The Pneumonias pp 288-312 | Cite as

Pitfalls in the Diagnosis of Pneumonia

  • Burke A. Cunha


As the diagnosis of pneumonia depends on a careful analysis of historical information, the physical examination, the chest roentgenogram, and selective laboratory values, the “pitfalls in the diagnosis of pneumonia” are concerned with noninfectious entities that may mimic bacterial pneumonia. There are two major areas of diagnostic difficulty facing the clinician who approaches the patient with presumed pneumonia. First, it must be determined if the patient in fact has an infectious explanation for the pulmonary symptomatology and findings, or if the process is noninfectious but has features that mimic an infectious pneumonia (Table 11.1). Second, if the process is infectious, the presentation may be atypical and mimic a noninfectious disorder in certain subpopulations (e.g., compromised hosts, the elderly, children). The essential diagnostic task is to differentiate infectious from noninfectious processes. The most common diagnostic confusion is caused by malignant diseases and, to a lesser extent, collagen-vascular diseases, drug reactions, and radiation pneumonitis.1–6 The clue to diagnostic pitfalls exists among the historical clues, physical findings, chest film abnormalities, and key laboratory tests. Such pitfalls should be kept in mind to avoid over- or underdiagnosing the infectious pneumonias.


Systemic Lupus Erythematosus Pleural Effusion Pleural Fluid Pulmonary Infiltrate Radiation Pneumonitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Cunha BA, Strampfer MJ: Pearls and pitfalls. In Brandstetter RD (ed): Pulmonary Medicine. Oradell, NJ: Medical Economics, 1989.Google Scholar
  2. 2.
    Wilson JD, Braunwald E, Isselbacher KJ, et al: (eds): Harrison’s Principles of Internal Medicine, 12th ed. New York: McGraw-Hill, 1991.Google Scholar
  3. 3.
    Gorbach SL, Bartlett JG, Blacklow NR (eds): Infectious Diseases. Philadelphia, Saunders, 1992.Google Scholar
  4. 4.
    Mandell GL, Gordon-Douglas R Jr, Bennett JE (eds): Principles and Practice of Infectious Diseases, 3rd ed. New York: Churchill Livingstone, 1985.Google Scholar
  5. 5.
    Brandstetter RD, Hausen HS, Desvarieux H: Noninfectious pulmonary disorders radiographically mimicking infection. Infect Dis Pract 1991; 15: 1–8.Google Scholar
  6. 6.
    Leatherman JW (ed): Noninfectious pulmonary infiltrates. Semin Respir Infect 1988; 3 (3): 179–274.Google Scholar
  7. 7.
    Sapira JD: The Art and Science of Bedside Diagnosis. Baltimore: Urban & Schwarzenberg, 1990.Google Scholar
  8. 8.
    Reed, JC: Chest Radiology, 3rd ed. St. Louis: Mosby-Year Book, 1991.Google Scholar
  9. 9.
    Lippington GA, Jamplis RW: A Diagnostic Approach to Chest Diseases, 2nd ed. Baltimore: Williams & Wilkins, 1977.Google Scholar
  10. 10.
    Chapman S, Nakielny R: Aids to Radiological Differential Diagnosis, 2nd ed. London: Baillière, Tindall, 1990.Google Scholar
  11. 11.
    Burgener FA, Kormano M: Differential Diagnosis in Conventional Radiology, 2nd ed. New York: Thieme, 1991.Google Scholar
  12. 12.
    Cunha BA: Pneumonias acquired from others. Postgrad Med 1987; 82: 126–156.PubMedGoogle Scholar
  13. 13.
    Wollschlager CM, Khan FA, Khan A: Utility of radiography and clinical features in the diagnosis of community acquired pneumonia. Clin Chest Med 1987; 3: 393.Google Scholar
  14. 14.
    Levison ME (ed). The Pneumonias. Boston: John Wright-PSG, 1984.Google Scholar
  15. 15.
    Pennington JE (ed): Respiratory Infections: Diagnosis and Management. New York: Raven Press, 1983.Google Scholar
  16. 16.
    White DA, Cooper JAD Jr: Drug-induced lung disease. In Brandstetter RD (ed): Pulmonary Medicine. Oradell, NJ: Medical Economics, 1989.Google Scholar
  17. 17.
    Matthay RA (ed): Clinics in Chest Medicine: Pulmonary Manifestations of Systemic Disease, Vol. 10. Philadelphia: Saunders, 1989, pp. 469–818.Google Scholar
  18. 18.
    Hunnighake GW, Fauci AS: Pulmonary involvement in collagen vascular diseases. Am Rev Respir Dis 1979; 119: 471.Google Scholar
  19. 19.
    Sarosi GA, Davies SF (eds): Fungal Diseases of the Lung. Orlando, FL: Grune & Stratton, 1986.Google Scholar
  20. 20.
    Davis SF: Fungal disease. Semin Respir Infect 1990; 5 (2): 91–154.Google Scholar

Copyright information

© Springer-Verlag New York, Inc. 1993

Authors and Affiliations

  • Burke A. Cunha

There are no affiliations available

Personalised recommendations