Cavitary Lung Disease - Differential Diagnosis and Workup Algorithm Acute / Subacute: •

Lung Nodule - Differential Diagnosis Algorithm Nodule on > 2 Years Without a Change in Size: • Scar • Granuloma • Arteriovenous Malformation Solitary Nodule: • Malignant Neoplasm • Benign Neoplasm (eg. Hamartoma, Lipoma, Fibroma) • Granuloma • Abscess • Arteriovenous Malformation • Bronchogenic Cyst • Rounded Atelectasis Malignancy: • Primary lung cancer • Metastases ("cannonball lesions"; Eg. Melanoma, Head & Neck, Sarcoma, Colon, Kidney, Breast, Testicle) Infection: • Fungal • Tuberculosis • Septic Embolism • Parasitic Inflammation: • Rheumatoid Arthritis • Granulomatosis with polyangiitis (GPA) / microscopic polyangiitis (MPA) • Sarcoidosis • Pneumoconiosis Vascular: • Arteriovenous Malformation #Lung #Nodule #Differential #Diagnosis #Algorithm #Causes #Pulmonary

Granulomatous Lung Disease - Differential Diagnosis Algorithm OP: organising pneumonia; EGPA: eosinophilic granulomatosis with polyangiitis; NSG: necrotising sarcoid granulomatosis; GPA: granulomatosis with polyangiitis; GLILD: granulomatous-lymphocytic interstitial lung disease; HP: hypersensitivity pneumonitis; PLCH: pulmonary Langerhans cell histiocytosis. DOI: 10.1183/16000617.0012-2017 #Granulomatous #granuloma #Lung #Disease #pulmonary #Differential #Diagnosis #Algorithm

CAVITY – a useful mnemonic for the causes of a cavitating lung mass. C = cancer - bronchogenic carcinoma : most frequently SCC (left image) - cavitatory metastasis : again most frequently SCC A = autoimmune granulomas from - Wegener’s granulomatosis (right image) - rheumatoid arthritis (rheumatoid nodules) V = vascular - pulmonary embolus I = infection - pulmonary abscess (TB, fungal, staph aureus) T = trauma - pneumatocoeles Y = youth - CPAM - pulmonary sequestration - bronchogenic cyst #Diagnosis #CAVITY #Mnemonic #Cavitary #Lesions #Differential #Lung #Pulmonary

Lung Nodules - Differential Diagnosis by Distribution • Centrilobular: Hypersensitivity Pneumonitis, RB-ILD, Pneumoconiosis, Infectious Bronchiolitis, Vasculitis, Diffuse panbronchiolitis • Perilymphatic: Sarcoidosis, Silicosis, Amyloidosis, LIP, Lymphangitis Carcinomatosis • Random: Metastasis, Infectious (viral, TB, fungal), Septic emboli, LCH BWH Medicine Chiefs @BrighamChiefs #Lung #Nodules #Differential #Diagnosis #Distribution #pulmonary

Cavity Mnemonic for Cavitary Pulmonary Lesions: C: cancer - bronchogenic carcinoma: most frequently squamous cell carcinoma (SCC) - cavitary pulmonary metastasis(es): most frequently SCC A: autoimmune; granulomas from - granulomatosis with polyangiitis - rheumatoid arthritis (rheumatoid nodules) etc. V: vascular (both bland and septic pulmonary emboli) I: infection (bacterial/fungal) - pulmonary abscess - pulmonary tuberculosis T: trauma - pneumatoceles Y: youth - CPAM (congenital pulmonary airway malformation) - pulmonary sequestration - bronchogenic cyst #Diagnosis #CAVITY #Mnemonic #Cavitary #Lesions #Differential

Causes of Encephalopathy - Differential Diagnosis Algorithm Hyperacute: - Primary Neurologic: Vascular (IS, ICH), Seizure, Migraine, Trauma - Systemic: Hypertensive encephalopathy Acute: - Primary Neurologic: Vascular (SDH), Inflammatory (Acute demyelination), Infectious (bacterial/viral meningitis encephalitis) - Systemic: Systemic infection Subacute: - Primary Neurologic: Vascular (SDH), Neoplasm-related (brain tumors, paraneoplastic syndromes), Inflammatory, Infectious (fungal, TB, parasitic, complications of HIV) - Systemic: Chronic systemic conditions: Heart failure, Endocrinopathy, Malignancy, Autoimmune, OSA Chronic: - Primary Neurologic: Vascular (SDH), Degenerative, NPH, Infectious (syphilis, HIV-associated neurocognitive disease) #Encephalopathy #Differential #Diagnosis #Algorithm #Causes

Cystic lung disease Lung cysts are defined as radiolucent areas with a wall thickness of less than 4mm. Cystic lung diseases as listed in the table on the left. Cavities are defined as radiolucent areas with a wall thickness of more than 4mm and are seen in infection (TB, Staph, fungal, hydatid), septic emboli, squamous cell carcinoma and Wegener's disease. #Diagnosis #Radiology #Pulmonary #Cystic #Lung #CysticLungDisease #Differential #RadiologyAssistant

Hemoptysis - Differential Diagnosis Framework Airways: • Bronchitis • Bronchiectasis • Malignancy: Primary bronchogenic CA, Endobronchial metastatic CA, Bronchial carcinoid, Kaposi's sarcoma • Foreign Bodies • Trauma • Fistulas • Dieulafoy lesion Parenchyma: • Infection: TB, Paragonimus westermani, PNA, Lung abscess, Aspergillosis • Rheumatic/lmmune: Goodpastures, Lupus Pneumonitis, GPA, Behcet syndrome, Idiopathic pulmonary hemosiderosis • Genetic • Coagulopathy • Cocaine Cardiac/Vascular: • AVMs such an Osler-Weber-Rendu syndrome • Valvular Disease • Left Heart Failure SCVMC Internal Medicine @SCVMCMed #Hemoptysis #Differential #Diagnosis #pulmonary #causes

More common & convincing pneumonia mimics Aspiration pneumonitis, Pulmonary vasculitis, Acute eosinophilic pneummia, Cryptogeric organizing pneumonia, Drug -induced pneumonitis, Pneumocystis jiroveci (PIP), Fungal pneumonia, Exacerbation of idiopathic pulmonary fibrosis (IPF), Pulmonary Embolism, Septic Pulmonary Emboli #Pneumonia #Mimics #Differential #Diagnosis #Pulmonary

Lung Infections in HIV - Differential Diagnosis Framework Disease by CD4 Count: Any CD4 Count: • Mycobacterium tuberculosis, Bacterial pneumonia • Seasonal influenza CD4 <200: • Pneumocystis jirovecii pneumonia (PJP), MAI, Cryptococcal pneumonia, Extrapulmonary tuberculosis, Blastomycosis CD4 <50-100: • Toxoplasmosis • Histoplasmosis, Coccidioidomycosis, CMV, Mycobacterium avium, Mycobacterium kansasii, Invasive aspergillosis, Rhodococcus equi, Pseudomonas FUNGAL PNEUMONIAS: • Weight loss, lethargy, fever • Disseminated • Pleuritic CP • Cough, dyspnea • (Less common since cART) Aspergillus Pneumonia: • 3 syndromes: ABPA, Mycetoma, Invasive Aspergillosis • High fever, cough, and dyspnea, wheezing • Pleuritic chest pain may be present. Hemoptysis (occasionally massive) - angioinvasive disease. • CT: Halo sign Coccidioides Immitis Pneumonia: • "Flu-like", Valley fever • Fever, weight loss, Lymphadenopathy, Chest pain, cough • Polymorphic skin lesions (papules, pustules, erythematous nodules, plaques) Cryptococcus Neoformans Pneumonia: • Cough and dyspnea • Lobar consolidation or nodular infiltrates PJP Pneumonia: • Risk: Can produce significant depression of the phagocytic function of alveolar macrophages in HIV • Lung Exam: Can be normal • Fever (It's usually low if you have HIV), Chills, Dry cough or wheezing, Shortness of breath, Fatigue, Chest pain or tightness when you breathe, Weight loss Histoplasma Capsulatum Pneumonia: • (Fever, weight loss), Lymphadenopathy, dry cough or dyspnea, hepatomegaly, • Oral mucosal ulcers, erythema nodosum or erythema multiforme, • Multiple skin lesions (pustules, crusted papules), • Cytopenias VIRAL PNEUMONIAS: Influenza: • Rapid onset of a "flu-like syndrome" consisting of dry cough, myalgias, headache and high fever CMV: • 2-4 week subacute course • Nonproductive cough, dyspnea, and fever BACTERIAL PNEUMONIAS: Most Common: • Streptococcus pneumoniae - 20% of pneumonias • Haemophilus influenzae - 10-15% of pneumonias • Staphylococcus aureus Nocardia Pneumonia: • Chest pain, cough, bloody sputum, sweats, chills, weakness, lack of appetite, weight loss • Imaging: Irregular nodules or infiltrates-necrotizing • Lung most commonly infected M. Tuberculosis Pneumonia: • Upper lung zone infiltrates • Cavities • Fever, chills, night sweats, anorexia, productive cough, and occasional hemoptysis • Lymphadenopathy, CNS involvement MAI Pneumonia: • Constitutional symptoms (fever, weight loss, anorexia) Hepatosplenomegaly, lymphadenopathy, • Abdominal pain, chronic diarrhea, cytopenias M. Kansasii Legionella: • Nausea, vomiting, and diarrhea • Hyponatremia • Elevated hepatic transaminases • C-reactive protein levels >100 mg/L • Rhabdomyolysis (rare) Co-MRSA Pneumonia: • PVL virulence factor • May cause rapidly progressive necrotizing pneumonia Rhodococcus Equi Pneumonia: • Indolent course with fever, cough and cavitary infiltrates, mimicking TB Chlamydia Pneumoniae: • Focal pneumonia, pleural effusion, or bronchitis Mycoplasma Pneumoniae: • Cough (reported in 100% of cases), anemia, arthralgia, dyspnea, sore throat along with fever, rales, interstitial infiltrates or lobar pneumonia Coxiella Burnetii: • Fever, headache, non-productive cough, myalgia • Lung nodules possible in HIV PARASITIC PNEUMONIAS: • Toxoplasma gondii - Fever, nonproductive cough, and dyspnea • Strongyloides stercoralis - Worms in lungs • Cryptosporidium, and Microsporidium #Lung #Infections #HIV #AIDS #pulmonary #differential #diagnosis #infectiousdiseases