Pediatric Pneumonia Differential Diagnoses

Updated: Mar 10, 2023
  • Author: Muhammad Waseem, MBBS, MS, FAAP, FACEP, FAHA; Chief Editor: Russell W Steele, MD  more...
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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 simply 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 such 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 be superimposed by 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 both very  helpful to further narrow the differential diagnosis. However, additional testing is often needed to confirm most of these diagnoses and is generally outside the scope of a primary care provider.

Differential Diagnoses