Community-acquired pneumonia differential diagnosis: Difference between revisions

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{{Community-acquired pneumonia}}
{{Community-acquired pneumonia}}
{{CMG}}
{{CMG}}
==Overview==
Pneumonia should be differentiated from other conditions that cause [[cough]], [[fever]], [[shortness of breath]] and [[tachypnea]], such as [[asthma]], [[COPD]], [[CHF]], [[cancer]], [[GERD]], and [[pulmonary emboli]].


==Differentiating Pneumonia From Other Diseases==
==Differentiating Pneumonia from other Diseases==
{| style="border: 0px; font-size: 90%; margin: 3px; width: 700px;" align=center
|valign=top|
|+'''Differential Diagnosis of Pneumonia''' <ref name="pmid1458569">{{cite journal| author=Schiele F, Muller J, Colinet E, Siest G, Arzoglou P, Brettschneider H et al.| title=Interlaboratory study of the IFCC method for alanine aminotransferase performed with use of a partly purified reference material. | journal=Clin Chem | year= 1992 | volume= 38 | issue= 12 | pages= 2365-71 | pmid=1458569 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1458569  }} </ref><ref name="pmid11113658">{{cite journal| author=Castro-Guardiola A, Armengou-Arxé A, Viejo-Rodríguez A, Peñarroja-Matutano G, Garcia-Bragado F| title=Differential diagnosis between community-acquired pneumonia and non-pneumonia diseases of the chest in the emergency ward. | journal=Eur J Intern Med | year= 2000 | volume= 11 | issue= 6 | pages= 334-339 | pmid=11113658 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11113658  }} </ref><ref name="Ahnsjö1935">{{cite journal|last1=Ahnsjö|first1=Sven|title=Contribution to the Differential Diagnosis of Pneumonia in Childhood|journal=Acta Paediatrica|volume=17|issue=3|year=1935|pages=439–446|issn=0803-5253|doi=10.1111/j.1651-2227.1935.tb07697.x}}</ref>


* [[Acute bronchitis]] - No infiltrates on the CXR.
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Disease}}
* [[Asthma]]- No infiltrates on the CXR.
! style="background: #4479BA; width: 500px;" | {{fontcolor|#FFF|Findings}}
* [[Bronchiolitis obliterans organizing pneumonia|Bronchiolitis obliterans with organizing pneumonia]] should be suspected in patients who fail to respond to antibiotics.
|-
* [[Congestive heart failure]] - Bilateral [[pulmonary edema]], involving more than the lower lung fields.
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | [[Acute bronchitis]]
* [[Chronic obstructive pulmonary disease]] - No infiltrates on the CXR.
| style="padding: 5px 5px; background: #F5F5F5;" | No infiltrates seen on the CXR.
* [[Empyema]] - [[Pleural effusion]]s on the CXR; positive inflammatory markers on [[pleural fluid]] anaylsis.
|-
* [[Endocarditis]] with septic [[pulmonary emboli]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | [[Asthma]]
* [[Gastroesophageal reflux disease]] - Normal chest X Ray, symptoms worsening during night.
| style="padding: 5px 5px; background: #F5F5F5;" | Past medical history, no infiltrates seen on chest X Ray.
* [[Influenza]]
|-
* [[Lung abscess]] - CXR showing signs of [[lung abscess]].
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | [[Bronchiolitis obliterans]]  
* [[Malignancy]] - CT scan and biopsy are helpful in ruling out malignancy.
| style="padding: 5px 5px; background: #F5F5F5;" | Should be suspected in patients with pneumonia who do not respond to antibiotics treatment.
* [[Pertussis]] - Productive cough for weeks, nasopharyngeal aspirate aids in diagnosis.
|-
* [[Pulmonary embolus]] - A high degree of suspicion should be kept for [[pulmonary embolus]]. CXR may be insiginificant.
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | [[Congestive heart failure]]  
* [[Sinusitis]] - Sinus tenderness, [[post-nasal drip]].
| style="padding: 5px 5px; background: #F5F5F5;" | Bilateral [[pulmonary edema]], shortness of breath.
* [[Upper respiratory tract infection]]
|-
* [[Vasculitis]] - Systemic manifestations of [[collagen vascular disease]] may be seen.
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | [[COPD]]
| style="padding: 5px 5px; background: #F5F5F5;" | Past medical history, no infiltrates on chest X Ray, fever is uncommon
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | [[Empyema]]
| style="padding: 5px 5px; background: #F5F5F5;" | CXR showing features of [[pleural effusion]], inflammatory markers on [[thoracocentesis]].  
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | [[Endocarditis]]
| style="padding: 5px 5px; background: #F5F5F5;" | Finding of septic [[pulmonary emboli]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | [[Gastroesophageal reflux disease]] (GERD)
| style="padding: 5px 5px; background: #F5F5F5;" | Normal chest X ray, symptoms worsening during night and associated with meals.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Lung abscess]]  
| style="padding: 5px 5px; background: #F5F5F5;" | CXR showing signs of [[lung abscess]], such as unilateral and single mass involving posterior segments of the upper lobes, air-fluid levels may be seen.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | [[Lung cancer]]  
| style="padding: 5px 5px; background: #F5F5F5;" | Weight loss, clear sputum.  CT scan and biopsy are helpful in ruling out malignancy.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Pertussis]]
| style="padding: 5px 5px; background: #F5F5F5;" | Productive cough for weeks, nasopharyngeal aspirate aids in diagnosis.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | [[Pulmonary embolus]]
| style="padding: 5px 5px; background: #F5F5F5;" | A high degree of suspicion should be kept for [[pulmonary embolus]] in patients with a sudden onset of chest pain. Chest X ray may be normal. Fever could be present.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Sinusitis]]
| style="padding: 5px 5px; background: #F5F5F5;" | Sinus tenderness, post nasal drip.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | [[Vasculitis]]
| style="padding: 5px 5px; background: #F5F5F5;" | Systemic manifestations of [[collagen vascular disease]] may be seen.
|}


==Differential Diagnosis of Community-Acquired Pneumonia Depending on Chest Radiograph==
==Differential Diagnosis of Community-Acquired Pneumonia Depending on Chest Radiograph==


====Abnormal chest radiograph====
{| style="border: 0px; font-size: 85%; margin: 3px; width:600px;" align=center
 
|valign=top|
|+
! style="background: #4479BA; color:#FFF;  width: 300px;" | Normal chest X-ray
! style="background: #4479BA; color:#FFF;  width: 300px;" | Abormal chest X-ray
|-
| style="padding: 5px 5px; background: #F5F5F5;" |
* Acute exacerbation of [[chronic obstructive pulmonary disease]]
* [[Influenza]]
* [[Acute bronchitis]]
* [[Pertussis]]
* [[Asthma]] with viral infection
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Congestive heart failure]] accompanied by viral infection
* [[Congestive heart failure]] accompanied by viral infection
* [[Aspiration pneumonia]]
* [[Aspiration pneumonia]]
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* Pulmonary [[vasculitis]]
* Pulmonary [[vasculitis]]
* Cocaine-induced lung injury
* Cocaine-induced lung injury
 
|-
====Normal chest radiograph====
| style="padding: 0px 5px; background: #F5F5F5;" colspan=2 | Adapted from N Engl J Med 2014; 370:543-551<ref name="SolomonWunderink2014">{{cite journal|last1=Solomon|first1=Caren G.|last2=Wunderink|first2=Richard G.|last3=Waterer|first3=Grant W.|title=Community-Acquired Pneumonia|journal=New England Journal of Medicine|volume=370|issue=6|year=2014|pages=543–551|issn=0028-4793|doi=10.1056/NEJMcp1214869}}</ref>
 
|}
* Acute exacerbation of [[chronic obstructive pulmonary disease]]
* [[Influenza]]
* [[Acute bronchitis]]
* [[Pertussis]]
* [[Asthma]] with viral infection


==References==
==References==
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[[Category:Disease]]
[[Category:Disease]]
[[Category:Pulmonology]]
[[Category:Pulmonology]]
[[Category:Infectious disease]]
[[Category:Pneumonia|Pneumonia]]
[[Category:Pneumonia|Pneumonia]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:primary care]]

Latest revision as of 21:02, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Pneumonia should be differentiated from other conditions that cause cough, fever, shortness of breath and tachypnea, such as asthma, COPD, CHF, cancer, GERD, and pulmonary emboli.

Differentiating Pneumonia from other Diseases

Differential Diagnosis of Pneumonia [1][2][3]
Disease Findings
Acute bronchitis No infiltrates seen on the CXR.
Asthma Past medical history, no infiltrates seen on chest X Ray.
Bronchiolitis obliterans Should be suspected in patients with pneumonia who do not respond to antibiotics treatment.
Congestive heart failure Bilateral pulmonary edema, shortness of breath.
COPD Past medical history, no infiltrates on chest X Ray, fever is uncommon
Empyema CXR showing features of pleural effusion, inflammatory markers on thoracocentesis.
Endocarditis Finding of septic pulmonary emboli
Gastroesophageal reflux disease (GERD) Normal chest X ray, symptoms worsening during night and associated with meals.
Lung abscess CXR showing signs of lung abscess, such as unilateral and single mass involving posterior segments of the upper lobes, air-fluid levels may be seen.
Lung cancer Weight loss, clear sputum. CT scan and biopsy are helpful in ruling out malignancy.
Pertussis Productive cough for weeks, nasopharyngeal aspirate aids in diagnosis.
Pulmonary embolus A high degree of suspicion should be kept for pulmonary embolus in patients with a sudden onset of chest pain. Chest X ray may be normal. Fever could be present.
Sinusitis Sinus tenderness, post nasal drip.
Vasculitis Systemic manifestations of collagen vascular disease may be seen.

Differential Diagnosis of Community-Acquired Pneumonia Depending on Chest Radiograph
Normal chest X-ray Abormal chest X-ray
Adapted from N Engl J Med 2014; 370:543-551[4]

References

  1. ↑ Schiele F, Muller J, Colinet E, Siest G, Arzoglou P, Brettschneider H; et al. (1992). "Interlaboratory study of the IFCC method for alanine aminotransferase performed with use of a partly purified reference material". Clin Chem. 38 (12): 2365–71. PMID 1458569.
  2. ↑ Castro-Guardiola A, Armengou-Arxé A, Viejo-Rodríguez A, Peñarroja-Matutano G, Garcia-Bragado F (2000). "Differential diagnosis between community-acquired pneumonia and non-pneumonia diseases of the chest in the emergency ward". Eur J Intern Med. 11 (6): 334–339. PMID 11113658.
  3. ↑ Ahnsjö, Sven (1935). "Contribution to the Differential Diagnosis of Pneumonia in Childhood". Acta Paediatrica. 17 (3): 439–446. doi:10.1111/j.1651-2227.1935.tb07697.x. ISSN 0803-5253.
  4. ↑ Solomon, Caren G.; Wunderink, Richard G.; Waterer, Grant W. (2014). "Community-Acquired Pneumonia". New England Journal of Medicine. 370 (6): 543–551. doi:10.1056/NEJMcp1214869. ISSN 0028-4793.
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