Differential diagnosis project

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

Instructions

Differentiating Legionnaires' disease from other diseases

The following conditions must be considered in the differential diagnosis of Legionnaires' disease: DDx [1][2][3][4][5][6][7]
  • Acute interstitial pneumonia DDx
  • Mycoplasma pneumonia DDx
  • Pneumococcal pneumonia DDx
  • Pneumocystis carinii pneumonia DDx
  • Pulmonary embolism DDx
  • Streptococcal pneumonia DDx
  • Viral pneumonia DDx

Findings suggestive of Legionnaires' disease

Clinical manifestations

  • High grade fever
  • Dry cough
  • Progressive dyspnea
  • Bronchial breath sounds
  • Adult respiratory distress syndrome

Laboratory abnormalities

  • Legionella urinary antigen positive
  • Alveolar consolidation on chest radiograph
  • Lobar consolidation on chest radiograph

Findings suggestive of Acute interstitial pneumonia

Clinical manifestations

  • Dry cough
  • Progressive dyspnea
  • Adult respiratory distress syndrome

Laboratory abnormalities

  • Disseminated consolidation on chest radiograph
  • Interstitial infiltrate on chest radiograph
  • Increased uptake on Gallium scan

Findings suggestive of Mycoplasma pneumonia

Clinical manifestations

  • Dry cough
  • Pleuritic chest pain
  • Inflammed, opaque, hypomobile tympanic membrane
  • Bronchial breath sounds

Laboratory abnormalities

  • Lymphocytosis
  • Cold agglutinins positive
  • Alveolar consolidation on chest radiograph
  • Interstitial infiltrate on chest radiograph
  • Lobar consolidation on chest radiograph

Findings suggestive of Pneumococcal pneumonia

Clinical manifestations

  • Hemoptysis
  • Fine rales
  • Pleuritic chest pain
  • Increased breath sounds
  • Bronchial breath sounds
  • Dullness on chest percussion
  • Purulent sputum
  • Shallow respiration
  • Pectoriloquy
  • Increased tactile fremitus
  • Productive cough
  • Egophony
  • High grade fever

Laboratory abnormalities

  • Pleural effusion (exudative)
  • Respiratory alkalosis
  • Parenchymal hyperlucency on chest radiograph
  • Increased uptake on Gallium scan
  • Unilateral diaphragm elevation on chest radiograph
  • Alveolar consolidation on chest radiograph
  • Lobar consolidation on chest radiograph
  • Gram positive diplococci on sputum Gram stain

Findings suggestive of Pneumocystis carinii pneumonia

Clinical manifestations

  • Immunosuppressive state
  • Mediastinal emphysema
  • Subcutaneous emphysema
  • Hacking cough
  • Progressive dyspnea

Laboratory abnormalities

  • Respiratory alkalosis
  • Serum beta-D-glucan elevated
  • Alveolar consolidation on chest radiograph
  • Lobar consolidation on chest radiograph
  • Interstitial infiltrate on chest radiograph

Findings suggestive of Pulmonary embolism

Clinical manifestations

  • Calf pain / swelling
  • Decreased pulse pressure
  • Dyspnea with normal chest X-ray
  • Hemoptysis
  • Hyperventilation
  • Immobility
  • Increased pulmonic component of heart sound
  • Pleuritic chest pain
  • Prior DVT
  • Pulmonary hypertension
  • Right ventricular heave
  • Right ventricular hypertrophy
  • Right-to-left shunt
  • Substernal chest pain
  • Tachypnea
  • Thrombophlebitis
  • Unilateral lower extremity edema
  • Venous stasis

Laboratory abnormalities

  • Atrial fibrillation
  • Bone fracture
  • Atelectasis on chest radiograph
  • Lobar consolidation on chest radiograph
  • Prominent pulmonary artery on chest radiograph
  • Hampton's hump on chest radiograph
  • D-dimer elevated
  • Right ventricular enlargement on echocardiography
  • Thrombus on echocardiography
  • Hypocapnia
  • Hypoxia
  • Segmental perfusion defect on lung scan
  • V/Q mismatch on lung scan
  • Pleural effusion (exudative / bloody)
  • RVH on ECG
  • Right axis deviation on ECG

Findings suggestive of Streptococcal pneumonia

Clinical manifestations

  • Pectoriloquy
  • Bronchial breath sounds
  • Empyema
  • Erythema nodosum
  • Purulent sputum
  • Shallow respiration
  • Increased tactile fremitus
  • Pleuritic chest pain
  • Egophony

Laboratory abnormalities

  • Respiratory alkalosis
  • Pleural effusion (exudative)
  • Increased uptake on Gallium scan
  • Gram-positive cocci in chains on sputum Gram stain
  • Alveolar consolidation on chest radiograph
  • Lobar consolidation on chest radiograph

Findings suggestive of Viral pneumonia

Clinical manifestations

  • Pleuritic chest pain
  • Bronchial breath sounds
  • Influenza
  • Fine rales
  • Bronchovesicular breath sounds

Laboratory abnormalities

  • Lymphocytosis
  • Respiratory alkalosis
  • Lobar consolidation on chest radiograph
  • Interstitial infiltrate on chest radiograph
  1. Ferri, Fred (2011). Ferri's differential diagnosis: a practical guide to the differential diagnosis of symptoms, signs, and clinical disorders. Philadelphia, PA: Elsevier/Mosby. ISBN 978-0323076999.
  2. Siegenthaler, Walter (2007). Differential diagnosis in internal medicine: from symptom to diagnosis. Stuttgart New York: Thieme. ISBN 978-1588905512.
  3. Mesko, Dusan (2002). Differential diagnosis by laboratory medicine: a quick reference for physicians. Berlin New York: Springer-Verlag. ISBN 978-3540430575.
  4. Reeder and Felson's gamuts in radiology: comprehensive lists of roentgen differential diagnosis. Place of publication not identified: Springer. 2014. ISBN 978-1475781229.
  5. Burgener, Francis (2008). Differential diagnosis in conventional radiology. Stuttgart New York: Thieme. ISBN 978-1588902757.
  6. Gattuso, Paolo (2015). Differential diagnosis in surgical pathology. Philadelphia, PA: Saunders/Elsevier. ISBN 978-1455770137.
  7. "DXplain".