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Table 1: Diagnostic approach: characteristic causes and tests.22-24 |
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Category |
Specific examples/traits |
Diagnostic test |
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Acquired bronchial obstruction (several produce localized bronchiectasis) |
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Foreign body suction |
Peanuts, bone, tooth, etc. |
X-ray, CT scan; FBC |
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Tumors |
Laryngeal papillomatosis; adenoma, endobronchial teratomas |
X-ray, CT scan; FBC |
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Adenopathy |
Tuberculosis; histoplasmosis; sarcoidosis |
PPD; X-ray, CT scan; FBC |
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COPD |
Chronic bronchitis |
PFT, symptoms |
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Connectivopathies |
Polychondritis, amyloidosis |
Cartilage biopsy |
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Mucoid impaction |
ABPA; bronchocentric granulomatosis; post-surgical |
Total and specific IgE aspergillosis; skin reaction, X-ray, CT scan; bronchial biopsy |
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Congenital anatomical defects causing bronchial obstruction |
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Tracheo-bronchial |
Bronchomalacia; bronchial cyst; cartilaginous deficiency (Sx Williams-Campbell); tracheobroncomegaly (Sx Mounier-Kuhn); ectopic bronchus; tracheoesophageal fistula |
X-ray, CT scan |
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Vascular |
Intralobar sequestration, pulmonary arterial aneurysm |
X-ray, CT scan |
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Lymphatics |
yellow nail syndrome |
History of dystrophy, slow-growing nails |
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Immunodeficiencies |
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IgG |
Congenital (Bruton type), agammaglobulinemia; selective deficiency (IgG2, IgG4); acquired Ig deficiency; variable common hypogammaglobulinemia; Nezelof Syndrome; «Naked lymphocyte syndrome» |
Quantitative Ig and subclasses; damaged response to pneumococcal vaccine |
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IgA |
Selective deficiency with or without ataxia-telangiectasia syndrome |
Quantitative Ig |
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Leukocyte dysfunction |
Chronic granulomatous disease (NADPH oxidase dysfunction) |
Dihydrorhodamine 123; oxidation test; tetrazolium nitroblue test, genetic testing |
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Humoral immunodeficiencies (CXCR4 mutation, CD40 and ligand deficiency) |
WHIM syndrome; hypergammaglobulinemia M |
Neutrophil count; Ig levels |
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Abnormal clearance of secretions |
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Mucociliary defects |
Kartagener syndrome; ciliary dyskinesias |
X-ray, CT scan (situs inversus); bronchial biopsy; ciliary motility; electron microscopy of sperm or respiratory mucosa |
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Cystic fibrosis |
Typical early infantile LH; late presentation with sinopulmonary symptoms |
Chlorine in sweat; genetic testing |
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Young syndrome |
Obstructive azoospermia with sinopulmonary infections |
Spermatocrit |
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Miscellaneous disorders |
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Alpha-1 antitrypsina deficiency |
Absence or synthesis/abnormal function |
Alpha-1 antitrypsin levels |
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Recurrent bronchoaspiration pneumonia |
Alcoholism; neurological disorders; lipoid pneumonia |
Medical record; X-ray, CT scan |
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Connectivopathies |
Sjogren syndrome and Rheumatoid Arthritis |
Rheumatoid factor; antiSSA/antiSSB; salivary gland biopsy |
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Toxic inhalation of fumes and dusts |
Ammonium; nitrogen dioxide, irritant gases; fumes; talc; silicates |
Medical record; X-ray, CT scan |
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Post-transplant rejection |
Bone marrow, bronchiolitis obliterans (lung transplant) |
PFT; X-ray, CT scan |
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Childhood infections |
Pertussis; measles |
Medical record |
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Bacterial infections |
Staphylococcus aureus, Klebsiella, Pseudomonas aeruginosa |
Medical history; cultures |
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Viral infections |
Adenovirus (types 7 and 21), influenza, herpes simplex |
Medical history, evidence of infection |
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Other infections |
Histoplasmosis; Mycobacterium tuberculosis, non-tuberculous mycobacterium; mycoplasma |
Cultures; stains |
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X-ray = simple chest X-ray. CT scan=computed tomography of the chest. FBC = fibrobronchoscopy. COPD = chronic obstructive pulmonary disease. ABPA = allergic broncho pulmonary aspergillosis. Ig = immunoglobulin. PFT = pulmonary function tests. Sx =syndrome. NADPH = nicotinamide adenine dinucleotide phosphate. Whim = warts, hypogammaglobulinemia, infections and myelocatexis. PPD = purified protein derivative. antiSSA =antibody Sjögren’ssyndrome A/Ro. antiSSB = antibody Sjögren’s syndrome B/La. |
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