Abnormality – effusion, pneumo, diaphragmatic hernia
Partial Absent Pericardium

ANTERIOR MEDIASTINAL MASS
Thymus
Germ Cell – teratoma, seminoma, choriocarcinoma
Thyroid
Lymphoma
Cardiovascular – aneurysm, pericardial cyst, epicardial fat pad
Cystic Hygroma

MIDDLE MEDIASTINAL MASS
Lymphadenopathy – met, castleman’s
Neoplasm
Vascular
Achalasia
Duplications – bronchogenic cyst, sequestration

POSTERIOR MEDIASTINAL MASS
Neural – nerve root tumors, gangliomas, paragangliomas, lat meningocele
Duplication – enteric, neurenteric cysts
Inflammation – paraspinous abcess, sarcoid
Hematoma – trauma
Extramedullary Hematopoesis

HILAR ENLARGEMENT
TB,Bronchogenic Carcinoma
Lymphoma
Sarcoid
Histo
Pneumoconiosis

TRACHEAL MASSES
Squamous Cell
Adenoid Cystic – cylindroma
Carcinoid – “iceberg”
Chondroma
Fibroma
Papilloma – aquired at birth
Hemangioma – children only

TRACHEAL NARROWING
Saber Sheath
Postintubation Stenosis
Relapsing Polychondritis
Amyloidosis
Tracheobronchopathia Osteochondroplastica – benign calc nodules

TRACHEAL DILATION
Mounier-Kuhn Syn
Tracheobronchomalacia
Ehler’s-Danlos Syn

ATELECTASIS
Obstructive – bronchial neoplasm, inflammatory, FB
Passive – plueral process
Compressive – intraparenchymal mass, air trapping
Adhesive – PE, hyaline membrane Dz
Cicatrization

AIRSPACE CONSOLIDATION
Blood – trauma, DIC, PE, vasculitis, hemosiderosis
Pus – bacteria, PCP, fungus, TB
Fluid – CHF, renal failure, toxic inhalation, ARDS
Cells – bronchoalveolar Ca, lymphoma
Protien – alveolar portienosis, mucus plug

SEGMENTAL CONSOLIDATION
Lobar Pneumonia
Bronchopneumonia
Interstitial Pneumonia – viral, mycoplasm
Aspiration
TB & Atypical Mycobacterium
Trauma
Pulmonary Embolism
Obstructing Neoplasm
Mitral Regurgitation

ADULT RESPIRATORY DISTRESS SYNDROME
Event
White Out
Loss of Compliance
Refractory Hypoxemia
Shunt – precapillary
PULMONARY VASCULITIS 4
Infectious – RM spotted fever, mucormycosis
Wegener’s – diffuse, cavitate, nasal, 40+yrs, 2:1 male
Goodpasture’s – perihilar, hemoptysis, 25yrs, 7:1 male
SLE

PATTERNS OF INTERSTITIAL DISEASE
Septal Lines – CHF, lyphangitic Ca
Reticular (irregular lines) – UIP, sarcoid, asbestos, drug
Air Cysts (round) – UIP, PCP, LAM, EG, bronchiectasis
Nodules – sarcoid, silicosis, EG, EAA (extrinsic allergic alveolitis)
Ground Glass Opacities – DIP, PCP, EAA, alveolar proteinosis
Hyperinflation – LAM, EG, CF, or any w COPD

LOWER LOBE INTERSTITIAL DZ
Bronchiectasis
Aspiration
DIP – desquamative interstitial pneumonitis
Dermatomyositis
Lymphangitic spread
Asbestosis
Scleroderma
Sarcoid
Rheumatoid Lung
Furadantin

UPPER LOBE INTERSTITIAL DZ
Cystic Fibrosis
Ankylosing Spondylitis
Silicosis
Sarcoid
Eosinophilic Granuloma
TB

BRONCHIECTASIS (saccular & cylindrical types)
Infectious – aspergilla, TB, Sweyer-James
Congenital – cystic fibrosis, Kartagner syn, agammaglobulinemia
Obstructive – neoplasm, nodes
Chemical – aspiration, inhalation
Fibrotic – COPD

SOLITARY PULMONARY NODULE
Bronchogenic Ca
Hamartoma
Granuloma
AVM
Abcess

CAVITATING PULMONARY NODULES 6
Infection – staph, klebsiella, TB, coccidiomycosis, septic emboli, PCP
Neoplasm – squamous cell ca, osteosarcoma
Vasculitis – wegener’s, rheumatoid
Trauma – pneumatoceles
Bronchogenic Cyst
Pulmonary Embolism

PULMONARY CALCIFICATION
TB
Histo
Silicosis
Alveolar Microlithiasis
Hyperparathyroidism
Chronic Venous Congestion – mitral stenosis
Treated Lymphoma
Idiopathic Pulmonary Osteopathy

UNILATERAL HYPERLUCENT LUNG
Chest wall defect – mastectomy, absent pectoralis
PE – westmarks sign
FB – obstuctive emphysema
Pulmonary hypoplasia
Sweyer-James

AORTIC ANEURYSMS
Atherosclerosis – abd
Marfan’s
Vasculitis – Syphilis, Takayasu, Kawasaki, fungal, TB, polyarteritis nodosa
Aortic Valve Stenosis – asc dilation

CAUSES OF RIB NOTCHING
Coarctation
Aortic Thrombosis
Subclavian Obs – Blalock shunt for tricuspid atresia
Pulmonary Oligemia – any cause of dec flow

CARDIOMEGALY
Highoutput Failure – vein of Galen aneurysm, AVM etc
Outflow Obstruction Failure
Cardiomyopathy
Pericardial Effusion – always rule out

PULMONARY ARTERIAL HYPERTENSION
Primary
Lung Disease – COPD
Multiple PE
Eisenmienger

EMPHYSEMA TYPES
Centrilobular – #1, smoker, upper
Panacinar – alpha-1-antitrypsin, diffuse
Paraseptal – peripheral blebs

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