Differentials
Pneumonia
SIGNS / SYMPTOMS
Fever, cough, productive sputum.
Focal signs of consolidation - increased vocal fremitus and bronchial breathing.
INVESTIGATIONS
WBC: elevated.
Blood cultures: positive for organism.
Chest x-ray: consolidation.
Pulmonary embolism
SIGNS / SYMPTOMS
Haemoptysis and sharp, pleuritic chest pain.
Risk factors of thromboembolism (TE) include personal history of TE, family history, recent trauma, prolonged immobilisation, smoker, or combined hormonal contraception use.
INVESTIGATIONS
CT pulmonary angiography: clot in pulmonary artery.
Asthma
SIGNS / SYMPTOMS
Wheezing on physical examination.
INVESTIGATIONS
Reduced peak flow.
Spirometry: obstructive pattern, reversibility with beta-agonist inhalers
Interstitial lung disease
SIGNS / SYMPTOMS
Progressively increasing dyspnoea.
Oxygen desaturation with exercise.
Fine bibasal crepitations with no other signs of heart failure.
INVESTIGATIONS
Chest x-ray: reticular infiltrate in the late stages of disease.
High-resolution CT scan: ground-glass appearance, reticular infiltrates, honeycombing, and architectural distortion.
Spirometry: restrictive pattern.
Acute respiratory distress syndrome
SIGNS / SYMPTOMS
Severe hypoxia, fine crepitations.
INVESTIGATIONS
Chest x-ray: diffuse infiltrates
Pulmonary artery wedge pressure: <18 mmHg
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