COVID-19-associated pneumonia differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usman Ali Akbar, M.B.B.S.[2]

Overview

COVID-19-associated pneumonia should be differentiated from other Diseases.

Differentiating COVID-19-associated pneumonia from other Diseases

• COVID-19-associated pneumonia should be diffrentiated from other Diseases.

Differential Diagnosis of COVID-associated Pneumonia

Disease	Findings
COVID-19 associated pneumonia	COVID-19 associated pneumonia can be classified from other viral pneumonia caused based on history of exposure to COVID-19, positive SARS-CoV-2 PCR, dyspnea, fever, cough, expectoration and uncommon associated findings like diarrhea, headache,vomiting and myalgias. Chest X-ray and other imaging modalities can further help us differentiate COVID-19 associated pneumonia from other causes. Chest X-ray usually shows bilateral, almost symmetrical areas of peripheral consolidation with perihilar infiltrates, and an indistinct left heart border. CT-scan chest may show classical appearances of sub-pleural organizing areas of consolidation with patchy peripheral ground-glass opacities.
Acute bronchitis	No infiltrates seen on the chest X-ray.
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 are worse at night and associated with meals.
Lung abscess	Chest X-ray shows signs of lung abscess.
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. A chest X-ray may be normal.
Sinusitis	Sinus tenderness Post-nasal drip
Vasculitis	Systemic manifestations of collagen vascular disease may be seen.