1. I Siegenthaler, Differential Diagnosis in Internal Medicine,
2007 Thieme All rights reserved. Usage subject to terms and
conditions of license.
2. II Siegenthaler, Differential Diagnosis in Internal
Medicine, 2007 Thieme All rights reserved. Usage subject to terms
and conditions of license.
3. III Differential Diagnosis in Internal Medicine From Symptom
to Diagnosis Walter Siegenthaler, MD Professor Emeritus of Internal
Medicine University of Zrich Zrich, Switzerland With contributions
by A. Aeschlimann, E. Baechli, C. Bassetti, E. Battegay, M.
Battegay, K. Bloch, H.E. Blum, F. Duru, F.R. Eberli, T. Fehr, A.
Fontana, M. Fox, M. Fried, K. Hess, U. Hoffmann, D. Jaeger, M.
Kraenzlin, H. Kupferschmidt, S. Lautenschlager, B. Michel, E.
Oechslin, P. Ott, P. Peghini, E.W. Russi, N. Schaefer, C. Scharf,
C. Schmid, U. Schwarz, G.A. Spinas, S. Stoeckli, F. Tat, A. von
Eckardstein, R. Weber, R.P. Wuethrich Specialist Consultants A.
Aeschlimann: Rheumatology M. Battegay: Fundamentals of Differential
Diagnosis H.E. Blum: Gastroenterology, Hepatology F.R. Eberli:
Cardiology P. Greminger: General Internal Medicine K. Hess:
Neurology A. Knuth: Hematology, Oncology E.W. Russi: Pneumology
G.A. Spinas: Endocrinology, Diabetology R. Weber: Infectiology R.P.
Wuethrich: Nephrology 789 illustrations 323 tables Thieme Stuttgart
New York Siegenthaler, Differential Diagnosis in Internal Medicine,
2007 Thieme All rights reserved. Usage subject to terms and
conditions of license.
4. IV Library of Congress Cataloging-in-Publication Data
Siegenthalers Differentialdiagnose. English. Differential diagnosis
in internal medicine / [edited by] Walter Siegenthaler ; with
contributions by A. Aeschlimann ... [et al.] ; specialist
consultants, A. Aeschlimann ... [et al.]. -- 1st English ed. p. ;
cm. ISBN 978-3-13-142141-8 (TPS : alk. paper) -- ISBN
978-1-58890-551-2 (TPN : alk. paper) 1. Diagnosis, Differential. 2.
Physical diagnosis. 3. Internal medicine. I. Siegenthaler, Walter,
1923- II. Title. [DNLM: 1. Diagnosis, Differential. 2. Internal
Medicine. WB 141.5 S571 2007a] RC71.D5447 2007 616.07'5--dc22
2007004243 This first English edition is a revised and updated
authorized translation of the 19th German edition pub- lished and
copyrighted 2005 by Georg Thieme Verlag, Stuttgart, Germany. Title
of the German edition: Siegen- thalers Differentialdiagnose: Innere
Krankheiten vom Symptom zur Diagnose. 2007 Georg Thieme Verlag,
Rdigerstrasse 14, 70469 Stuttgart, Germany http://www.thieme.de
Thieme New York, 333 Seventh Avenue, New York, NY 10001, USA
http://www.thieme.com Illustrator: Joachim Hormann, Stuttgart,
Germany; Plankensteiner + Hanig, Esslingen, Germany; Andrea
Schnitzler, Innsbruck, Austria Cover design: Thieme Publishing
Group Typesetting by primustype Hurler, Notzingen, Germany Printed
in Germany by APPL, aprinta druck, Wemding, Germany ISBN
978-3-13-142141-8 (TPS, Rest of World) ISBN 978-1-58890-551-2 (TPN,
The Americas) 1 2 3 4 5 6 Important note: Medicine is an
ever-changing science undergoing continual development. Research
and clinical experience are continually expanding our knowledge, in
particular our knowledge of proper treatment and drug therapy.
Insofar as this book mentions any dosage or appli- cation, readers
may rest assured that the authors, editors, and publishers have
made every effort to ensure that such references are in accordance
with the state of knowledge at the time of production of the book.
Nevertheless, this does not involve, imply, or express any
guarantee or responsibility on the part of the publishers in
respect to any dosage instructions and forms of applica- tions
stated in the book. Every user is requested to ex- amine carefully
the manufacturers leaflets accompanying each drug and to check, if
necessary in consultation with a physician or specialist, whether
the dosage schedules men- tioned therein or the contraindications
stated by the manu- facturers differ from the statements made in
the present book. Such examination is particularly important with
drugs that are either rarely used or have been newly re- leased on
the market. Every dosage schedule or every form of application used
is entirely at the users own risk and re- sponsibility. The authors
and publishers request every user to report to the publishers any
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on the pro- duct description page. Some of the product names,
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fact registered trademarks or proprietary names even though
specific reference to this fact is not always made in the text.
Therefore, the appear- ance of a name without designation as
proprietary is not to be construed as a representation by the
publisher that it is in the public domain. This book, including all
parts thereof, is legally protected by copyright. Any use,
exploitation, or commercialization outside the narrow limits set by
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Siegenthaler, Differential Diagnosis in Internal Medicine, 2007
Thieme All rights reserved. Usage subject to terms and conditions
of license.
5. V Preface The present book, Differential Diagnosis in
Internal Medicine, first appeared as a German edition in 1952 and
since then has been translated into 10 other languages. Over the
past 50 years 19 Ger- man editions have been published, and now the
19th edition of the work, which has become the classic differential
diagnosis textbook, is available in English for the first time.
This book encompasses differential diagnosis across the spectrum of
internal medicine, cover- ing dermatology, neurology, and
rheumatology, and provides the very latest knowledge including
pathophysiological aspects. In contrast to ency- clopedically
structured textbooks, this book traces the path from symptom to
diagnosis, just as the physician encounters the situation in the
hospital and in the office. With this pragmatic approachstarting
from the symptom(s)the physician will usually suc- ceed in
substantiating the suspected diagnosis. Using this method,
Siegenthalers Differential Di- agnosis in Internal Medicine guides
the reader through the differential diagnostic challenges in the
entire field of internal medicine, including dermatology,
neurology, and rheumatology. The book incorporates many relevant
and instructive illustrations, tables, graphics, and algorithms,
all contributing to the process of narrowing down a definitive
diagnosis. The book is intended for medical students, phy- sicians
in clinical practice, generalists, and special- ists in internal
medicine, dermatology, neurology, and rheumatology, and also for
all those concerned with the fundamental subjects of medicine, who
wish to gain a competent knowledge of internal medicine. My thanks
are due to all of the colleagues who worked with me on the book,
and also to Thieme Publishing Group, in particular Thieme
Publishers Stuttgart. I hope that, with the launch of the Eng- lish
edition, this classic textbook of differential di- agnosis in
internal medicine will now also find its place in the
English-speaking world. Walter Siegenthaler, MD Professor Emeritus
of Internal Medicine University of Zrich Zrich, Switzerland Preface
Siegenthaler, Differential Diagnosis in Internal Medicine, 2007
Thieme All rights reserved. Usage subject to terms and conditions
of license.
6. VI Contributors Siegenthaler, Differential Diagnosis in
Internal Medicine, 2007 Thieme All rights reserved. Usage subject
to terms and conditions of license.
7. VII Foreword Foreword I first met Professor Walter
Siegenthaler in the 1970s while he was at the University of Zrich,
where both he and his late wife, the superb clini- cian Doctor
Gertrud Siegenthaler-Zuber, were ad- mired for their many
accomplishments and dedi- cation to the advancement of medicine. At
that time, Professor Siegenthaler helped me establish a program to
bring cardiologists from the Baylor College of Medicine and the
Methodist Hospital in Houston, Texas, to Switzerland to study the
pioneering balloon angioplasty work of Andreas Gruentzig.
Subsequently, he honored us by serv- ing as a Visiting Professor at
Baylor, exemplifying the best of Swiss medicine. Now, 30 years
later, Professor Siegenthaler remains at the leading edge of
medicine, as this expertly realized book in your hands attests.
Differential diagnosis is the fundamental meth- odology of modern
clinical medicine: we note the patients symptoms; we develop
hypotheses for the affliction and propose treatment; and we ad-
just treatment based on the patients response. Thus, differential
diagnosis requires the physician to be observant, knowledgeable,
thoughtful, thorough, and organized, qualities that could also be
used to describe the conceptualization and ex- ecution of the
following pages. In the last few de- cades, we have seen stunning
advances in the level of clinical care and diagnostic procedures
available across the spectrum of human diseases. The sophistication
of contemporary nosology is truly impressive. On the other hand,
the rapid turnover of medi- cal information can prove daunting to
many clini- cians, and the application of the latest evidence to
our daily interactions with patients may seem un- clear or too
complex. Siegenthalers Differential Diagnosis in Internal Medicine
reminds us to ap- proach diagnostic problems in a practical,
system- atic, and critical manner, remembering that each patients
circumstance is unique and that it is every doctors responsibility
to exercise his or her best educated judgment to present rational
choices about the most probable diagnoses and optimal treatment
courses. Occams Razor, which advises us that the simplest
explanation is usually the correct one, all things being equal, is
an im- portant precept in diagnostic medicine, yet doc- tors must
also be flexible and adaptable to the ec- centricities of every
case. Thus, physicians should not expect to see a zebra when
confronted with a horse, but they should be able to recognize the
zebra on the rare occasion that it makes an ap- pearance. I believe
that the scholarship, clinical skill, and practical wisdom that
Professor Siegenthaler and his colleagues share with us in this
text are indis- pensable resources for the medical community. The
wealth of illustrative photographs, informa- tive tables, and
up-to-date discussion of issues in internal medicine will prove
very useful in daily clinical practice. Antonio M. Gotto, Jr., MD,
DPhil The Stephen and Suzanne Weiss Dean Professor of Medicine
Weill Cornell Medical College Provost for Medical Affairs Cornell
University New York, USA Siegenthaler, Differential Diagnosis in
Internal Medicine, 2007 Thieme All rights reserved. Usage subject
to terms and conditions of license.
8. VIII Contributors Contributors Editor Prof. Dr. med. Dr. h.
c. Walter Siegenthaler Forsterstr. 61 8044 Zrich, Switzerland
Authors Andr Aeschlimann, MD Professor RehaClinic Zurzach Zurzach,
Switzerland Esther Baechli, MD Spital Uster Medical Clinic Uster,
Switzerland Claudio Bassetti, MD Professor University Hospital
Zrich Clinic and Policlinic for Neurology Zrich, Switzerland
Edouard Battegay, MD Professor University Hospital Basel Medical
Policlinic Basel, Switzerland Manuel Battegay, MD Professor
University Hospital Basel Department of Medicine Division of
Infectiology Basel, Switzerland Peter Bauerfeind, MD Associate
Professor University Hospital Zrich Departement of Internal
Medicine Division of Gastroenterology and Hepatology Zrich,
Switzerland Konrad Bloch, MD Professor University Hospital Zrich
Department of Internal Medicine Division of Pneumology Zrich,
Switzerland Hubert E. Blum, MD Professor and Director Department of
Internal Medicine II University Medical Center Freiburg, Germany
Thomas Bombeli, MD Associate Professor Research and Development
Novo Nordisk S/A Bagsvaerd, Denmark Firat Duru, MD Professor
University Hospital Zrich Department of Internal Medicine Division
of Cardiology Cardiovascular Center Zrich, Switzerland Franz
Eberli, MD Associate Professor University Hospital Zrich Department
of Internal Medicine Division of Cardiology Cardiovascular Center
Zrich, Switzerland Joerg Fehr, MD Professor University Hospital
Zrich Department of Internal Medicine Division of Hematology Zrich,
Switzerland Thomas Fehr, MD Associate Professor Center for
Nephrology University Hospital Zrich Zrich, Switzerland Adriano
Fontana, MD Professor University Hospital Zrich Faculty of Medicine
Department of Internal Medicine Division of Clinical Immunology
Zrich, Switzerland Mark Fox, MD Research Consultant University
Hospital Zrich Zrich, Switzerland Michael Fried, MD Professor
University Hospital Zrich Department of Internal Medicine Division
of Gastroenterology and Hepatology Zrich, Switzerland Peter
Greminger, MD Professor St Gallen Canton Hospital Department of
Internal Medicine St Gallen, Switzerland Klaus Hess, MD Professor
University Hospital Zrich Clinic and Policlinic for Neurology
Zrich, Switzerland Ulrich Hoffmann, MD Professor University of
Munich Hospital Vascular CenterAngiology Munich, Germany Sabina
Hunziker, MD University Hospital Basel Medical Policlinic Basel,
Switzerland Dirk Jaeger, MD Associate Professor Director of
Clinical Oncology National Center for Tumor Diseases Heidelberg,
Germany Alexander Knuth, MD Professor University Hospital Zrich
Clinic and Policlinic for Oncology Zrich, Switzerland Siegenthaler,
Differential Diagnosis in Internal Medicine, 2007 Thieme All rights
reserved. Usage subject to terms and conditions of license.
9. IX Marius Kraenzlin, MD Associate Professor Basel,
Switzerland Hugo Kupferschmidt, MD Swiss Toxicology Information
Center (STIZ) Zrich, Switzerland Stephan Lautenschlager, MD
Associate Professor Dermatology Clinic Stadtspital Triemli Zrich,
Switzerland Hans-Peter Marti, MD Professor University Hospital
Zrich Department of Internal Medicine Division of Nephrology Zrich,
Switzerland Benedict Martina, MD Associate Professor Basel
University Hospital Medical Policlinic Basel, Switzerland Darius
Moradpour, MD Professor Vaudois University Hospital
Gastroenterology and Hepatology Service Lausanne, Switzerland Beat
Muellhaupt, MD Associate Professor University Hospital Zrich
Department of Internal Medicine Division of Gastroenterology and
Hepatology Zrich, Switzerland Beat A. Michel, MD Professor
University Hospital Zrich Rheumatism Clinic and Instititute of
Physical Medicine Zrich, Switzerland Erwin Oechslin, MD Professor
Director Congenital Cardiac Centre for Adults University Health
Network Toronto, Canada Peter Ott, MD Professor University Hospital
Zrich Otorhinolaryngology Policlinic Zrich, Switzerland Pietro
Peghini, MD University Hospital Zrich Department of Internal
Medicine Division of Hematology Zrich, Switzerland Erich W. Russi,
MD Professor University Hospital Zrich Department of Internal
Medicine Division of Pneumology Zrich, Switzerland Niklaus
Schaefer, MD University Hospital Zrich Clinic and Policlinic for
Oncology Zrich, Switzerland Urs Schanz, MD Associate Professor
University Hospital Zrich Department of Internal Medicine Division
of Hematology Zrich, Switzerland Christoph Scharf, MD Associate
Professor Klinik im Park Zrich, Switzerland Christoph Schmid, MD
Professor University Hospital Zrich Department of Internal Medicine
Division of Endocrinology and Diabetology Zrich, Switzerland Urs
Schwarz, MD Associate Professor University Hospital Zrich Clinic
and Policlinic for Neurology Zrich, Switzerland Werner Schwizer, MD
Associate Professor University Hospital Zrich Department of
Internal Medicine Division of Gastroenterology and Hepatology
Zrich, Switzerland Giatgen A. Spinas, MD Professor University
Hospital Zrich Department of Internal Medicine Division of
Endocrinology and Diabetology Zrich, Switzerland S. Stoeckli, MD
Associate Professor University Hospital Zrich Otorhinolaryngology
Clinic Zrich, Switzerland Federico Tat, MD Associate Professor
University of Munich Hospital Vascular CenterAngiology Munich,
Germany Miriam Thumshirn, MD Associate Professor University
Hospital Zrich Department of Internal Medicine Division of
Gastroenterology and Hepatology Zrich, Switzerland Arnold von
Eckardstein, MD Professor University Hospital Zrich Institute of
Clinical Chemistry Zrich, Switzerland Rainer Weber, MD Professor
University Hospital Zrich Department of Internal Medicine Division
of Infectious Diseases and Hospital Hygiene Zrich, Switzerland
Rudolf P. Wuethrich, MD Professor University Hospital Zrich
Department of Internal Medicine Division of Nephrology Zrich,
Switzerland Contributors Siegenthaler, Differential Diagnosis in
Internal Medicine, 2007 Thieme All rights reserved. Usage subject
to terms and conditions of license.