Pediatric Pneumonia Differential Diagnoses

  • Author: Nicholas John Bennett, MB, BCh, PhD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Sep 7, 2011
 
 

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

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Nicholas John Bennett, MB, BCh, PhD  Fellow in Pediatric Infectious Disease, Department of Pediatrics, State University of New York Upstate Medical University

Nicholas John Bennett, MB, BCh, PhD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Pediatrics

Disclosure: Nothing to disclose.

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, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

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.

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.

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

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, and Southern Medical Association

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Laura E Ferguson, MD, Brent R King, MD, and Lakshmi V Atkuri, MD, to the development and writing of a source article.

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(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
1Persistent or recurrent radiologic findingsPersistent or recurrent fever and symptomsCystic fibrosis, immunodeficiencies, obstruction (intrinsic [eg, foreign body] or extrinsic [eg, compressing nodes or tumor]), pulmonary sequestration, bronchial stenosis, or bronchiectasis
2Persistent radiologic findingsNo clinical findingsAnatomic abnormality (eg, sequestration, fibrosis, pleural lesion)
3Recurrent pulmonary infiltrates with interval radiologic clearingNo clinical findingsAsthma and atelectasis that has been misdiagnosed as a bacterial pneumonia; aspiration syndrome, hypersensitivity pneumonitis, idiopathic pulmonary hemosiderosis, or a mild immunodeficiency disorder
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