According to the Centers for Disease Control and Prevention (CDC), COVID-19 is a respiratory illness. World Health Organization. X-ray has a sensitivity of 46-77% in diagnosing pneumonia. Pneumonia is the sixth leading cause of death and tends to be more prevalent and severe in the elderly.17, 28 It is estimated that there are more than 3 million episodes of pneumonia in the United States per year, with more than half of patients being treated as outpatients, resulting in annual costs of $23 billion. Infective endocarditis (IE) can easily be confused with pneumonia in a patient presenting with fever and dyspnea or chest pain. Rubenfeld GD, Caldwell E, Peabody E, et al. Hu QJ, Shen YC, Jia LQ, et al. Epidemiology, risk factors, and microbiology of infective endocarditis. 2014;7(1):115-21. This review evaluates history and physical examination findings of pneumonia and several conditions that mimic pneumonia. A PE most commonly has non-specific chest x-ray findings (atelectasis, pleural effusion, peripheral infarct/consolidation, elevated hemidiaphragm) or is normal.2 That being said, while a normal chest x-ray is helpful in distinguishing PE from pneumonia, a normal chest x-ray does not definitively exclude pneumonia or pulmonary embolism. Diagnosis includes the Duke Criteria. Pneumonia in people with lung cancer. Matthay RA, Schwarz MI, Petty TL, et al. Contact us at editors@emdocs.net. Usually, it is said that death is due to complications from pneumonia. About 80% of coronavirus infections have no symptoms or mild symptoms consistent with the flu. 2007;120(10):871.). Ang S-H, Andrus P. Lung Ultrasound in the Management of Acute Decompensated Heart Failure. emDOCs subscribes to the Free Open Access Meducation. Pleural effusion is actually a complication of many illnesses that directly or indirectly exert an adverse impact on the airways and lung parenchyma whereas pneumonia is one such illness that can give rise to pleural effusion. Dynamic air bronchograms (those that move) are considered pathognomonic for pneumonia. Maintenance of a high index of suspicion and knowledge of these atypical locations is crucial. This has been described in 13 to 44% of patients with IE.18,19 Septic emboli can lead to damage in the systemic or pulmonary artery circulation, depending on left vs. right-sided disease. Infective endocarditis (IE) can easily be confused with pneumonia in a patient presenting with fever and dyspnea or chest pain. Sexton DJ. Needless to say that a ZN stain to look repeatedly for acid fast bacilli will be vital in ruling out TB which can mimic many of the pneumonias in presentation. However, it is often challenging to differentiate between these in the ED, and many patients will not have an etiologic agent identified even after inpatient evaluation. In PE, US may reveal RV strain with dilated RV and free wall hypokinesis and normal RV apical contractility (McConnell Sign). Clinical Presentation, Etiology and Outcome of Infective Endocarditis in the 21. Complications and outcome of infective endocarditis. Would you like to contribute? Thompson BT. Clinical manifestations and diagnosis of heart failure with preserved ejection fraction. MacCallum NS, Evans TW. [. Address reprint requests to Michael Lippmann, MD, Albert Einstein Medical Center, 5401 Old York Road, Klein #363, Philadelphia, PA 19141. valvular or congenital), Marx JA. This wide variation in symptoms and presentation provides potential for misdiagnosis, especially if other conditions are not considered. Am J Med. The expertise of the micro biologist and recent antibiotic therapy will also play a key role in the final outcome of a gram stain examination. Castillo FJ, Anguita M, Castillo JC, et al. The patient with ARDS will appear sick and will likely require high levels of FiO2 or positive pressure ventilation if not intubated, while the severity of pneumonia varies greatly based on the patient and infectious microbe. The remainder of this discussion will focus on differentiating each of these from pneumonia. Steckelberg JM, Murphy JG, Ballard D, et al. Copyright © 2021 Elsevier B.V. or its licensors or contributors. Patients with acute decompensated heart failure most commonly present with cough, shortness of breath, fatigue, and/or peripheral edema. It is therefore more precise to use the term nonresolving pneumonia syndrome when approach-ing these cases, since a nonresolving pneumonia These patients often have nonspecific EKGs showing left-ventricular hypertrophy, bundle branch block, or signs of a previous MI such as prominent Q waves or T wave inversions. Pneumonia can be dangerous for … Bacteria from the stomach or mouth can also cause bacterial pneumonia. Int J Clin Exp Med. Hampton’s Hump (peripheral wedge-shaped opacity with base against pleural surface) and Westermark’s Sign (focus of oligemia and vessel collapse distal to the PE) are classic findings in the PE radiograph, but they lack sensitivity. Discussion with the oncology service is advised. Pneumonia is a lung infection that leads to breathing difficulties and fluid in the lungs. Dellaripa PF, Danoff Sonye. McGraw Hill Professional 2016. Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II. Table 3. US may reveal valvular vegetation(s) and/or regurgitation. Table 2. The chest x-ray in patients with a primary lung cancer may display a solitary nodule, an interstitial infiltrate, or may be normal.2. You order a chest x-ray, which demonstrates a right lower lobe infiltrate. Siegel MD. Acute lupus pneumonitis can closely mimic an acute infectious pneumonia both clinically and radiographically. 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. The history and physical exam may be enough to differentiate a heart failure exacerbation from pneumonia. In summary, TB should be suspected in a patient with vague symptoms who possesses risk factors for TB, particularly in patients who are homeless, immunosuppressed, have a history of drug use, or have recently traveled to a TB endemic area. Lung tumors can be diagnosed as pneumonia when they are first detected on a chest x-ray. Lung cancer and pneumonia have similar symptoms, and both can be fatal. It is estimated that a microbial agent cannot be identified in nearly half of cases of CAP.1 The “typical” pathogens in patients hospitalized with pneumonia include S. pneumoniae and H. influenza, with S. pneumoniae being the most common. Fighting off pneumonia can be very difficult for mesothelioma patients. The diseases that COVID-19 pneumonia may mimic can be broadly classified as infectious or non-infectious diseases (pulmonary edema, hemorrhage, neoplasms, organizing pneumonia, pulmonary alveolar proteinosis, sarcoidosis, pulmonary infarction, interstitial lung diseases, and aspiration pneumonia). emDocs is licensed under a Creative Commons Attribution 4.0 International License. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 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. Author information. A chest x-ray in a person with pneumonia does not always have the characteristic “infiltrate” early in the course of the illness. There are several dangerous medical conditions that can look a lot like pneumonia upon initial examination. Unfortunately, many of these diagnoses are not even considered in a patient with a classic presentation for pneumonia until the patient fails to improve with initial antibiotic management. As the presentation of PE is nonspecific, clinical gestalt and risk stratification are useful. Multiple other infective and non-infective conditions can mimic community-acquired pneumonia, leading to misdiagnosis in 5–17% of cases. Physical exam may reveal an S3 or S4 heart sound, elevated jugular venous pressures, lower extremity edema, and crackles indicating interstitial pulmonary edema on auscultation of the lungs. Viral pneumonia is a common complication of influenza-like illnesses and is a complication of SARS-COV-2. In addition to pneumonia, you decide to begin to work up this gentleman for a possible deep venous thrombosis and pulmonary embolism. Sorry, your blog cannot share posts by email. Fungal pneumonia is often associated with patients who are immunocompromised or possess other risk factors.1,2. Notify me of follow-up comments by email. His vital signs include HR 103, RR 24, BP 128/72, T 99.8, and SpO2 95% on room air. with the risk factors shown in Table 4, warrants further evaluation for IE. Horsburgh CR. Are there other diagnoses you should consider? The most common identified viral causes of pneumonia are influenza and parainfluenza viruses. We summarize the Risk factors for IE are shown below in Table 4. Overview of acute pulmonary embolism in adults. Barnes PF, et al: Chest roentgenogram in pulmonary TB: new data on an old test. Again, the chest x-ray may demonstrate multiple infarcts or consolidations. Symptoms of lung cancer at presentation. Benign and malignant neoplasms may present as a nonresolving pneumonia. One of the most important aspects to not miss is the patient with multiple infiltrates on chest x-ray, as a dreaded complication of IE is septic emboli. Tuberculosis and substance abuse in the United States, 1997-2006. The inflammation comes from the toxic effects of stomach acid and enzymes on lung tissue. The most common cause of pneumonia, S. pneumoniae, classically presents with a lobar infiltrate visualized on chest x-ray. As a result, when pneumonia fails to respond to treatment, the question becomes whether or not the diagnosis of pneumonia is even correct, since many conditions can mimic pneu-monia. World Cancer Research Fund International. Hill EE, Herijgers P, Claus P. Infective endocarditis: changing epidemiology and predictors of 6-month mortality: a prospective cohort study. Diagnosis includes the Duke Criteria. malar rash, oral ulcers, polyserositis, renal insufficiency, cytopenia, thrombophilia, lymphadenopathy, splenomegaly, or arthritis) and signs of lung involvement warrants treatment for infection and worsening vasculitis. Elderly or debilitated patients in particular can present with non-specific complaints, such as altered mental status without the classic symptoms.1,2 In addition, pneumonia may cause lightheadedness, malaise, weakness, headache, nausea/vomiting, joint pain, and rash. 8th ed. Chemotherapy can weaken the body’s immune system. Pleural effusion and pneumonia are two conditions that affect our respiratory system. 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. Chapter 65: Pneumonia and Pulmonary Infiltrates. When considering ARDS, several factors come into play. 68, 69 Pulmonary PTLD can also radiographically mimic infectious etiologies of pneumonia. 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. Bacteria, viruses, and fungi cause pneumonia. You have a full waiting room and multiple patients who have been roomed but not seen. 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. The diseases that COVID-19 pneumonia may mimic can be broadly classied as infectious or non-infectious diseases (pulmonary edema, hemorrhage, neoplasms, organizing pneumonia, pulmonary alveolar proteinosis, sarcoidosis, pulmonary infarction, interstitial lung diseases, and aspiration pneumonia). 2014;15:50. Unfortunately, many of these conditions are not considered until the patient fails to improve after treatment with antibiotics. US has demonstrated tremendous utility differentiating pneumonia from other conditions. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. NONRESOLVING PNEUMONIA AND MIMICS OF PNEUMONIA. Hansen-Flaschen J, Siegel MD. 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. Bronchial Neoplasms. Pneumonia is a very serious health condition that should be treated by a doctor as it can be fatal or land you in the hospital for extended periods of time. Emboli in infective endocarditis: the prognostic value of echocardiography. 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