Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Pediatric Pneumonia Differential Diagnoses

  • Author: Nicholas John Bennett, MBBCh, PhD, MA(Cantab), FAAP; Chief Editor: Russell W Steele, MD  more...
 
Updated: Jun 30, 2016
 
 

Diagnostic Considerations

Pneumonia can occur at any age, although it is more common in younger children. Different age groups tend to be infected by different pathogens, which affects diagnostic and therapeutic decisions.

Many patients referred for evaluation for recurrent pneumonia are diagnosed with asthma. In emergency department studies, 35% of children with an asthma exacerbation have abnormalities visible on chest radiographs. In a child not yet diagnosed with asthma, these abnormalities are frequently interpreted as pneumonia. Inflammation, often triggered by viral infection, is part of the asthmatic response. Wheezing responsive to bronchodilators, a history of atopy, a family history of asthma, and a history of cough or wheeze with exercise may be helpful in identifying these patients.

Consider any other diseases that may present with respiratory dysfunction in the first 24 hours of life. Keep in mind that any of the conditions listed below may also have superimposed pneumonia:

  • Alveolar-capillary dysplasia
  • Arrhythmia
  • Asphyxia
  • Bronchial duplication
  • Chest wall injury or anomaly
  • Choanal atresia
  • Chylothorax
  • Diaphragmatic eventration
  • Heart block
  • Intracranial hemorrhage
  • Laryngeal cleft
  • Laryngeal nerve injury
  • Mutation of ABCA3 gene (for surfactant phospholipid transport)
  • Neuromuscular disorders
  • Phrenic nerve injury
  • Pulmonary hemorrhage
  • Pulmonary hypoplasia
  • Pulmonary lymphangiectasia
  • Spinal injury
  • Surfactant-related protein B deficiency
  • Tachycardia syndromes
  • Tracheoesophageal fistula
  • Transplacental medications
  • Vascular catheter accident
  • Other causes of airway obstruction
  • Other congenital heart diseases
  • Other inborn errors of metabolism
  • Other neuromuscular diseases

A careful history and examination in patients with recurrent pneumonia are helpful to further narrow the differential diagnosis. However, more testing is often needed to confirm most of these diagnoses and is generally outside the scope of a primary care provider.

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Nicholas John Bennett, MBBCh, PhD, MA(Cantab), FAAP Assistant Professor of Pediatrics, Co-Director of Antimicrobial Stewardship, Medical Director, Division of Pediatric Infectious Diseases and Immunology, Connecticut Children's Medical Center

Nicholas John Bennett, MBBCh, PhD, MA(Cantab), FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics

Disclosure: Received research grant from: Cubist Pharmaceuticals, Durata Therapeutics, and Biota Pharmaceutical<br/>Received income in an amount equal to or greater than $250 from: HealthyCT insurance<br/>Medico legal consulting for: Various.

Coauthor(s)

Joseph Domachowske, MD Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa

Disclosure: Received research grant from: Pfizer;GlaxoSmithKline;AstraZeneca;Merck;American Academy of Pediatrics<br/>Received income in an amount equal to or greater than $250 from: Sanofi Pasteur;Astra Zeneca;Novartis<br/>Consulting fees for: Sanofi Pasteur; Novartis; Merck; Astra Zeneca.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Leslie L Barton, MD Professor Emerita of Pediatrics, University of Arizona College of Medicine

Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Heidi Connolly, MD Associate Professor of Pediatrics and Psychiatry, University of Rochester School of Medicine and Dentistry; Director, Pediatric Sleep Medicine Services, Strong Sleep Disorders Center

Disclosure: Nothing to disclose.

Brent R King , MD, MMM Clive Nancy and Pierce Runnells Distinguished Professor of Emergency Medicine; Professor of Pediatrics, University of Texas Health Science Center at Houston; Chair, Department of Emergency Medicine, Chief of Emergency Services, Memorial Hermann Hospital and LBJ Hospital

Disclosure: Nothing to disclose.

Jeff L Myers, MD, PhD Chief, Pediatric and Congenital Cardiac Surgery, Department of Surgery, Massachusetts General Hospital; Associate Professor of Surgery, Harvard Medical School

Disclosure: Nothing to disclose.

Mark I Neuman, MD, MPH Assistant Professor of Pediatrics, Harvard Medical School; Attending Physician, Division of Emergency Medicine, Children's Hospital Boston

Mark I Neuman, MD, MPH is a member of the following medical societies: Society for Pediatric Research

Disclosure: Nothing to disclose.

José Rafael Romero, MD Director of Pediatric Infectious Diseases Fellowship Program, Associate Professor, Department of Pediatrics, Combined Division of Pediatric Infectious Diseases, Creighton University/University of Nebraska Medical Center

José Rafael Romero, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, New York Academy of Sciences, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Manika Suryadevara, MD Fellow in Pediatric Infectious Diseases, Department of Pediatrics, State University of New York Upstate Medical University

Disclosure: Nothing to disclose.

Isabel Virella-Lowell, MD Department of Pediatrics, Division of Pulmonary Diseases, Pediatric Pulmonology, Allergy and Immunology

Disclosure: Nothing to disclose.

Garry Wilkes, MBBS, FACEM Director of Emergency Medicine, Calvary Hospital, Canberra, ACT; Adjunct Associate Professor, Edith Cowan University, Western Australia

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Grace M Young, MD Associate Professor, Department of Pediatrics, University of Maryland Medical Center

Disclosure: Nothing to disclose.

References
  1. Boggs W. Point-of-Care Ultrasound Diagnoses Pneumonia in Children. Medscape Medical News. December 10, 2012. Available at http://www.medscape.com/viewarticle/775961. Accessed: January 9, 2013.

  2. Shah VP, Tunik MG, Tsung JW. Prospective Evaluation of Point-of-Care Ultrasonography for the Diagnosis of Pneumonia in Children and Young Adults. Arch Pediatr Adolesc Med. 2012 Dec 10. 1-7. [Medline].

  3. Metinko AP. Neonatal pulmonary host defense mechanisms. Polin RA, Fox WW, eds. Fetal and Neonatal Physiology. 3rd ed. Philadelphia, Pa: WB Saunders Co; 2004. 1620-73.

  4. Barnett ED, Klein JO. Bacterial infections of the respiratory tract. Remington JS, Klein JO, eds. Infectious Diseases of the Fetus and Newborn Infant. 6th ed. Philadelphia, Pa: Elsevier Saunders Co; 2006. 297-317.

  5. Bone RC, Grodzin CJ, Balk RA. Sepsis: a new hypothesis for pathogenesis of the disease process. Chest. 1997 Jul. 112(1):235-43. [Medline].

  6. Michelow IC, Olsen K, Lozano J, Rollins NK, Duffy LB, Ziegler T, et al. Epidemiology and clinical characteristics of community-acquired pneumonia in hospitalized children. Pediatrics. 2004 Apr. 113(4):701-7. [Medline].

  7. Stoll BJ, Hansen NI, Higgins RD, Fanaroff AA, Duara S, Goldberg R, et al. Very low birth weight preterm infants with early onset neonatal sepsis: the predominance of gram-negative infections continues in the National Institute of Child Health and Human Development Neonatal Research Network, 2002-2003. Pediatr Infect Dis J. 2005 Jul. 24(7):635-9. [Medline].

  8. Mishaan AM, Mason EO Jr, Martinez-Aguilar G, Hammerman W, Propst JJ, Lupski JR, et al. Emergence of a predominant clone of community-acquired Staphylococcus aureus among children in Houston, Texas. Pediatr Infect Dis J. 2005 Mar. 24(3):201-6. [Medline].

  9. Kotecha S, Hodge R, Schaber JA, Miralles R, Silverman M, Grant WD. Pulmonary Ureaplasma urealyticum is associated with the development of acute lung inflammation and chronic lung disease in preterm infants. Pediatr Res. 2004 Jan. 55(1):61-8. [Medline].

  10. Katz B, Patel P, Duffy L, Schelonka RL, Dimmitt RA, Waites KB. Characterization of ureaplasmas isolated from preterm infants with and without bronchopulmonary dysplasia. J Clin Microbiol. 2005 Sep. 43(9):4852-4. [Medline]. [Full Text].

  11. Heggie AD, Bar-Shain D, Boxerbaum B, Fanaroff AA, O'Riordan MA, Robertson JA. Identification and quantification of ureaplasmas colonizing the respiratory tract and assessment of their role in the development of chronic lung disease in preterm infants. Pediatr Infect Dis J. 2001 Sep. 20(9):854-9. [Medline].

  12. Ballard HO, Bernard P, Whitehead V, et al. Determining the incidence of Ureaplasma spp. and its role in development of bronchopulmonary dysplasia. [Abstract 3858.111]. Pediatric Academic Societies Meeting 2009. Baltimore, MD. May 3, 2009. aps-spr.org. Available at http://www.abstracts2view.com/pas/view.php?nu=PAS09L1_3037. Accessed: November 5, 2010.

  13. Tsolia MN, Psarras S, Bossios A, Audi H, Paldanius M, Gourgiotis D, et al. Etiology of community-acquired pneumonia in hospitalized school-age children: evidence for high prevalence of viral infections. Clin Infect Dis. 2004 Sep 1. 39(5):681-6. [Medline].

  14. Nascimento-Carvalho CM, Ribeiro CT, Cardoso MR, Barral A, Araújo-Neto CA, Oliveira JR, et al. The role of respiratory viral infections among children hospitalized for community-acquired pneumonia in a developing country. Pediatr Infect Dis J. 2008 Oct. 27(10):939-41. [Medline].

  15. Juvén T, Mertsola J, Waris M, Leinonen M, Meurman O, Roivainen M, et al. Etiology of community-acquired pneumonia in 254 hospitalized children. Pediatr Infect Dis J. 2000 Apr. 19(4):293-8. [Medline].

  16. [Guideline] American Academy of Pediatrics Committee on Infectious Diseases. Recommended childhood and adolescent immunization schedules--United States, 2009. Pediatrics. 2009 Jan. 123(1):189-90. [Medline].

  17. Tajima T, Nakayama E, Kondo Y, Hirai F, Ito H, Iitsuka T, et al. Etiology and clinical study of community-acquired pneumonia in 157 hospitalized children. J Infect Chemother. 2006 Dec. 12(6):372-9. [Medline].

  18. Thomson J, Hall M, Ambroggio L, Stone B, Srivastava R, Shah SS, et al. Aspiration and Non-Aspiration Pneumonia in Hospitalized Children With Neurologic Impairment. Pediatrics. 2016 Feb. 137 (2):1-10. [Medline].

  19. Denny FW, Clyde WA Jr. Acute lower respiratory tract infections in nonhospitalized children. J Pediatr. 1986 May. 108(5 Pt 1):635-46. [Medline].

  20. Thompson WW, Shay DK, Weintraub E, Brammer L, Bridges CB, Cox NJ, et al. Influenza-associated hospitalizations in the United States. JAMA. 2004 Sep 15. 292(11):1333-40. [Medline].

  21. Black SB, Shinefield HR, Ling S, Hansen J, Fireman B, Spring D, et al. Effectiveness of heptavalent pneumococcal conjugate vaccine in children younger than five years of age for prevention of pneumonia. Pediatr Infect Dis J. 2002 Sep. 21(9):810-5. [Medline].

  22. Li ST, Tancredi DJ. Empyema hospitalizations increased in US children despite pneumococcal conjugate vaccine. Pediatrics. 2010 Jan. 125(1):26-33. [Medline].

  23. Rudan I, Tomaskovic L, Boschi-Pinto C, Campbell H. Global estimate of the incidence of clinical pneumonia among children under five years of age. Bull World Health Organ. 2004 Dec. 82(12):895-903. [Medline]. [Full Text].

  24. Shah S, Bachur R, Kim D, Neuman MI. Lack of predictive value of tachypnea in the diagnosis of pneumonia in children. Pediatr Infect Dis J. 2010 May. 29(5):406-9. [Medline].

  25. Wingerter SL, Bachur RG, Monuteaux MC, Neuman MI. Application of the World Health Organization Criteria to Predict Radiographic Pneumonia in a US-based Pediatric Emergency Department. Pediatr Infect Dis J. 2012 Jun. 31(6):561-4. [Medline].

  26. Lynch T, Platt R, Gouin S, Larson C, Patenaude Y. Can we predict which children with clinically suspected pneumonia will have the presence of focal infiltrates on chest radiographs?. Pediatrics. 2004 Mar. 113(3 Pt 1):e186-9. [Medline].

  27. Mahabee-Gittens EM, Grupp-Phelan J, Brody AS, Donnelly LF, Bracey SE, Duma EM, et al. Identifying children with pneumonia in the emergency department. Clin Pediatr (Phila). 2005 Jun. 44(5):427-35. [Medline].

  28. Rothrock SG, Green SM, Fanelli JM, Cruzen E, Costanzo KA, Pagane J. Do published guidelines predict pneumonia in children presenting to an urban ED?. Pediatr Emerg Care. 2001 Aug. 17(4):240-3. [Medline].

  29. Jones BP, Tay ET, Elikashvili I, Sanders JE, Paul AZ, Nelson BP, et al. Feasibility and Safety of Substituting Lung Ultrasound for Chest X-ray When Diagnosing Pneumonia in Children: A Randomized Controlled Trial. Chest. 2016 Feb 25. [Medline].

  30. Bachur R, Perry H, Harper MB. Occult pneumonias: empiric chest radiographs in febrile children with leukocytosis. Ann Emerg Med. 1999 Feb. 33(2):166-73. [Medline].

  31. Murphy CG, van de Pol AC, Harper MB, Bachur RG. Clinical predictors of occult pneumonia in the febrile child. Acad Emerg Med. 2007 Mar. 14(3):243-9. [Medline].

  32. Rutman MS, Bachur R, Harper MB. Radiographic pneumonia in young, highly febrile children with leukocytosis before and after universal conjugate pneumococcal vaccination. Pediatr Emerg Care. 2009 Jan. 25(1):1-7. [Medline].

  33. Wubbel L, Muniz L, Ahmed A, Trujillo M, Carubelli C, McCoig C, et al. Etiology and treatment of community-acquired pneumonia in ambulatory children. Pediatr Infect Dis J. 1999 Feb. 18(2):98-104. [Medline].

  34. Waris ME, Toikka P, Saarinen T, Nikkari S, Meurman O, Vainionpää R, et al. Diagnosis of Mycoplasma pneumoniae pneumonia in children. J Clin Microbiol. 1998 Nov. 36(11):3155-9. [Medline]. [Full Text].

  35. Chaaban H, Singh K, Huang J, Siryaporn E, Lim YP, Padbury JF. The role of inter-alpha inhibitor proteins in the diagnosis of neonatal sepsis. J Pediatr. 2009 Apr. 154(4):620-622.e1. [Medline].

  36. Blaschke AJ, Heyrend C, Byington CL, Obando I, Vazquez-Barba I, Doby EH, et al. Molecular analysis improves pathogen identification and epidemiologic study of pediatric parapneumonic empyema. Pediatr Infect Dis J. 2011 Apr. 30(4):289-94. [Medline]. [Full Text].

  37. Neuman MI, Harper MB. Evaluation of a rapid urine antigen assay for the detection of invasive pneumococcal disease in children. Pediatrics. 2003 Dec. 112(6 Pt 1):1279-82. [Medline].

  38. Sherman MP, Goetzman BW, Ahlfors CE, Wennberg RP. Tracheal asiration and its clinical correlates in the diagnosis of congenital pneumonia. Pediatrics. 1980 Feb. 65(2):258-63. [Medline].

  39. Gauvin F, Dassa C, Chaïbou M, Proulx F, Farrell CA, Lacroix J. Ventilator-associated pneumonia in intubated children: comparison of different diagnostic methods. Pediatr Crit Care Med. 2003 Oct. 4(4):437-43. [Medline].

  40. Gauvin F, Lacroix J, Guertin MC, Proulx F, Farrell CA, Moghrabi A, et al. Reproducibility of blind protected bronchoalveolar lavage in mechanically ventilated children. Am J Respir Crit Care Med. 2002 Jun 15. 165(12):1618-23. [Medline].

  41. Labenne M, Poyart C, Rambaud C, Goldfarb B, Pron B, Jouvet P, et al. Blind protected specimen brush and bronchoalveolar lavage in ventilated children. Crit Care Med. 1999 Nov. 27(11):2537-43. [Medline].

  42. Falade AG, Mulholland EK, Adegbola RA, Greenwood BM. Bacterial isolates from blood and lung aspirate cultures in Gambian children with lobar pneumonia. Ann Trop Paediatr. 1997 Dec. 17(4):315-9. [Medline].

  43. Klein JO. Diagnostic lung puncture in the pneumonias of infants and children. Pediatrics. 1969 Oct. 44(4):486-92. [Medline].

  44. Wigglesworth JS. Perinatal Pathology. 2nd ed. Philadelphia, Pa: WB Saunders Co; 1996. 131-57, 184-7.

  45. Bradley JS, Byington CL, Shah SS, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the pediatric infectious diseases society and the infectious diseases society of america. Clin Infect Dis. 2011 Oct. 53(7):e25-76. [Medline].

  46. Willwerth BM, Harper MB, Greenes DS. Identifying hospitalized infants who have bronchiolitis and are at high risk for apnea. Ann Emerg Med. 2006 Oct. 48(4):441-7. [Medline].

  47. Muszynski JA, Knatz NL, Sargel CL, Fernandez SA, Marquardt DJ, Hall MW. Timing of correct parenteral antibiotic initiation and outcomes from severe bacterial community-acquired pneumonia in children. Pediatr Infect Dis J. 2011 Apr. 30(4):295-301. [Medline].

  48. [Guideline] Cincinnati Children''s Hospital Medical Center. Evidence based care guideline for community acquired pneumonia in children 60 days through 17 years of age. Cincinnati (OH): Cincinnati Children''s Hospital Medical Center. Jul. 2006. Available at http://guideline.gov/index.aspx. Accessed: September 22, 2010.

  49. Neuman MI, Kelley M, Harper MB, File TM Jr, Camargo CA Jr. Factors associated with antimicrobial resistance and mortality in pneumococcal bacteremia. J Emerg Med. 2007 May. 32(4):349-57. [Medline]. [Full Text].

  50. Barber J Jr. Narrow-Spectrum Antibiotics Effective for Pediatric Pneumonia. Medscape Medical News. Oct 29 2013. [Full Text].

  51. Williams DJ, Hall M, Shah SS, et al. Narrow Vs broad-spectrum antimicrobial therapy for children hospitalized with pneumonia. Pediatrics. 2013 Nov. 132(5):e1141-8. [Medline].

  52. Braude AC, Hornstein A, Klein M, Vas S, Rebuck AS. Pulmonary disposition of tobramycin. Am Rev Respir Dis. 1983 May. 127(5):563-5. [Medline].

  53. Pennington JE. Penetration of antibiotics into respiratory secretions. Rev Infect Dis. 1981 Jan-Feb. 3(1):67-73. [Medline].

  54. Clark RH, Bloom BT, Spitzer AR, Gerstmann DR. Empiric use of ampicillin and cefotaxime, compared with ampicillin and gentamicin, for neonates at risk for sepsis is associated with an increased risk of neonatal death. Pediatrics. 2006 Jan. 117(1):67-74. [Medline].

  55. Siempos II, Vardakas KZ, Kopterides P, Falagas ME. Adjunctive therapies for community-acquired pneumonia: a systematic review. J Antimicrob Chemother. 2008 Oct. 62(4):661-8. [Medline].

  56. Black S, Shinefield H, Fireman B, Lewis E, Ray P, Hansen JR, et al. Efficacy, safety and immunogenicity of heptavalent pneumococcal conjugate vaccine in children. Northern California Kaiser Permanente Vaccine Study Center Group. Pediatr Infect Dis J. 2000 Mar. 19(3):187-95. [Medline].

  57. FDA. FDA Approves Pneumococcal Disease Vaccine with Broader Protection. February 24, 2010. Available at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm201758.htm. Accessed: September 22, 2010.

  58. Melville N.A. Pneumonia Vaccine Benefits Extend to Unvaccinated Children. Medscape Medical News. Available at http://www.medscape.com/viewarticle/845102. Accessed: May 28, 2015.

  59. Lassi ZS, Haider BA, Bhutta ZA. Zinc supplementation for the prevention of pneumonia in children aged 2 months to 59 months. Cochrane Database Syst Rev. 2010 Dec 8. CD005978. [Medline].

  60. Douglas D. Twice-Daily Amoxicillin Effective in Children With Pneumonia. Medscape Medical News. Available at http://www.medscape.com/viewarticle/823469. Accessed: April 22, 2014.

  61. Vilas-Boas AL, Fontoura MS, Xavier-Souza G, Araújo-Neto CA, Andrade SC, Brim RV, et al. Comparison of oral amoxicillin given thrice or twice daily to children between 2 and 59 months old with non-severe pneumonia: a randomized controlled trial. J Antimicrob Chemother. 2014 Mar 19. [Medline].

  62. Addo-Yobo E, Chisaka N, Hassan M, Hibberd P, Lozano JM, Jeena P, et al. Oral amoxicillin versus injectable penicillin for severe pneumonia in children aged 3 to 59 months: a randomised multicentre equivalency study. Lancet. 2004 Sep 25-Oct 1. 364(9440):1141-8. [Medline].

  63. Brasfield DM, Stagno S, Whitley RJ, Cloud G, Cassell G, Tiller RE. Infant pneumonitis associated with cytomegalovirus, Chlamydia, Pneumocystis, and Ureaplasma: follow-up. Pediatrics. 1987 Jan. 79(1):76-83. [Medline].

  64. Brewster DR, De Silva LM, Henry RL. Chlamydia trachomatis and respiratory disease in infants. Med J Aust. 1981 Oct 3. 2(7):328-30. [Medline].

  65. Cevey-Macherel M, Galetto-Lacour A, Gervaix A, Siegrist CA, Bille J, Bescher-Ninet B, et al. Etiology of community-acquired pneumonia in hospitalized children based on WHO clinical guidelines. Eur J Pediatr. 2009 Dec. 168(12):1429-36. [Medline].

  66. Courtoy I, Lande AE, Turner RB. Accuracy of radiographic differentiation of bacterial from nonbacterial pneumonia. Clin Pediatr (Phila). 1989 Jun. 28(6):261-4. [Medline].

  67. de Man P, Verhoeven BA, Verbrugh HA, Vos MC, van den Anker JN. An antibiotic policy to prevent emergence of resistant bacilli. Lancet. 2000 Mar 18. 355(9208):973-8. [Medline].

  68. Fasoli L, Paldanius M, Don M, Valent F, Vetrugno L, Korppi M, et al. Simkania negevensis in community-acquired pneumonia in Italian children. Scand J Infect Dis. 2008. 40(3):269-72. [Medline].

  69. Gückel C, Benz-Bohm G, Widemann B. Mycoplasmal pneumonias in childhood. Roentgen features, differential diagnosis and review of literature. Pediatr Radiol. 1989. 19(8):499-503. [Medline].

  70. Haney PJ, Bohlman M, Sun CC. Radiographic findings in neonatal pneumonia. AJR Am J Roentgenol. 1984 Jul. 143(1):23-6. [Medline].

  71. Hansen J, Black S, Shinefield H, Cherian T, Benson J, Fireman B, et al. Effectiveness of heptavalent pneumococcal conjugate vaccine in children younger than 5 years of age for prevention of pneumonia: updated analysis using World Health Organization standardized interpretation of chest radiographs. Pediatr Infect Dis J. 2006 Sep. 25(9):779-81. [Medline].

  72. Korppi M, Kiekara O, Heiskanen-Kosma T, Soimakallio S. Comparison of radiological findings and microbial aetiology of childhood pneumonia. Acta Paediatr. 1993 Apr. 82(4):360-3. [Medline].

  73. Mathews B, Shah S, Cleveland RH, Lee EY, Bachur RG, Neuman MI. Clinical predictors of pneumonia among children with wheezing. Pediatrics. 2009 Jul. 124(1):e29-36. [Medline].

  74. Puumalainen T, Quiambao B, Abucejo-Ladesma E, Lupisan S, Heiskanen-Kosma T, Ruutu P, et al. Clinical case review: a method to improve identification of true clinical and radiographic pneumonia in children meeting the World Health Organization definition for pneumonia. BMC Infect Dis. 2008 Jul 21. 8:95. [Medline]. [Full Text].

  75. Radkowski MA, Kranzler JK, Beem MO, Tipple MA. Chlamydia pneumonia in infants: radiography in 125 cases. AJR Am J Roentgenol. 1981 Oct. 137(4):703-6. [Medline].

  76. Wahlgren H, Mortensson W, Eriksson M, Finkel Y, Forsgren M, Leinonen M. Radiological findings in children with acute pneumonia: age more important than infectious agent. Acta Radiol. 2005 Jul. 46(4):431-6. [Medline].

  77. Wildin SR, Chonmaitree T, Swischuk LE. Roentgenographic features of common pediatric viral respiratory tract infections. Am J Dis Child. 1988 Jan. 142(1):43-6. [Medline].

  78. Wolf DG, Greenberg D, Shemer-Avni Y, Givon-Lavi N, Bar-Ziv J, Dagan R. Association of human metapneumovirus with radiologically diagnosed community-acquired alveolar pneumonia in young children. J Pediatr. 2010 Jan. 156(1):115-20. [Medline].

  79. World Health Organization. Handbook. IMCI integrated management of childhood illness. Available at http://whqlibdoc.who.int/publications/2005/9241546441.pdf. Accessed: November 5,2010.

 
Previous
Next
 
(Left) Gram stain demonstrating gram-positive cocci in pairs and chains and (right) culture positive for Streptococcus pneumoniae.
A breakdown of test results and recommended treatment for pneumonia with effusion. Gm = Gram; neg = negative; pos = positive; VATS = video-assisted thoracic surgery
(A) Anteroposterior radiograph from a child with presumptive viral pneumonia. (B) Lateral radiograph of the same child with presumptive viral pneumonia.
Radiograph from a patient with bacterial pneumonia (same patient as in the preceding image) a few days later. This radiograph reveals progression of pneumonia into the right middle lobe and the development of a large parapneumonic pleural effusion.
Right lower lobe consolidation in a patient with bacterial pneumonia.
(A) Anteroposterior radiograph from a child with a left lower lobe infiltrate. (B) Lateral radiograph of the same child with a left lower lobe infiltrate.
Anteroposterior radiograph from a child with a round pneumonia.
Table. Categorizing Patients Based on Symptoms, Which Assists in Differential Diagnosis of Those With Recurrent Pneumonias
Category Laboratory and Imaging Findings Clinical Findings Differential Diagnosis
1 Persistent or recurrent radiologic findings Persistent or recurrent fever and symptoms Cystic fibrosis, immunodeficiencies, obstruction (intrinsic [eg, foreign body] or extrinsic [eg, compressing nodes or tumor]), pulmonary sequestration, bronchial stenosis, or bronchiectasis
2 Persistent radiologic findings No clinical findings Anatomic abnormality (eg, sequestration, fibrosis, pleural lesion)
3 Recurrent pulmonary infiltrates with interval radiologic clearing No clinical findings Asthma and atelectasis that has been misdiagnosed as a bacterial pneumonia; aspiration syndrome, hypersensitivity pneumonitis, idiopathic pulmonary hemosiderosis, or a mild immunodeficiency disorder
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.