Wheeze DDx

OVERVIEW

Wheeze indicates lower airway obstruction, which can be  due to the following factors:

• luminal (e.g. secretions)
• intramural (e.g. bronchospasm, or bronchogenic tumour)
• extramural (e.g. mass causing external compression)

DIFFERENTIAL DIAGNOSIS

Monophonic wheeze (large airway)

• ETT malposition
• foreign body
• blood
• secretions
• tumour
• compression by lymph nodes

Polyphonic wheeze (small airways + multiple sites)

• aspiration
• unilateral emphysema
• contralateral pneumothorax
• asthma in a pneumonectomised patient

ASSESSMENT

Perform Simultaneous Assessment and Management

History

• events leading up to onset (eating)
• onset
• severity
• associated with pain
• voice change
• depressed LOC
• trauma
• significant PMHx – dysphagia, aspirations, CVA’s, bulbar dysfunction, oesophageal ca, asthma, previous lung surgery

Examination

• observations: T, P, BP, RR, SpO2
• airway – patent and protected, tracheal position,
• breathing – WOB, chest expansion, percussion, auscultation, vocal resonance, pneumothorax, intrinsic PEEP
• circulation – depressed venous return, hypotension
• clubbing, lymphadenopathy

Investigations

• CXR: ET position, contralateral disease, foreign body
• bronchoscopy: luminal pathology (blood, foreign body, tumour, compression)
• CT Chest: if necessary