Version June 2024
| Disease | Clinical features | Laboratory | Pulmonary function testing | Chest imaging | Other |
| Bronchiectasis | History of recurrent episodes of productive cough or pneumonia; may also have chronic or recurrent sinusitis; sometimes digital clubbing | Quantitative immunoglobulins Immunoglobulin subclasses Assess response to polysaccharide vaccines Testing for cystic fibrosis if not previously done Cultures for bacteria and mycobacteria (MAC, TB) | Often shows airflow limitation; may show mixed obstruction and restriction | Chest radiograph may show tram tracks or increased bronchovascular markings HRCT with 1 to 1.5 mm slices every 10 mm or multidetector chest CT with 1 to 1.5 mm contiguous slices (preferred) | |
| Bronchiolitis | History of respiratory infection, rheumatic disease, transplantation, ulcerative colitis, development of chronic airflow obstruction over months to few years | Serologic studies for rheumatic diseases suspected on basis of clinical findings (eg, rheumatoid factor) Cultures and immunoassays for infection (eg, respiratory syncytial virus) | Spirometry with lung volumes: mixed obstructive and restrictive pattern | Chest radiograph: hyperinflation and fine nodular opacities HRCT: may show mosaic pattern; expiratory views may show patchy airtrapping | |
| Carcinoid syndrome due to extrathoracic carcinoid tumor or bronchial carcinoid | History of episodes of flushing, wheezing, and watery diarrhea | Elevated 5-hydroxyindoleacetic acid level in a 24 hour urine specimen | Chest CT may show nodule in case of bronchial carcinoid, but may be negative in carcinoid of gastrointestinal origin | ||
| Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) | Wheeze, dyspnea, and cough in middle-aged woman | Serum chromogranin A may be elevated | Airflow limitation without bronchodilator reversibility | HRCT shows patchy mosaic attenuation due to constrictive bronchiolitis and multiple small (4 to 10 mm) pulmonary nodules | |
| Heart failure | Orthopnea, peripheral edema Crackles in addition to wheeze | Elevated brain natriuretic peptide | Chest radiograph may show cephalization of flow, enlarged heart | Echocardiogram: systolic or diastolic left ventricular dysfunction | |
| Noncardiogenic pulmonary edema | Acute onset of dyspnea in setting of risk factors for ARDS | Chest imaging shows diffuse reticular or ground glass opacities | Echocardiogram: normal left ventricular function Pulmonary artery catheterization: normal pulmonary capillary wedge pressure | ||
| Parasitic infection with VLM (eg, Ascaris Strongyloides, filaria) | Travel or residence in endemic area | Elevated eosinophil count; stools for ova and parasites for non-filarial causes; serologic immunoassay for filaria/strongyloides/ascaris antibodies | Chest imaging may show migratory opacities | ||
| Pulmonary thromboembolism (uncommon cause of wheeze) | History of risk factors for thromboembolic disease | Elevated D-dimer | Not usually obtained, but DLCO is reduced | CT pulmonary angiogram shows intraluminal defects and/or cut-offs | |
| Reactive airways dysfunction syndrome | History of an inhalational exposure to a high concentration of an irritant gas or aerosol | Spirometry may show airflow limitation Post bronchodilator spirometry often shows irreversibility Bronchoprovocation challenge usually shows airways hyperresponsiveness | Chest radiograph is usually normal or shows hyperinflation | ||
| Tracheobronchomalacia | Dyspnea | Flow volume loop may show expiratory slowing consistent with intrathoracic variable obstruction | Inspiratory and expiratory multidetector CT images show airway collapse during expiration |
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