Differential Diagnosis for Chest Radiograph Findings
The provided chest radiograph findings indicate mild bilateral central and basal peribronchial thickening, low lung volumes, and no evidence of pleural effusion, pneumothorax, or acute bony abnormalities. Based on these findings, the following differential diagnoses are considered:
- Single most likely diagnosis
- Acute Bronchitis: This is the most likely diagnosis given the clinical presentation of cough and the radiographic findings of mild bilateral central and basal peribronchial thickening. Bronchitis is an inflammation of the bronchial tubes, which can cause cough and peribronchial thickening visible on a chest X-ray.
- Other Likely diagnoses
- Chronic Obstructive Pulmonary Disease (COPD): COPD can present with similar radiographic findings, especially in patients with a history of smoking or long-term exposure to lung irritants. The low lung volumes could be indicative of hyperinflation or air trapping, common in COPD.
- Asthma: Asthma can cause peribronchial thickening due to chronic inflammation and airway remodeling. The clinical history of cough, especially if it is episodic or associated with wheezing, would support this diagnosis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pulmonary Embolism: Although the radiograph does not show classic signs of pulmonary embolism like the "Westermark sign" or "Hampton's hump," it is crucial to consider this diagnosis, especially if the patient has risk factors or symptoms suggestive of embolism, as it can be life-threatening.
- Lung Cancer: While less likely given the bilateral and diffuse nature of the findings, lung cancer can cause peribronchial thickening, especially if there are associated masses or nodules. This diagnosis is particularly important to consider in patients with a history of smoking or other risk factors.
- Rare diagnoses
- Cystic Fibrosis: This genetic disorder can cause chronic bronchitis and bronchiectasis, leading to peribronchial thickening. It is more common in younger patients and those with a family history of the disease.
- Sarcoidosis: Sarcoidosis can cause peribronchial thickening and lung infiltration. It is often associated with lymphadenopathy, which is not mentioned in the provided findings, but it remains a consideration in the differential diagnosis of unexplained peribronchial thickening.