Differential diagnoses of COVID-19 pneumonia: the current challenge for the radiologist—a pictorial essay

Abstract Background COVID-19 pneumonia represents the most severe pandemic of the twenty-first century and has crucial clinical, social and economical implications. The scientific community has focused attention and resources on clinical and radiological features of COVID-19 pneumonia. Few papers analysing the vast spectrum of differential diagnoses have been published. Main body Complexity of differential diagnosis lays in the evidence of similar radiological findings as ground-glass opacities, crazy paving pattern and consolidations in COVID-19 pneumonia and a multitude of other lung diseases. Differential diagnosis is and will be extremely important during and after the pandemic peak, when there are fewer COVID-19 pneumonia cases. The aim of our pictorial essay is to schematically present COVID-19 pneumonia most frequent differential diagnoses to help the radiologist face the current COVID-19 pneumonia challenge. Conclusions Clinical data, laboratory tests and imaging are pillars of a trident, which allows to reach a correct diagnosis in order to grant an excellent allocation of human and economical resources. The radiologist has a pivotal role in the early diagnosis of COVID-19 pneumonia because he may raise suspicion of the pathology and help to avoid COVID-19 virus spread.

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Idiopathic Interstitial Pneumonias and COVID-19 Pneumonia: Review of the Main Radiological Features and Differential Diagnosis

Tomography ◽

10.3390/tomography7030035 ◽

2021 ◽

Vol 7 (3) ◽

pp. 397-411

Author(s):

Alessia Guarnera ◽

Elena Santini ◽

Pierfrancesco Podda

Keyword(s):

Differential Diagnosis ◽

Lung Diseases ◽

Correct Diagnosis ◽

Healthcare Systems ◽

Economic Resources ◽

Differential Diagnoses ◽

Radiological Findings ◽

Idiopathic Interstitial Pneumonias ◽

Radiological Features ◽

Optimal Evaluation

COVID-19 pneumonia represents a challenging health emergency, due to the disproportion between the high transmissibility, morbidity, and mortality of the virus and healthcare systems possibilities. Literature has mainly focused on COVID-19 pneumonia clinical-radiological diagnosis and therapy, and on the most common differential diagnoses, while few papers investigated rare COVID-19 pneumonia differential diagnoses or the overlapping of COVID-19 pneumonia on pre-existing lung pathologies. This article presents the main radiological characteristics of COVID-19 pneumonia and Idiopathic Interstitial Pneumonias (IIPs) to identify key radiological features for a differential diagnosis among IIPs, and between IIPs and COVID-19 pneumonia. COVID-19 pneumonia differential diagnosis with IIPs is challenging, since these entities may share common radiological findings as ground glass opacities, crazy paving patterns, and consolidations. Multidisciplinary discussion is crucial to reach a final and correct diagnosis. Radiologists have a pivotal role in identifying COVID-19 pneumonia patterns, reporting possible overlapping with long-lasting lung diseases, and suggesting potential differential diagnoses. An optimal evaluation of HRTC may help in containing the disease, in promoting better treatment for patients, and in providing an efficient allocation of human and economic resources.

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Pancreatic heterotopia: An overview of a lesion often mimicking neuroendocrine tumour

Indian Journal of Pathology and Oncology ◽

10.18231/j.ijpo.2021.076 ◽

2021 ◽

Vol 8 (3) ◽

pp. 397-402

Author(s):

Jaydeep N Pol ◽

Medha P Kulkarni ◽

Rakhi V Jagadale ◽

Alka V Gosavi

Keyword(s):

Differential Diagnosis ◽

Histopathological Examination ◽

Neuroendocrine Tumour ◽

Correct Diagnosis ◽

Case Series ◽

Main Body ◽

Type I ◽

Vascular Connection ◽

Upper Gi ◽

High Degree

Pancreatic tissue that has no direct or vascular connection to the main body of the pancreas constitutes ectopic pancreas or heterotopic pancreas (HP). Majority are located in the upper gastrointestinal tract (GIT). HP may be mistaken for neoplasms like neuroendocrine tumour (NET) and adenocarcinoma on endoscopy as well as on histopathology. We report six cases of HP along with review of literature; three of them were misdiagnosed as NET. To the best of our knowledge, this is the first case series of HP from India, rest being case reports. Histopathological features of six cases of HP were analyzed. Variables examined were clinical presentation, age at diagnosis, location, histopathologic type and immunohistochemical profile. Two cases each were seen in duodenum and Meckel’s diverticulum while one case each was seen in stomach and an atretic segment of ileum, a site never reported previously. There were five males and one female with age ranging from one day to 48 years. Patients with gastric and duodenal HP were symptomatic. On histopathology, four cases were intramuscular and two were submucosal. Four cases were of Type I and two cases were of type II. HP should be considered in the differential diagnosis of submucosal upper GI lesions. Awareness, high degree of suspicion and thorough histopathological examination are necessary to arrive at a correct diagnosis. Immunohistochemistry for chromogranin and synaptophysin is useful for confirming the islets especially on small endoscopic biopsies. HP must be considered in the differential diagnosis of submucosal upper GI lesions. Knowledge about this entity, high degree of suspicion and thorough histopathological examination help in arriving at a correct diagnosis and excluding mimics.

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Clinical and Histopathological Features of Scleroderma-like Disorders: An Update

Medicina ◽

10.3390/medicina57111275 ◽

2021 ◽

Vol 57 (11) ◽

pp. 1275

Author(s):

Rosario Foti ◽

Rocco De Pasquale ◽

Ylenia Dal Bosco ◽

Elisa Visalli ◽

Giorgio Amato ◽

...

Keyword(s):

Differential Diagnosis ◽

Systemic Sclerosis ◽

Antinuclear Antibodies ◽

Correct Diagnosis ◽

Main Body ◽

Muscular Tissue ◽

Histological Features ◽

Histopathological Features ◽

Clinical Evolution ◽

Pathological Conditions

Scleroderma-like disorders include a set of entities involving cutis, subcutis and, sometimes, even muscular tissue, caused by several pathogenetic mechanisms responsible for different clinical–pathological pictures. The absence of antinuclear antibodies (ANA), Raynaud’s phenomenon and capillaroscopic anomalies constitutes an important element of differential diagnosis with systemic sclerosis. When scleroderma can be excluded, on the basis of the main body sites, clinical evolution, any associated pathological conditions and specific histological features, it is possible to make a correct diagnosis.

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Can conversation analytic findings help with differential diagnosis in routine seizure clinic interactions?

Communication & Medicine ◽

10.1558/cam.v12i1.26851 ◽

2016 ◽

Vol 12 (1) ◽

pp. 13-24 ◽

Cited By ~ 7

Author(s):

Katie Ekberg ◽

Markus Reuber

Keyword(s):

Differential Diagnosis ◽

Correct Diagnosis ◽

Diagnostic Errors ◽

Epileptic Seizures ◽

Routine Clinical Setting ◽

Choice Of Treatment ◽

Transient Loss ◽

Factual Content ◽

Patient’S History ◽

Linguistic Methods

There are many areas in medicine in which the diagnosis poses significant difficulties and depends essentially on the clinician’s ability to take and interpret the patient’s history. The differential diagnosis of transient loss of consciousness (TLOC) is one such example, in particular the distinction between epilepsy and ‘psychogenic’ non-epileptic seizures (NES) is often difficult. A correct diagnosis is crucial because it determines the choice of treatment. Diagnosis is typically reliant on patients’ (and witnesses’) descriptions; however, conventional methods of history-taking focusing on the factual content of these descriptions are associated with relatively high rates of diagnostic errors. The use of linguistic methods (particularly conversation analysis) in research settings has demonstrated that these approaches can provide hints likely to be useful in the differentiation of epileptic and non-epileptic seizures. This paper explores to what extent (and under which conditions) the findings of these previous studies could be transposed from a research into a routine clinical setting.

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A case of splenomegaly with RK-39 positivity: A diagnostic pitfall

Tropical Doctor ◽

10.1177/00494755211020610 ◽

2021 ◽

pp. 004947552110206

Author(s):

Prasad Dange ◽

Ankesh Gupta ◽

Richa Juneja ◽

Renu Saxena

Keyword(s):

Hereditary Spherocytosis ◽

Correct Diagnosis ◽

Young Male ◽

Differential Diagnoses ◽

Patient Evaluation ◽

Serological Testing ◽

Endemic Region ◽

Careful Patient ◽

Diagnostic Pitfall ◽

Marked Splenomegaly

Long-standing moderate to marked splenomegaly suggests several differential diagnoses, both haematological and infectious, particularly leishmaniasis and malaria in endemic areas. Non-infectious causes may be missed in these regions, especially if pitfalls of serological testing are not considered. Careful patient evaluation is necessary to arrive at the correct diagnosis. We report a case of a young male whose hereditary spherocytosis was initially missed because of RK-39 positivity, splenomegaly and the fact that he hailed from an endemic region.

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Development and evaluation of a computer-based decision support system for diffuse lung diseases at high-resolution computed tomography

Acta Radiologica ◽

10.1177/0284185121995799 ◽

2021 ◽

pp. 028418512199579

Author(s):

Simon S Martin ◽

Delina Kolaneci ◽

Julian L Wichmann ◽

Lukas Lenga ◽

Doris Leithner ◽

...

Keyword(s):

Computed Tomography ◽

Decision Support ◽

High Resolution ◽

Lung Diseases ◽

Differential Diagnoses ◽

High Resolution Computed Tomography ◽

Computer Based ◽

Diffuse Lung Diseases ◽

Hrct Patterns ◽

Diffuse Lung

Background High-resolution computed tomography (HRCT) is essential in narrowing the possible differential diagnoses of diffuse and interstitial lung diseases. Purpose To investigate the value of a novel computer-based decision support system (CDSS) for facilitating diagnosis of diffuse lung diseases at HRCT. Material and Methods A CDSS was developed that includes about 100 different illustrations of the most common HRCT signs and patterns and describes the corresponding pathologies in detail. The logical set-up of the software facilitates a structured evaluation. By selecting one or more CT patterns, the program generates a ranked list of the most likely differential diagnoses. Three independent and blinded radiology residents initially evaluated 40 cases with different lung diseases alone; after at least 12 weeks, observers re-evaluated all cases using the CDSS. Results In 40 patients, a total of 113 HRCT patterns were evaluated. The percentage of correctly classified patterns was higher with CDSS (96.8%) compared to assessment without CDSS (90.3%; P < 0.01). Moreover, the percentage of correct diagnosis (81.7% vs. 64.2%) and differential diagnoses (89.2% vs. 38.3%) were superior with CDSS compared to evaluation without CDSS (both P < 0.01). Conclusion Addition of a CDSS using a structured approach providing explanations of typical HRCT patterns and graphical illustrations significantly improved the performance of trainees in characterizing and correctly identifying diffuse lung diseases.

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Irritable Bowel Syndrome with Constipation

10.2310/gastro.5444 ◽

2015 ◽

Author(s):

Loni Tang ◽

Brooks D. Cash

Keyword(s):

Irritable Bowel Syndrome ◽

Differential Diagnosis ◽

Abdominal Pain ◽

Digital Rectal Examination ◽

Recurrent Abdominal Pain ◽

Differential Diagnoses ◽

Rectal Examination ◽

Stool Form ◽

Alarm Features ◽

Irritable Bowel

Irritable bowel syndrome (IBS) is characterized by recurrent abdominal pain or discomfort that has occurred at least 3 days per month in the 3 months prior to diagnosis. One of the subtypes of this disorder is IBS with constipation (IBS-C), where individuals experience hard or lumpy stools at least 25% of the time and loose or watery stools less than 25% of the time with defecation. This review addresses IBS-C, detailing the epidemiology, etiology, pathophysiology and pathogenesis, diagnosis, differential diagnosis, treatment, and prognosis. A figure shows the Bristol stool form scale. Tables list IBS subtypes, components of digital rectal examination, differential diagnoses for IBS and IBS-C, alarm features, and the American College of Gastroenterology Recommendations. This review contains 1 highly rendered figure, 6 tables, and 71 references.

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Approach to dyspnoea in pregnancy in the COVID-19 era

Acute Medicine Journal ◽

10.52964/amja.0831 ◽

2020 ◽

Vol 19 (4) ◽

pp. 230-234

Author(s):

Anita Banerjee ◽

◽

Lindsay A Arrandale ◽

Srividhya Sankaran ◽

Guy W Glover ◽

...

Keyword(s):

Decision Making ◽

Pregnant Women ◽

Correct Diagnosis ◽

Case Series ◽

Differential Diagnoses ◽

Shared Decision ◽

First Case ◽

Compromise Design ◽

A Current ◽

In Pregnancy

Importance: Dyspnoea and hypoxia in pregnant women during the COVID-19 pandemic may be due to causes other than SARS Co-V-2 infection which should not be ignored. Shared decision-making regarding early delivery is paramount. Objective: To highlight and discuss the differential diagnoses of dyspnoea and hypoxia in pregnant women and to discuss the risks versus benefit of delivery for maternal compromise. Design, setting and participants: Case series of two pregnant women who presented with dyspnoea and hypoxia during the COVID-19 pandemic. Results: Two pregnant women presented with dyspnoea and hypoxia. The first case had COVID-19 infection in the 3rd trimester. The second case had an exacerbation of asthma without concurrent COVID-19. Only the first case required intubation and delivery. Both recovered and were discharged home. Conclusion and relevance: Our two cases highlight the importance of making the correct diagnosis and timely decision-making to consider if delivery for maternal compromise is warranted. Whilst COVID-19 is a current healthcare concern other differential diagnoses must still be considered when pregnant women present with dyspnoea and hypoxia.

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Perianal Lymphangioma Circumscriptum Mistaken for Genital Warts

PEDIATRICS ◽

10.1542/peds.98.3.461 ◽

1996 ◽

Vol 98 (3) ◽

pp. 461-463

Author(s):

Gary L. Darmstadt

Keyword(s):

Sexual Abuse ◽

Differential Diagnosis ◽

Case Report ◽

Correct Diagnosis ◽

Genital Warts ◽

Diagnosis And Treatment ◽

Perianal Region ◽

Anogenital Region ◽

Left Buttock ◽

Lymphangioma Circumscriptum

Genital warts are common relative to other verrucous lesions of the anogenital region. Consideration of the differential diagnosis of verrucous anogenital lesions is necessary, however, to make a correct diagnosis consistently and to avoid futile, painful, and possibly traumatic attempts at treatment. In this report, I describe a child with a history suspicious for sexual abuse who was treated with inappropriate measures because of misdiagnosis of perianal lymphangioma circumscriptum as genital warts. The pathogenesis, differential diagnosis, and treatment of lymphangioma is presented. CASE REPORT A 5-year-old Hispanic boy was referred by his pediatrician to the Dermatology Service with an eruption of red papules on the left buttock and perianal region.

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BRAIN TUMORS IN INFANCY

PEDIATRICS ◽

10.1542/peds-1-3-346 ◽

1948 ◽

Vol 1 (3) ◽

pp. 346-363

Author(s):

I. WALLACE LEIBNER

Keyword(s):

Nervous System ◽

Differential Diagnosis ◽

Brain Tumors ◽

Correct Diagnosis ◽

Full Recovery ◽

The Other ◽

Congenital Hydrocephalus ◽

First Case ◽

Clinical Patterns

Seven cases of brain tumors occurring in infants are presented. Six occurred in males and one was in a female. Three of them arose in the cerebellum while the other four were supratentorial. The tumors included two medulloblastomas, one [See Table II in Source Pdf] spongioblastoma polare, one ependymoma, one astrocytoma and one hemangioblastoma. The seventh case probably was also one of medulloblastoma. One of the proven medulloblastomas was supratentorial, which is unusual so faras location is concerned. The hemangioblastoma arose in the cerebrum. The location of this tumor is also a rare one and to my knowledge, it is the first case of its type reported in an infant in whom full recovery occurred following removal of the tumor. The diagnosis was unsuspected in four cases. Three of these infants were believed to be suffering from congenital hydrocephalus while the fourth was thought to be afflicted with encephalitis. The ways in which the correct diagnosis might have been made are discussed. Since bizarre clinical patterns are sometimes produced by brain tumors in infants and the diagnosis frequently overlooked, the possibility should be kept in mind by the pediatrician in considering the differential diagnosis of conditions producing signs referable to the nervous system.

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