Community-acquired pneumonia differential diagnosis

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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

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
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