Emphysema Differential Diagnoses

Updated: Dec 30, 2019
  • Author: Kamran Boka, MD, MS; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Diagnostic Considerations

Common alternative diagnoses and suggestive diagnostic features are as follows:

  • Congestive heart failure: This condition may produce wheezing and is often difficult to differentiate from emphysema. However, a history of orthopnea and paroxysmal nocturnal dyspnea, the presence of fine basal crackles, and typical findings on chest radiographs can lead to the diagnosis of congestive heart failure.
  • Bronchiectasis: Patients with bronchiectasis have chronic production of copious purulent sputum, coarse crackles and clubbing upon physical examination, and abnormal findings on chest radiographs and CT scans.
  • Bronchiolitis obliterans: Obliterative bronchiolitis is observed in younger persons who do not smoke and in persons with collagen-vascular diseases. A CT scan characteristically shows areas of mosaic attenuation without evidence of generalized emphysema.
  • Chronic asthma: The delayed onset of severe asthma may be difficult to distinguish in older patients, but the important distinction is a significant bronchodilator response and normal diffusion (ie, diffusing capacity of lung for carbon monoxide [DLCO]) on pulmonary function tests.

Differential Diagnoses