Community-acquired pneumonia differential diagnosis

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

Differentiating Pneumonia From Other Diseases

• Acute bronchitis - No infiltrates on the CXR.
• Asthma- No infiltrates on the CXR.
• 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.
• Chronic obstructive pulmonary disease - No infiltrates on the CXR.
• Empyema - Pleural effusions on the CXR; positive inflammatory markers on pleural fluid anaylsis.
• Endocarditis with septic pulmonary emboli
• Gastroesophageal reflux disease - Normal CXR, symptoms worsen at night.
• Influenza
• Lung abscess - CXR showing signs of lung abscess.
• Malignancy - 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. CXR may be insiginificant.
• Sinusitis - Sinus tenderness, post-nasal drip.
• Upper respiratory tract infection
• 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
Acute exacerbation of chronic obstructive pulmonary disease Influenza Acute bronchitis Pertussis Asthma with viral infection	Congestive heart failure accompanied by viral infection Aspiration pneumonia Pulmonary infarction Acute exacerbation of pulmonary fibrosis Acute exacerbation of bronchiectasis Acute eosinophilic pneumonia Hypersensitivity pneumonitis Pulmonary vasculitis Cocaine-induced lung injury
Adapted from N Engl J Med 2014; 370:543-551