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TETRALOGY OF FALLOT
Based from History
History of present Illness:
The patient is apparently well until 3 years
and 8 months prior to admission when the
patient experienced shortness of breath
described as a whistling-like sound. This
was associated with circumoral and
peripheral cyanosis with her tongue hanging
outside her mouth as if she was gasping for
air
DIFFERENTIAL DIAGNOSIS
Differential
Description
Rule In
Rule Out
Diagnosis
AIRWAY NON-INFECTIOUS CAUSES
Non-infectious causes are typically ruled out because according to Del Mundo et al. (2000),
presence of fever with the cough indicates it is at least related to an infection.
Bronchial
Asthma is a chronic
The patient presents with
However, this was
Asthma
inflammatory condition cough, shortness of breath
ruled out because of
of the lung airways
described as a whistlingthe patient presented
resulting in episodic
like sound, respiratory rate
with fever, suggesting
airflow obstruction.
is 62 cycles per minute. In
an infectious cause.
most children, asthma
develops before age 5 years
(our patient is 4 years old).
The patient also has a
positive family history of
asthma.
Pulmonary
Pulmonary edema is the Cough is a frequent
However, this can be
Edema
excessive accumulation complaint and may provide ruled out because of
of fluid in the
an early clue to worsening
the patient presented
interstitium and air
pulmonary edema. In
with fever, suggesting
spaces of the lung,
addition, this can be ruled
an infectious cause.
leading to oxygen
in because of the presence
desaturation, decreased of tachypnea, and dyspnea.
lung compliance, and
respiratory distress. It
can result from
increased pulmonary
capillary pressure,
increased capillary
permeability, lymphatic
insufficiency, decreased
oncotic pressure, and
increased negative
interstitial pressure.
AIRWAY INFECTIOUS CAUSES
Bronchitis
Bronchitis is a
Cough is the most common Fever is a relatively
nonspecific
observed symptom in
unusual sign and,
inflammation of the
bronchitis. The patient also when accompanied by
bronchial. Acute
presented with clubbing of
cough, suggests either
bronchitis is a
digits and peripheral
influenza or
syndrome, which is
cyanosis.
pneumonia. There
Bronchiolitis is an
acute inflammatory
injury of the
bronchioles that is
usually caused by a
viral infection (most
commonly respiratory
syncytial virus and
human
metapneumovirus).
References:
Del Mundo, et al. (2000), Textbook of Pediatrics and Child Health. The Respiratory System. 4th
Edition.
Rudolph, C. D. (2003). Rudolph`s pediatrics. New York: McGraw-Hill, Medical Pub. Division.