COVID-19-associated pneumonia differential diagnosis

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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[1][2][3][4]
  • 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
COPD
  • Past medical history
  • No infiltrates on chest X-ray
  • Fever is uncommon.
Empyema
Endocarditis
Gastroesophageal reflux disease (GERD)
  • Normal chest X-ray
  • Symptoms are worse at night and associated with meals.
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

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.