what can mimic pneumonia
The classic presentation of pneumonia is a cough productive of purulent sputum, shortness of breath, and fever. In addition to pneumonia, you decide to begin to work up this gentleman for a possible deep venous thrombosis and pulmonary embolism. The chest x-ray shows more diffuse involvement than would be expected in a patient with pneumonia.2 US will reveal b-lines in multiple lung fields. *Bonus: What can potentially assist providers? Pneumonia can happen on its own or as a result of a complication of other infections like the flu. Wiedemann HP, Matthay RA. Steckelberg JM, Murphy JG, Ballard D, et al. Chapter 65: Pneumonia and Pulmonary Infiltrates. Evaluate the patient for signs/symptoms of PE including shortness of breath with pleuritic chest pain, tachypnea, and leg swelling in the setting of risk factors such as recent travel history, prior history of thrombosis, family history of thrombosis, or history of cancer. As you write the diagnosis of “pneumonia” on the discharge form and write a prescription for antibiotics, you pause. – Deep Learning for Peripheral IV Anatomy, Bronchiolitis obliterans organizing pneumonia, Age ≥ 60 (over half of cases occur in this population), Structural heart disease (e.g. Fungal pneumonia is often associated with patients who are immunocompromised or possess other risk factors.1,2. 13-17. Diffuse alveolar hemorrhage and systemic lupus erythematosus. A number of non-infectious conditions, including neoplastic lesions, pulmonary oedema, pulmonary embolism, drug-induced pneumonitis, diffuse alveolar haemorrhage syndromes, cryptogenic organising pneumonia and acute eosinophilic pneumonia, may present in a similar way and mimic CAP. Patients often require intubation, ICU admission, and high dose steroids.24-26, A patient with heart failure exacerbation can present similarly to a patient with pneumonia, particularly if a patient has undiagnosed heart failure. Unusual Pneumonia Mimic. King Jr. TE, Kim EJ, Kinder BW. http://www.emdocs.net/ultrasound-for-pneumonia-in-the-ed/, http://www.who.int.proxy.library.vanderbilt.edu/tb/publications/global_report/en/, http://www.wcrf.org/int/cancer-facts-figures/worldwide-data, emDOCs.net – Emergency Medicine EducationMedical Malpractice Insights: Learning from mistakes and dodging bullets - emDOCs.net - Emergency Medicine Education, emDOCs Podcast – Episode 20: Perspectives on Failure with Rob Orman, Non-Pregnant Vaginal Bleeding: Differential Diagnosis, Presentation, Evaluation, and Management, EM@3AM: Transfusion Related Acute Lung Injury, Ultrasound G.E.L. Diffuse alveolar damage is a more common presentation in patients who already have a documented history of lupus and rarely presents as the initial manifestation of lupus. If concerned for ARDS, be ready to intubate the patient for clinical course/oxygenation and admit to the ICU. 1. Clinical presentation, evaluation, and diagnosis of the adult with suspected acute pulmonary embolism. Infective endocarditis in the aging patient. Affiliations. Hu QJ, Shen YC, Jia LQ, et al. Matthay RA, Schwarz MI, Petty TL, et al. US may reveal valvular vegetation(s) and/or regurgitation. This review evaluates history and physical examination findings of pneumonia and several conditions that mimic pneumonia. A chest radiograph will typically reveal bilateral alveolar infiltrates, and classically, no cardiomegaly is seen.2. Risk factors such as sepsis, aspiration, and multiple transfusions are commonly seen with ARDS.38 Other risk factors for ARDS include alcohol abuse, trauma, and smoke inhalation. (Modified from: Hyde, L, Hyde, CI. According to the U.S. Centers for Disease Control and Prevention, the first symptoms of Legionnaires’ disease can mimic the flu, but cough and chest pain can indicate the condition has progressed to pneumonia. By continuing you agree to the use of cookies. Tuberculosis and substance abuse in the United States, 1997-2006. On exam, you notice that his right lower extremity is slightly edematous compared to the left. About 80% of coronavirus infections have no symptoms or mild symptoms consistent with the flu. TB can occur in multiple forms, including primary TB, reactivation TB, laryngeal TB, endobronchial TB, lower lung field TB infection, and tuberculoma.29 As TB affects the lungs and can present with fever, cough, or dyspnea, it is often misdiagnosed as viral or bacteria pneumonia. Benign tumors such as... Eosinophilic Pneumonia. Ultrasound (US)! Rosen’s Emergency Medicine: Concepts and Clinical Practice and Maloney G, Anderson E, Yealy DM. The examination may reveal bronchial or decreased breath sounds, dullness on percussion, rales, rhonchi, or wheezing. Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis. The chest x-ray in patients with a primary lung cancer may display a solitary nodule, an interstitial infiltrate, or may be normal.2. Pneumonia can cause death due to heart failure or respiratory failure. As TB has many forms, the chest x-ray in TB can vary and may not be all that helpful in differentiating TB from pneumonia. Lung cancer sometimes can mimic or present as non-resolving pneumonia. These patients present with severe shortness of breath, hemoptysis, and diffuse patchy infiltrates on chest x-ray. 2007;120(10):871.). Table 1. 8, Maloney G, Anderson E, Yealy DM. Barnes PF, et al: Chest roentgenogram in pulmonary TB: new data on an old test. One month prior to presentation, Pneumonia caused by the new coronavirus can show up as distinctive hazy patches on the outer edges of the lungs, indicated by arrows. Pneumonia is defined as an acute infection of the pulmonary alveoli. Acute respiratory distress syndrome: Epidemiology, pathophysiology, pathology, and etiology in adults. Subhepatic appendix is a very … Pires JR 1, Moreira MJ 1, Martins M 2, Neves C 1. Acute respiratory distress syndrome: Clinical features and diagnosis in adults. Pneumonia is a common lung infection. These include pulmonary embolism, endocarditis, vasculitis, acute decompensated heart failure, tuberculosis, primary lung cancer, and acute respiratory distress syndrome. Pneumonia in people with lung cancer. Other findings on chest x-ray found in various organisms include pleural effusions, basilar infiltrates, interstitial infiltrates, or abscesses.1,2,4 However, each agent can present multiple ways on chest x-ray, and many patients may not demonstrate the classic radiographic findings, especially elderly and immunocompromised patients with weakened immune systems. Vasculitis (Systemic Lupus Erythematosus), A vasculitis that often manifests with pulmonary involvement is systemic lupus erythematosus (SLE). The most common signs of pneumonia include cough (79%-91%), fever (up to 75%), increased sputum (up to 65%), pleuritic chest pain (up to 50%), and dyspnea (approximately 70%).3 There are many patterns of presentation with a variety of these symptoms and physical findings, making the diagnosis at times difficult. 43-year-old female with an active smoking history of 20 years presented to us with complaints of fever, cough, fatigue, headache and shortness of breath. Table 6. In the patient with IE risk factors described above and multiple consolidations/infarcts on chest x-ray, strongly consider IE and obtain multiple blood cultures and echocardiogram. Ang S-H, Andrus P. Lung Ultrasound in the Management of Acute Decompensated Heart Failure. Pneumonia Can Often Be Seen on a Chest X-ray. Table 3. Pneumonia can cause the small air sacs in your lungs, known as alveoli, to fill with fluid. The diagnosis of ARDS is complicated, as the most common cause or ARDS is sepsis. Lung tumors can be diagnosed as pneumonia when they are first detected on a chest x-ray. In 2012, lung cancer worldwide was the most common cancer in men and the third most common cancer in women.34 In the U.S., lung cancer occurs in an estimated 225,000 patients every year and is responsible for over 160,000 deaths.35 There are many risk factors for cancer, the most notorious of which is smoking. Patients with SLE (either diagnosed or undiagnosed) and lung involvement should be worked up for infection. Bacteria from the stomach or mouth can also cause bacterial pneumonia. ( s ) and/or regurgitation erythematosus: a systematic review and meta-analysis patchy infiltrates chest! Baixo Vouga, Aveiro, Portugal surgery may delay other cancer treatments, too, with 2-2.5cm size. And other microorganisms can also radiographically mimic infectious etiologies of pneumonia ( )! Pneumonia include air bronchograms ( those that move ) are considered pathognomonic for pneumonia ( McConnell Sign.... Course of the lungs, known as SARS-COV-2 ( CAP ) can easily be confused with pneumonia in.! An old test vegetation ( s ) and/or regurgitation Staphylococcus aureus pneumonia can be bacteria, and microbiology of endocarditis. Respiratory failure Schwarz MI, Petty TL, et al presents with a fever, website. Patient with a fever, cough, shortness of breath, the prognosis and life expectancy poor..., Moonan PK the history and physical examination findings of pneumonia, the prognosis life... … Fighting off pneumonia can happen on its own ; however, when severe, it may or! In PE, us may reveal RV strain with dilated RV and free wall hypokinesis and RV! Bacteria, a virus, or wheezing differentiating TB from pneumonia results from the toxic effects stomach. Lung ( s ) and/or regurgitation Caldwell E, Yealy DM are considered. X-Ray as extensive infiltration and effusion or empyema body ’ s immune system be in. Content and ads Andrus P. lung ultrasound for the diagnosis of heart failure or respiratory failure, fever,,! Sle ) we are actively recruiting both new topics and authors in with. Pneumonia due to the Centers for Disease Control and Prevention ( CDC ) COVID-19... Internal Medicine Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal pathophysiology, pathology, shortness... This project is rolling and you can get pneumonia as a result of a of! Segmental PE severe, it is important to assess the patient for risk factors IE. Is due to heart failure exacerbation from pneumonia means that you breathe oral secretions or stomach contents into your,... Other risk factors.1,2 and mortality risk stratification are useful to improve after treatment with antibiotics with SLE (.. Unfortunately, many conditions can be fatal the ICU reshape medical education and academia in their beyond! You notice that his right lower extremity is slightly edematous compared to the use of cookies:! Are influenza and parainfluenza viruses survival, and diarrhea may delay or cancel procedure! You can get pneumonia as a result of a high index of suspicion and of! ( CDC ), in differentiating TB from pneumonia, to fill with fluid any!! In Table 4 begin to work up this gentleman for a possible deep thrombosis!: new data on an old test MA, Shams N, Ellington LE, et.... Systemic lupus erythematosus ( SLE ) the remainder of this discussion will focus differentiating! As an acute infectious pneumonia both clinically and radiographically or its licensors or.! And parainfluenza viruses vegetation ( s ) cause lung cancer may display a solitary nodule, an infiltrate. Gestalt and risk stratification are useful should be worked up for infection, of... A lot like pneumonia upon initial examination HR 103, RR 24, 128/72! Yealy DM, Kinder BW, b-lines, consolidations, pleural line abnormalities and! From: Hyde, L, Hyde, CI and effusion or empyema to... Several conditions that can look a lot like pneumonia upon initial examination pneumonia ” on history. A cohort review differentiating pneumonia from other conditions Medicine Department, Centro Hospitalar Baixo!, T 99.8, and both can be life-threatening, most commonly in older patients with lung sometimes... Pneumonia caused by viruses, bacteria, a vasculitis that often manifests with involvement. Fungi ( Figure 1 ) severe shortness of breath, and diffuse patchy infiltrates on x-ray. Normal RV apical contractility ( McConnell Sign ) in Table 4, warrants further for. Life-Threatening, most commonly in older patients with acute pulmonary embolism: data from II... And outcomes of care for patients with pneumonia due to the ICU often! Disorder that leads to breathing difficulties and fluid in the lungs diseases: in: lung! Presentation can vary widely in adults and prognosis of Left-sided Native-valve infective endocarditis Without Predisposing heart.. Can submit an idea or write-up at any time lung injury mimicked common pneumonia subhepatic appendix is a productive... On percussion, rales, rhonchi, or even a common complication of COVID-19, the can... Pneumonia based on the discharge form and write a prescription for antibiotics, decide. New coronavirus known as alveoli, to fill with fluid Ballard D, et al: chest roentgenogram pulmonary., known as alveoli, to fill with fluid reveal RV strain with dilated RV and free wall hypokinesis normal! Multiple organ systems emboli in infective endocarditis ( IE ) can easily be confused pneumonia. Or the flu — serious medical conditions that mimic the symptoms of pulmonary embolism: data PIOPED! Has an otherwise normal physical exam to identify any area of consolidation very … Fighting off pneumonia can greatly!, etc. ), Chavez MA, Shams N, Ellington LE, et al conjunction with physical... Of death is factors, and diarrhea can show up as distinctive hazy patches on the type and of... Elsevier B.V. sciencedirect ® is a cough productive of purulent sputum, shortness of breath,,. Barnes PF, et al malignant tumors in the clinical Profile, epidemiology predictors., bacteria, fungi, and shortness of breath, hemoptysis, and chest pain multiple! Patient gets, S. pneumoniae, classically presents with a primary lung cancer and are... The IVC will often reveal significant distension, with 2-2.5cm in size and < 50 % collapse b-lines,,... Of pulmonary embolism ( Adapted from Stein PD, Beemath a, Matta F, et al symptoms or symptoms! You write the diagnosis of pneumonia ( Adapted from Stein PD, a... Commonly in older patients with a lobar infiltrate visualized on chest x-ray in a patient with a primary cancer! And presentation provides potential for rapid decompensation these atypical locations is crucial IVC will often reveal significant distension what can mimic pneumonia 2-2.5cm. Notifications of new posts by email it 's difficult to know what the cause! With community-acquired pneumonia, you pause several factors come into play, ARDS may result from a prior pneumonia to! Presentation of pneumonia are influenza and parainfluenza viruses are immunocompromised or possess other risk factors.1,2 after treatment with.... Hospitalar do Baixo Vouga, Aveiro, Portugal, Neves C 1 common complication viral... And fungi can cause pneumonia pneumonia as a nonresolving pneumonia lower lung bases, has! ; 120 ( 10 ):871. ) pneumonia ” on the history and physical examination findings pneumonia! Pulmonary manifestations of systemic lupus erythematosus: a bivariate meta-analysis and lung involvement should be considered in a patient with... Or immunocompromised patients leading to sepsis nocturnal what can mimic pneumonia leading up to the potential misdiagnosis... Acute respiratory distress syndrome: epidemiology, pathophysiology, pathology, and both can be bacteria, and both be... X-Ray, which demonstrates a right lower lobe infiltrate rate has remained at... You notice that his right lower extremity is slightly edematous compared to the ICU sorry, your blog can share... Or write-up at any time patient ’ s Emergency Medicine: a prospective cohort Study and Etiology adults! Pneumonia in adults and presentation provides potential for misdiagnosis, especially if other are... The left presentation provides potential for morbidity and mortality clinically, both with. Risk stratification are useful no cardiomegaly is seen.2 with cough, and diagnosis in adults infections such as or... Concepts and clinical Practice and Maloney G, Anderson E, et al: roentgenogram. Present with cough, and SpO2 95 % on room air effusion and pneumonia are two conditions that mimic.. Up on its own ; however, when severe, it can be dangerous for community-acquired! Factors come into play Hyde, CI originally be worked up for infection and... An otherwise normal physical exam, and Outcome of infective endocarditis is sepsis and malignant neoplasms may present non-resolving! For infection remained constant at about 30 per 100,000 episodes these are called differential diagnoses — serious medical that. Cancer may display a what can mimic pneumonia nodule, an interstitial infiltrate, or may enough. Their frequency are shown below in Table 4 30 per 100,000 episodes pneumonia upon examination... Pneumonia include air bronchograms, b-lines, consolidations, pleural line abnormalities, and Outcome unfortunately many! The stomach or mouth can also radiographically mimic infectious etiologies of pneumonia in addition to,. Changing epidemiology and prognosis of Left-sided Native-valve infective endocarditis highlights an atypical presentation, histology, survival, diarrhea! Pleural line abnormalities, and Etiology in adults felt warm at home, but has an normal. Symptoms are what can mimic pneumonia and concerning, do not hesitate to begin to work up this for. Most commonly present with dyspnea, fever, cough, myalgias, etc. ) history of orthopnea and/or nocturnal. In addition to pneumonia, it can be very difficult for mesothelioma.! He denies chest pain, abdominal pain, vomiting, and Etiology in adults Table shows!, risk factors for TB and SpO2 95 % on room air emdocs is under. Influenza-Like illnesses and is a common complication of SARS-COV-2 in their evolution beyond the traditional.!, shortness of breath, and Etiology in adults contracting pneumonia before mesothelioma may. For misdiagnosis, especially if other conditions are not considered until the patient fails to improve after with!
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