Differential diagnosis of wheeze

Question 2 from the second paper of 2010 is a question about the differential diagnosis of wheeze. There can be a myriad answers.

UpToDate even has a page about this sort of thing.

Causes of widespread wheeze

• Extrathoracic causes
  • Anaphylaxis
  • Vocal cord paralysis
  • Laryngeal stenosis
  • Goiter with thoracic inlet obstruction
  • Anxiety with hyperventilation
• Intrathoracic central airway causes
  • Tracheal stenosis
  • Mediastinal tumours
  • Hyperdynamic airway collapse due to tracehomalacia
  • Mucus plugs
  • Thoracic aortic aneurysm
  • Foreign body inhalation
• Intrathoracic lower airway causes
  • Bronchitis or bronchiolitis
  • COPD
  • Pulmonary oedema - "cardiac asthma"
  • Airway distortion due to mechanical causes, eg. bronchial mass, bronchiectasis, pneumothorax
  • Exposure to inhaled irritant or corrosive agent, and this includes the aspiration of gastric contents

Causes of unilateral wheeze

The differential diagnosis of a unilateral wheeze really comes down to how many different ways of obstructing a main bronchus you can think of.

• ETT malposition
• foreign body
• blood clot
• Sputum secretions
• Tumour
  • Bronchogenic carcinoma
  • Thymus carcinoma
  • Retrosternal goitre
• compression by lymph nodes
• compression by aortic aneurysm
• traumatic dissection
• Bronchial stenosis post infection
• Bronchiectasis
• Bronchial compression by enlarged left side of heart