Symptom Finder - Non Bloody Discharge
Non bloody Discharge
The differential diagnosis of a nonbloody discharge, like that of a bloody discharge, begins with the basic science of anatomy. Visualizing where the discharge could come from means visualizing the anatomic “tree” or tract of the organ system involved. Unlike a bloody discharge, a non bloody discharge is most likely due to inflammation. For example, a 48-year-old black man presents with a productive cough of 2 weeks duration.
Visualizing the respiratory tree, we find the nasopharynx, larynx, trachea, bronchi, and alveoli. Now, translating each structure into common
inflammatory diseases that may involve each of them, we can develop a useful list of diagnostic possibilities as follows:
1. Nasopharynx: rhinitis, sinusitis
2. Larynx: laryngitis
3. Trachea: tracheobronchitis
4. Bronchi: bronchitis, bronchiectasis, foreign body, bronchial asthma
5. Alveoli: pneumonia, lung abscess, pneumoconiosis, congestive heart failure
Proceeding to the second step, we can develop a list of causes of productive sputum further by recalling the etiologic categories of
respiratory diseases with the help of the mnemonic MINT. This would translate into a list of diagnoses as follows:
M—Malformations do not lead to a nonbloody discharge of themselves but predispose to infection. Bronchiectasis and lung cysts are examples
of malformations in the lung that can cause productive sputum.
I—Inflammation would bring to mind rhinitis, sinusitis, pharyngitis, laryngitis, tracheobronchitis and abscess, or pneumonia. Hay fever and
asthma should be included here.
N—Neoplasms predispose to infection. Thus, a bronchogenic carcinoma or bronchial adenoma may cause pneumonia or bronchitis with
productive sputum.
T—Toxins would be suggested by this category and should bring to mind pneumoconiosis, foreign body, and lipoid pneumonia as causes of a
nonbloody discharge.
As with the other symptom categories, a differential diagnosis table can
be constructed by combining the first and second steps in this process. One can develop inflammation further by thinking of the smallest
organism to the largest. Considering the alveoli or lung would prompt recall of viral pneumonia, mycoplasma, psittacosis, bacterial pneumonia or
tuberculosis, fungal pneumonia such as histoplasmosis, and parasitic infestation such as Pneumocystis carinii or Echinococcus.
Now, with these diagnostic possibilities in mind, one can proceed with the interview asking meaningful questions that will help pinpoint the
diagnosis.
The differential diagnosis of a nonbloody discharge, like that of a bloody discharge, begins with the basic science of anatomy. Visualizing where the discharge could come from means visualizing the anatomic “tree” or tract of the organ system involved. Unlike a bloody discharge, a non bloody discharge is most likely due to inflammation. For example, a 48-year-old black man presents with a productive cough of 2 weeks duration.
Visualizing the respiratory tree, we find the nasopharynx, larynx, trachea, bronchi, and alveoli. Now, translating each structure into common
inflammatory diseases that may involve each of them, we can develop a useful list of diagnostic possibilities as follows:
1. Nasopharynx: rhinitis, sinusitis
2. Larynx: laryngitis
3. Trachea: tracheobronchitis
4. Bronchi: bronchitis, bronchiectasis, foreign body, bronchial asthma
5. Alveoli: pneumonia, lung abscess, pneumoconiosis, congestive heart failure
Proceeding to the second step, we can develop a list of causes of productive sputum further by recalling the etiologic categories of
respiratory diseases with the help of the mnemonic MINT. This would translate into a list of diagnoses as follows:
M—Malformations do not lead to a nonbloody discharge of themselves but predispose to infection. Bronchiectasis and lung cysts are examples
of malformations in the lung that can cause productive sputum.
I—Inflammation would bring to mind rhinitis, sinusitis, pharyngitis, laryngitis, tracheobronchitis and abscess, or pneumonia. Hay fever and
asthma should be included here.
N—Neoplasms predispose to infection. Thus, a bronchogenic carcinoma or bronchial adenoma may cause pneumonia or bronchitis with
productive sputum.
T—Toxins would be suggested by this category and should bring to mind pneumoconiosis, foreign body, and lipoid pneumonia as causes of a
nonbloody discharge.
As with the other symptom categories, a differential diagnosis table can
be constructed by combining the first and second steps in this process. One can develop inflammation further by thinking of the smallest
organism to the largest. Considering the alveoli or lung would prompt recall of viral pneumonia, mycoplasma, psittacosis, bacterial pneumonia or
tuberculosis, fungal pneumonia such as histoplasmosis, and parasitic infestation such as Pneumocystis carinii or Echinococcus.
Now, with these diagnostic possibilities in mind, one can proceed with the interview asking meaningful questions that will help pinpoint the
diagnosis.
