Sandbox g57

# Differential Diagnosis Project

# Differentiating Legionnaires' disease from other diseases

# Distinctive features of Legionnaires' disease

## Clinical manifestations
- High grade fever
- Dry cough
- Progressive dyspnea
- Bronchial breath sounds
- Adult respiratory distress syndrome

## Laboratory abnormalities
- Legionella urinary antigen positive
- Alveolar consolidation on chest radiograph
- Lobar consolidation on chest radiograph

# Distinctive features of Acute interstitial pneumonia

## Clinical manifestations
- Dry cough
- Progressive dyspnea
- Adult respiratory distress syndrome

## Laboratory abnormalities
- Disseminated consolidation on chest radiograph
- Interstitial infiltrate on chest radiograph
- Increased uptake on Gallium scan

# Distinctive features of Mycoplasma pneumonia

## Clinical manifestations
- Dry cough
- Pleuritic chest pain
- Inflammed, opaque, hypomobile tympanic membrane
- Bronchial breath sounds

## Laboratory abnormalities
- Lymphocytosis
- Cold agglutinins positive
- Alveolar consolidation on chest radiograph
- Interstitial infiltrate on chest radiograph
- Lobar consolidation on chest radiograph

# Distinctive features of Pneumococcal pneumonia

## Clinical manifestations
- Hemoptysis
- Fine rales
- Pleuritic chest pain
- Increased breath sounds
- Bronchial breath sounds
- Dullness on chest percussion
- Purulent sputum
- Shallow respiration
- Pectoriloquy
- Increased tactile fremitus
- Productive cough
- Egophony
- High grade fever

## Laboratory abnormalities
- Pleural effusion (exudative)
- Respiratory alkalosis
- Parenchymal hyperlucency on chest radiograph
- Increased uptake on Gallium scan
- Unilateral diaphragm elevation on chest radiograph
- Alveolar consolidation on chest radiograph
- Lobar consolidation on chest radiograph
- Gram positive diplococci on sputum Gram stain

# Distinctive features of Pneumocystis carinii pneumonia

## Clinical manifestations
- Immunosuppressive state
- Mediastinal emphysema
- Subcutaneous emphysema
- Hacking cough
- Progressive dyspnea

## Laboratory abnormalities
- Respiratory alkalosis
- Serum beta-D-glucan elevated
- Alveolar consolidation on chest radiograph
- Lobar consolidation on chest radiograph
- Interstitial infiltrate on chest radiograph

# Distinctive features of Pulmonary embolism

## Clinical manifestations
- Calf pain / swelling
- Decreased pulse pressure
- Dyspnea with normal chest X-ray
- Hemoptysis
- Hyperventilation
- Immobility
- Increased pulmonic component of heart sound
- Pleuritic chest pain
- Prior DVT
- Pulmonary hypertension
- Right ventricular heave
- Right ventricular hypertrophy
- Right-to-left shunt
- Substernal chest pain
- Tachypnea
- Thrombophlebitis
- Unilateral lower extremity edema
- Venous stasis

## Laboratory abnormalities
- Atrial fibrillation
- Bone fracture
- Atelectasis on chest radiograph
- Lobar consolidation on chest radiograph
- Prominent pulmonary artery on chest radiograph
- Hampton's hump on chest radiograph
- D-dimer elevated
- Right ventricular enlargement on echocardiography
- Thrombus on echocardiography
- Hypocapnia
- Hypoxia
- Segmental perfusion defect on lung scan
- V/Q mismatch on lung scan
- Pleural effusion (exudative / bloody)
- RVH on ECG
- Right axis deviation on ECG

# Distinctive features of Streptococcal pneumonia

## Clinical manifestations
- Pectoriloquy
- Bronchial breath sounds
- Empyema
- Erythema nodosum
- Purulent sputum
- Shallow respiration
- Increased tactile fremitus
- Pleuritic chest pain
- Egophony

## Laboratory abnormalities
- Respiratory alkalosis
- Pleural effusion (exudative)
- Increased uptake on Gallium scan
- Gram-positive cocci in chains on sputum Gram stain
- Alveolar consolidation on chest radiograph
- Lobar consolidation on chest radiograph

# Distinctive features of Viral pneumonia

## Clinical manifestations
- Pleuritic chest pain
- Bronchial breath sounds
- Influenza
- Fine rales
- Bronchovesicular breath sounds

## Laboratory abnormalities
- Lymphocytosis
- Respiratory alkalosis
- Lobar consolidation on chest radiograph
- Interstitial infiltrate on chest radiograph
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