Chest pain and weight loss

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2]

Abbreviations: ABG (arterial blood gas); ACE (angiotensin converting enzyme); BMI (body mass index); CBC (complete blood count); CSF (cerebrospinal fluid); CXR (chest X-ray); ECG (electrocardiogram); FEF (forced expiratory flow rate); FEV1 (forced expiratory volume); FVC (forced vital capacity); JVD (jugular vein distention); MCV (mean corpuscular volume); Plt (platelet); RV (residual volume); SIADH (syndrome of inappropriate antidiuretic hormone); TSH (thyroid stimulating hormone); Vt (tidal volume); WBC (white blood cell); Coronary CT angiography (CCTA); multidetector row scanners (MDCT); Cardiovascular magnetic resonance — CMRI; Myocardial perfusion imaging (MPI); single-photon emission CT (SPECT); Positron emission tomography (PET) scanning; Magnetic resonance (MR) angiography, Computed tomographic (CT) angiography, and Transesophageal echocardiography (TEE), late gadolinium enhancement (LGE); right ventricular hypertrophy (RVH), right atrial enlargement (RAE), functional tricuspid regurgitation (TR), Pulmonary artery systolic pressure (PASP; adenosine deaminase (ADA); Serum amyloid A (SAA), soluble interleukin-2 receptor (sIL2R); High-resolution CT (HRCT) scanning

Differentials on the basis of Etiology  | Disease  | Clinical manifestations  | Diagnosis

|
|
|

Symptoms  | Risk factors  | Physical exam  | Lab Findings  | EKG  | Imaging  | Gold standard
Onset  | Duration  | Quality of Pain  | Cough  | Fever  | Dyspnea  | Weight loss  | Associated Features
Cardiac  | Heart Failure[1][2][3] | Subacute or chronic | Variable  |

* Dull
* Left sided chest pain

| \+  | +/-  | \+  | \+  |

* Orthopnea
* Peripheral edema
* Hemoptysis

| Dyslipidemia, hypertension, smoking, family history of premature disease, and diabetes |

* S3
* Elevated JVP
* Peripheral edema

* Hyponatremia
* Hypoalbuminemia
* ↑ Serum brain natriuretic peptide (BNP) or NT-proBNP level
* A mild elevation in serum bilirubin (total bilirubin <3 mg/dL)

* EKG findings are specific according to each cause of heart failure
* Q waves, ST and T wave abnormalities in patients with prior MI
* New onset arrhythmias (atrial fibrillation and ventricular tachycardia)

* CXR: Cardiomegaly
* Echocardiography: ↓ EF
* Right heart catheterization: Pulmonary capillary wedge pressure >20 mmHg, right atrial pressure ≥12 mmHg) and/or decreased cardiac index (≤2.2 L/min/m2

* Echocardiography

Pulmonary  | Pneumonia[4][5][6] | Acute or chronic | Variable  |

* Dull
* Localized to side of lesion

| \+  | \+  | \+  | +/-  |

* Altered mental status
* Tachycardia
* Rust-colored sputum
* Green sputum
* Red currant-jelly sputum
* Central cyanosis

* Long hospital stay
* Ill contact exposure
* Aspiration

* Wheezing
* Rhonchi
* Rales
* Decreased breath sounds
* Pleural friction rub

* Arterial blood gas : Hypoxia, hypoxemia
* ↑ Procalcitonin
* Leukocytosis
* Sputum evaluation
* Positive blood cultures

* Sinus tachycardia
* Nonspecific ST-segment or T-wave changes

* CXR: Interstitial infiltrates, lobar consolidation, cavitation

* CXR

Pleural Effusion[7][8][9] | Acute or subacute or chronic | Variable  |

* Dull
* Pleuritic pain

| \+  | +/-  | \+  | +/-  |

* Increasing lower extremity edema
* Orthopnea
* Paroxysmal nocturnal dyspnea
* Night sweats
* Hemoptysis

* Pneumonia

* Diminished or inaudible breath sounds
* Pleural friction rub
* Egophony (known as "E-to-A" changes)

* Pleural fluid LDH levels above 1000 IU/L Nucleated cells
* \- Lymphocytosis
* \- Eosinophilia
* \- Mesothelial cells
* Pleural fluid culture and cytology
* Pleural fluid antinuclear antibody and rheumatoid factor

* Typically not indicated

* Chest X Ray: Pleural fluid on one or both sides
* Computerized tomography (CT) scan: Detects small pleural effusions, ie, less than 10 mL and possibly as little as 2 mL of liquid in the pleural space, Thickening of the visceral and parietal pleura
* MRI: Characterize the content of pleural effusions

* Computed tomography

Asthma & COPD[10][11][12][13] | Acute or subacute or chronic | Variable  |

* Tightness

| \+  | +/-  | \+  | +/-  |

* Cyanosis

* Smoking
* HF
* HTN

* Elevated jugular venous pulse (JVP)
* Hyperinflation (barrel chest)
* Peripheral edema
* Clubbing
* Wheezing
* Rhonchi
* Diffusely decreased breath sounds
* Coarse crackles beginning with inspiration

* Leukocytosis
* Eosinophilia
* Respiratory alkalosis

* Peaked P-wave
* Reduced amplitude of the QRS complexes
* Multifocal atrial tachycardia (MAT)

* CXR: Hyperinflation
* Spirometry: ↓ FEV1, PEF, ↓ FEV1/FVC

* Spirometry

Pulmonary Malignancy[14][15][16][17] | Chronic  | Variable  |

* Dull aching

| \+  | +/-  | \+  | \+  |

* Bone pain
* Fatigue
* Neurologic dysfunction
* Superior vena cava (SVC) obstruction
* Hoarseness
* Hemidiaphragm paralysis
* Dysphagia
* Paraneoplastic syndromes
* Hypercalcemia

* Smoking
* Metastasis

* Wheeze
* Crackles
* Depending upon complications caused by the spread of cancer

* Hypercalcemia

* EKG may be performed before cancer treatment to identify any pre-existing conditions, or during treatment to check for possible heart damage

* CXR and CT scan: Mass lesion, hilar lymphadenopathy
* Spirometry: ↓Vt, ↑RV
* Bronchoscopy: Biopsy

* Bronchoscopy

Sarcoidosis[18][19][20][21] | Chronic  | Days to week  |

* Chest fullness

| \+  | \-  | \+  | \+  |

* Löfgren syndrome (fever, bilateral hilar lymphadenopathy (BHL), and polyarthralgias)
* Uveitis
* Heart block
* Lymphocytic meningitis
* Diabetes insipidus
* Fatigue
* Hypercalciuria

* Black population
* Autoimmune diseases

* Diminished respiratory sounds

* ↑ ACE level, adenosine deaminase, SAA, sIL2R
* Hypercalciuria
* Elevated 1,25-dihydroxyvitamin D levels

* AV block
* Prolongation of the PR interval (first-degree AV block)
* Ventricular arrhythmias (sustained or nonsustained ventricular tachycardia and ventricular premature beats [VPBs])
* Supraventricular arrhythmias

* Chest radiograph: Bilateral hilar adenopathy
* High-resolution CT (HRCT) scanning of the chest: Ground glass opacification, Hilar and mediastinal lymphadenopathy, Bronchial wall thickening

* Lung Biopsy

Differentials on the basis of Etiology  | Disease  | Clinical manifestations  | Diagnosis
Symptoms  | Risk factors  | Physical exam  | Lab Findings  | EKG  | Imaging  | Gold standard
Onset  | Duration  | Quality of Pain  | Cough  | Fever  | Dyspnea  | Weight loss  | Associated Features
Gastrointestinal  | GERD, Peptic Ulcer[22][23][24] | Acute |

* Minutes to hours (gastroesophageal reflux)
* Prolonged (peptic ulcer)
* 5 to 60 minutes

* Burning
* Substernal
* Epigastric

| +/-  | \-  | \-  | +/-  |

* Visceral, substernal, worse with recumbency, no radiation, relief with food, antacids
* Hematemesis or melena resulting from gastrointestinal bleeding
* Dyspepsia

* Prolonged NSAIDs intake
* Smoking
* Alcohol abuse
* Spicy foods
* H-pylori infection

* Not any auscultatory findings associated with this disease
* Enamel erosion or other dental manifestations

* ↑Serum Gastrin Level
* Secretin Stimulation Test
* H-Pylori testing

* EKG usually normal but may show T wave inversions in leads V2 through V4 consistent with myocardial ischemia in patients with peptic ulcer perforation

* Upper Gastrointestinal Endoscopy: Biopsy
* Esophageal Manometry: To exclude an esophageal motility disorder
* Esophageal impedance pH testing: Monitors esophageal pH

* Upper Gastrointestinal Endoscopy

Diffuse Esophageal Spasm[25][26][27][28] | Acute |

* Minutes to hours
* 5 to 60 minutes

* Burning
* Pressure
* Visceral, spontaneous, substernal

| \+  | \-  | +/-  | +/-  |

* Associated with cold liquids
* Relief with nitroglycerin

| \
  | \
  |

* Barium swallow: Multiple areas of spasm throughout the length of the esophagus
* Impedance testing: Higher amplitudes and better transit of swallowed boluses

* No ECG findings associated with DES, but ECG is done to exclude variant angina due to higher concurrent association of variant angina with DES

* Esophageal manometry : ≥20 percent premature contractions (distal latency <4.5 seconds)

* Esophageal manometry

Esophagitis[29][30][31] | Acute | Variable  |

* Burning
* Epigastric

| \+  | \+  | \-  | +/-  |

* Heartburn
* Abdominal pain

* HIV
* Immunosuppression

* No auscultatory finding

* Troponin or other cardiac markers
* Leukopenia
* ↓CD4 count
* Human immunodeficiency virus (HIV) test

* ECG is done to rule out acute coronary syndrome

* Double-contrast esophageal barium study (esophagography)
* Endoscopy: Biopsy

* Endoscopy

Pancreatitis[32][33][34][35][36] | Acute, Chronic | Variable  |

* Epigastric
* Upper left side of the abdomen
* Pressure like

| \-  | \+  | \+  | +/-  |

* Primary cirrhosis
* Primary sclerosing cholangitis
* Cystic fibrosis
* Autoimmune diseases

* Alcohol abuse
* Smoking
* Genetic predisposition

* Tachypnea
* Hypoxemia
* Hypotension
* Cullen's sign
* Grey Turner sign

* ↑Amylase levels
* ↑Lipase levels
* ↑ALT
* ↑ALP
* Leukocytosis

* T-wave inversion
* ST-segment depression
* ST-segment elevation rarely
* Q-waves

* CT: focal or diffuse enlargement of the pancreas
* MRI: Pancreatic enlargement

* CT Scan

Differentials on the basis of Etiology  | Disease  | Clinical manifestations  | Diagnosis
Symptoms  | Risk factors  | Physical exam  | Lab workup  | EKG  | Imaging  | Gold standard
Onset  | Duration  | Quality of Pain  | Cough  | Fever  | Dyspnea  | Weight loss  | Associated Features
Rheumatic  | Rheumatoid arthritis[37] | Chronic | Years  | Symmetrical joint pain in

* Wrist
* Fingers
* Knees
* Feet
* Ankles

| \-  | \+  | \-  | \+  |

* Extra-articular involvement of other organ systems
* Carpal tunnel syndrome
* Tarsal tunnel syndrome

* Old age
* Smoking
* Autoimmune conditions

* Reduced grip strength
* Rheumatoid nodules

* Positive Rheumatic Factor
* Anti-CCP body
* Synovial fluid analysis: WBC between 1500 and 25,000/cubicmm, low glucose, low C3 and C4 complement level.
* Thrombocytosis
* Anemia
* Mild leukocytosis

* ECG is done rule out the heart failure as RA is one of the causes of heart failure

* Plain film radiography: periarticular osteopenia, joint space narrowing, and bone erosions
* MRI: Bone erosions
* Ultrasonography: Degree of inflammation and the volume of inflamed tissue

| \

Systemic lupus erythematosus[38] [39][40] | Chronic | Years  |

* Skin
* Joints (fingers, wrist, knees)
* Kidneys
* SLE can affect any organ of the body

| \-  | \+  | \+  | \+  |

* HLA-genetic mutations
* Female gender
* Being younger than 50

* Autoimmune conditions
* Genetic predisposition
* Positive family history

* Malar rash
* Photosensitive rash
* Discoid rash
* Arthritis of the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints of the hands
* Pleuro-pericardial friction rubs
* Systolic murmurs

* Elevation of autoantibodies (ANA, anti-dsDNA, anti-SM, antiphospholipid)
* Complement levels decreased
* Anemia

* Sinus tachycardia, ST segment changes, and ventricular conduction disturbances

* Related to specific organ involvent

* Anti-dsDNA antibody test

Relapsing polychondritis[41] | Chronic | Years  | Intermittent pain in:

* Tissues that cover the end of the joints
* Cartilage of costal rib

| \+  | \+  | \+  | \+  |

* Hodkin's lymphoma
* Myelodysplastic syndromes
* Gastrointestinal disorders
* Type 1 Diabetes mellitus
* Auricular chondritis

* Autoimmune diseases

* Physical examinations findings are seen related to nasal chondritis, ocular inflammation, cardiovascular disease, skin disease, CNS and pulmonary system

* Negative rheumatoid factor
* Anti-type II collagen antibodies
* Antineutrophil cytoplasmic antibodies

* ECG is done to rule out the cardiovascular complications of this disease

* Non specific
* Related to specific organ involvent

* No gold standard test for this disease

Others

| Substance abuse

(Cocaine)[42][43][44]

| Acute (hours)  | Minutes to hours  | Pressure like pain in the center of chest  | \+  | \+  | \+  | \+  |

* Anxiety
* Dyspnea
* Nausea
* Palpitations

* Psychiatric disorders

* Signs of injection drug use
* Signs of drug inhalation
* Poor personal hygiene

* Serum biomarkers (Troponin I, Troponin T)
* Toxicologic tests or drug screens of bodily fluids (blood, urine, saliva) and hairs

*     * QT prolongation
* Sinus Tachycardia
* Arrhythmias
* Cardiac conduction abnormalities

| \
  |

* Gold standard test depends on the type of substance is abuse

## References

[edit | edit source]

1. ↑ Anker SD, Sharma R (September 2002). "The syndrome of cardiac cachexia". Int. J. Cardiol. 85 (1): 51–66. PMID 12163209.
2. ↑ Horwich TB, Kalantar-Zadeh K, MacLellan RW, Fonarow GC (May 2008). "Albumin levels predict survival in patients with systolic heart failure". Am. Heart J. 155 (5): 883–9. doi:10.1016/j.ahj.2007.11.043. PMID 18440336.
3. ↑ Breathett K, Allen LA, Udelson J, Davis G, Bristow M (October 2016). "Changes in Left Ventricular Ejection Fraction Predict Survival and Hospitalization in Heart Failure With Reduced Ejection Fraction". Circ Heart Fail. 9 (10). doi:10.1161/CIRCHEARTFAILURE.115.002962. PMC 5082710. PMID 27656000.
4. ↑ File TM (December 2003). "Community-acquired pneumonia". Lancet. 362 (9400): 1991–2001. doi:10.1016/S0140-6736(03)15021-0. PMID 14683661.
5. ↑ Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG (March 2007). "Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults". Clin. Infect. Dis. 44 Suppl 2: S27–72. doi:10.1086/511159. PMID 17278083.
6. ↑ Musher DM, Thorner AR (October 2014). "Community-acquired pneumonia". N. Engl. J. Med. 371 (17): 1619–28. doi:10.1056/NEJMra1312885. PMID 25337751.
7. ↑ Feinsilver SH, Barrows AA, Braman SS (October 1986). "Fiberoptic bronchoscopy and pleural effusion of unknown origin". Chest. 90 (4): 516–9. PMID 3757561.
8. ↑ Collins TR, Sahn SA (June 1987). "Thoracocentesis. Clinical value, complications, technical problems, and patient experience". Chest. 91 (6): 817–22. PMID 3581930.
9. ↑ Venekamp LN, Velkeniers B, Noppen M (2005). "Does 'idiopathic pleuritis' exist? Natural history of non-specific pleuritis diagnosed after thoracoscopy". Respiration. 72 (1): 74–8. doi:10.1159/000083404. PMID 15753638.
10. ↑ Kuempel ED, Wheeler MW, Smith RJ, Vallyathan V, Green FH (August 2009). "Contributions of dust exposure and cigarette smoking to emphysema severity in coal miners in the United States". Am. J. Respir. Crit. Care Med. 180 (3): 257–64. doi:10.1164/rccm.200806-840OC. PMID 19423717.
11. ↑ Lamprecht B, McBurnie MA, Vollmer WM, Gudmundsson G, Welte T, Nizankowska-Mogilnicka E, Studnicka M, Bateman E, Anto JM, Burney P, Mannino DM, Buist SA (April 2011). "COPD in never smokers: results from the population-based burden of obstructive lung disease study". Chest. 139 (4): 752–763. doi:10.1378/chest.10-1253. PMC 3168866. PMID 20884729.
12. ↑ Rennard S, Decramer M, Calverley PM, Pride NB, Soriano JB, Vermeire PA, Vestbo J (October 2002). "Impact of COPD in North America and Europe in 2000: subjects' perspective of Confronting COPD International Survey". Eur. Respir. J. 20 (4): 799–805. PMID 12412667.
13. ↑ Badgett RG, Tanaka DJ, Hunt DK, Jelley MJ, Feinberg LE, Steiner JF, Petty TL (February 1993). "Can moderate chronic obstructive pulmonary disease be diagnosed by historical and physical findings alone?". Am. J. Med. 94 (2): 188–96. PMID 8430714.
14. ↑ Kocher F, Hilbe W, Seeber A, Pircher A, Schmid T, Greil R, Auberger J, Nevinny-Stickel M, Sterlacci W, Tzankov A, Jamnig H, Kohler K, Zabernigg A, Frötscher J, Oberaigner W, Fiegl M (February 2015). "Longitudinal analysis of 2293 NSCLC patients: a comprehensive study from the TYROL registry". Lung Cancer. 87 (2): 193–200. doi:10.1016/j.lungcan.2014.12.006. PMID 25564398.
15. ↑ Hyde L, Hyde CI (March 1974). "Clinical manifestations of lung cancer". Chest. 65 (3): 299–306. PMID 4813837.
16. ↑ Chute CG, Greenberg ER, Baron J, Korson R, Baker J, Yates J (October 1985). "Presenting conditions of 1539 population-based lung cancer patients by cell type and stage in New Hampshire and Vermont". Cancer. 56 (8): 2107–11. PMID 2992757.
17. ↑ Hiraki A, Ueoka H, Takata I, Gemba K, Bessho A, Segawa Y, Kiura K, Eguchi K, Yoneda T, Tanimoto M, Harada M (March 2004). "Hypercalcemia-leukocytosis syndrome associated with lung cancer". Lung Cancer. 43 (3): 301–7. doi:10.1016/j.lungcan.2003.09.006. PMID 15165088.
18. ↑ Ungprasert P, Carmona EM, Utz JP, Ryu JH, Crowson CS, Matteson EL (February 2016). "Epidemiology of Sarcoidosis 1946-2013: A Population-Based Study". Mayo Clin. Proc. 91 (2): 183–8. doi:10.1016/j.mayocp.2015.10.024. PMC 4744129. PMID 26727158.
19. ↑ Baughman RP, Teirstein AS, Judson MA, Rossman MD, Yeager H, Bresnitz EA, DePalo L, Hunninghake G, Iannuzzi MC, Johns CJ, McLennan G, Moller DR, Newman LS, Rabin DL, Rose C, Rybicki B, Weinberger SE, Terrin ML, Knatterud GL, Cherniak R (November 2001). "Clinical characteristics of patients in a case control study of sarcoidosis". Am. J. Respir. Crit. Care Med. 164 (10 Pt 1): 1885–9. doi:10.1164/ajrccm.164.10.2104046. PMID 11734441.
20. ↑ Rizzato G, Tinelli C (2005). "Unusual presentation of sarcoidosis". Respiration. 72 (1): 3–6. doi:10.1159/000083392. PMID 15753626.
21. ↑ Rizzato G, Palmieri G, Agrati AM, Zanussi C (June 2004). "The organ-specific extrapulmonary presentation of sarcoidosis: a frequent occurrence but a challenge to an early diagnosis. A 3-year-long prospective observational study". Sarcoidosis Vasc Diffuse Lung Dis. 21 (2): 119–26. PMID 15281433.
22. ↑ Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R (August 2006). "The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus". Am. J. Gastroenterol. 101 (8): 1900–20, quiz 1943. doi:10.1111/j.1572-0241.2006.00630.x. PMID 16928254.
23. ↑ Vakil NB, Traxler B, Levine D (August 2004). "Dysphagia in patients with erosive esophagitis: prevalence, severity, and response to proton pump inhibitor treatment". Clin. Gastroenterol. Hepatol. 2 (8): 665–8. PMID 15290658.
24. ↑ Giannini EG, Zentilin P, Dulbecco P, Vigneri S, Scarlata P, Savarino V (February 2008). "Management strategy for patients with gastroesophageal reflux disease: a comparison between empirical treatment with esomeprazole and endoscopy-oriented treatment". Am. J. Gastroenterol. 103 (2): 267–75. doi:10.1111/j.1572-0241.2007.01659.x. PMID 18289194.
25. ↑ Katz PO, Dalton CB, Richter JE, Wu WC, Castell DO (April 1987). "Esophageal testing of patients with noncardiac chest pain or dysphagia. Results of three years' experience with 1161 patients". Ann. Intern. Med. 106 (4): 593–7. PMID 3826958.
26. ↑ Kahrilas PJ (May 2010). "Esophageal motor disorders in terms of high-resolution esophageal pressure topography: what has changed?". Am. J. Gastroenterol. 105 (5): 981–7. doi:10.1038/ajg.2010.43. PMC 2888528. PMID 20179690.
27. ↑ Pandolfino JE, Ghosh SK, Rice J, Clarke JO, Kwiatek MA, Kahrilas PJ (January 2008). "Classifying esophageal motility by pressure topography characteristics: a study of 400 patients and 75 controls". Am. J. Gastroenterol. 103 (1): 27–37. doi:10.1111/j.1572-0241.2007.01532.x. PMID 17900331.
28. ↑ Kahrilas PJ, Ghosh SK, Pandolfino JE (2008). "Esophageal motility disorders in terms of pressure topography: the Chicago Classification". J. Clin. Gastroenterol. 42 (5): 627–35. doi:10.1097/MCG.0b013e31815ea291. PMC 2895002. PMID 18364587.
29. ↑ Bott S, Prakash C, McCallum RW (August 1987). "Medication-induced esophageal injury: survey of the literature". Am. J. Gastroenterol. 82 (8): 758–63. PMID 3605035.
30. ↑ Parfitt JR, Jayakumar S, Driman DK (September 2008). "Mycophenolate mofetil-related gastrointestinal mucosal injury: variable injury patterns, including graft-versus-host disease-like changes". Am. J. Surg. Pathol. 32 (9): 1367–72. PMID 18763324.
31. ↑ Jaspersen D (March 2000). "Drug-induced oesophageal disorders: pathogenesis, incidence, prevention and management". Drug Saf. 22 (3): 237–49. PMID 10738847.
32. ↑ Dickson AP, Imrie CW (October 1984). "The incidence and prognosis of body wall ecchymosis in acute pancreatitis". Surg Gynecol Obstet. 159 (4): 343–7. PMID 6237447.
33. ↑ Yadav D, Agarwal N, Pitchumoni CS (June 2002). "A critical evaluation of laboratory tests in acute pancreatitis". Am. J. Gastroenterol. 97 (6): 1309–18. doi:10.1111/j.1572-0241.2002.05766.x. PMID 12094843.
34. ↑ Fortson MR, Freedman SN, Webster PD (December 1995). "Clinical assessment of hyperlipidemic pancreatitis". Am. J. Gastroenterol. 90 (12): 2134–9. PMID 8540502.
35. ↑ Lecesne R, Taourel P, Bret PM, Atri M, Reinhold C (June 1999). "Acute pancreatitis: interobserver agreement and correlation of CT and MR cholangiopancreatography with outcome". Radiology. 211 (3): 727–35. doi:10.1148/radiology.211.3.r99jn08727. PMID 10352598.
36. ↑ Stimac D, Miletić D, Radić M, Krznarić I, Mazur-Grbac M, Perković D, Milić S, Golubović V (May 2007). "The role of nonenhanced magnetic resonance imaging in the early assessment of acute pancreatitis". Am. J. Gastroenterol. 102 (5): 997–1004. doi:10.1111/j.1572-0241.2007.01164.x. PMID 17378903.
37. ↑ Rodríguez-Henríquez P, Solano C, Peña A, León-Hernández S, Hernández-Díaz C, Gutiérrez M, Pineda C (July 2013). "Sternoclavicular joint involvement in rheumatoid arthritis: clinical and ultrasound findings of a neglected joint". Arthritis Care Res (Hoboken). 65 (7): 1177–82. doi:10.1002/acr.21958. PMID 23335586.
38. ↑ Turner-Stokes L, Turner-Warwick M (April 1982). "Intrathoracic manifestations of SLE". Clin Rheum Dis. 8 (1): 229–42. PMID 6749397.
39. ↑ Hunder GG, McDuffie FC, Hepper NG (March 1972). "Pleural fluid complement in systemic lupus erythematosus and rheumatoid arthritis". Ann. Intern. Med. 76 (3): 357–63. PMID 5015911.
40. ↑ Porcel JM, Ordi-Ros J, Esquerda A, Vives M, Madroñero AB, Bielsa S, Vilardell-Tarrés M, Light RW (2007). "Antinuclear antibody testing in pleural fluid for the diagnosis of lupus pleuritis". Lupus. 16 (1): 25–7. doi:10.1177/0961203306074470. PMID 17283581.
41. ↑ Chopra R, Chaudhary N, Kay J (May 2013). "Relapsing polychondritis". Rheum. Dis. Clin. North Am. 39 (2): 263–76. doi:10.1016/j.rdc.2013.03.002. PMID 23597963.
42. ↑ Grant BF, Goldstein RB, Saha TD, Chou SP, Jung J, Zhang H, Pickering RP, Ruan WJ, Smith SM, Huang B, Hasin DS (August 2015). "Epidemiology of DSM-5 Alcohol Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions III". JAMA Psychiatry. 72 (8): 757–66. doi:10.1001/jamapsychiatry.2015.0584. PMC 5240584. PMID 26039070.
43. ↑ Cosci F, Schruers KR, Abrams K, Griez EJ (June 2007). "Alcohol use disorders and panic disorder: a review of the evidence of a direct relationship". J Clin Psychiatry. 68 (6): 874–80. PMID 17592911.
44. ↑ George DT, Nutt DJ, Dwyer BA, Linnoila M (February 1990). "Alcoholism and panic disorder: is the comorbidity more than coincidence?". Acta Psychiatr Scand. 81 (2): 97–107. PMID 2183544.