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how to diagnose and differentiate socially acquired pneumonia-socially acquired pneumonia is easy to confuse diseases

how to diagnose and differentiate socially acquired pneumonia-socially acquired pneumonia is easy to confuse diseases


According to the patient's medical history, clinical manifestations, and combined with the images on the chest X-ray, the diagnosis of pneumonia is generally not difficult, but the final diagnosis needs to exclude other non-inflammatory diseases of the lung, especially tuberculosis and tumor diseases first. This is because pulmonary tuberculosis and lung tumors are common clinical diseases, which can be manifested as inflammatory infiltration shadows or concurrent inflammatory manifestations on X-ray chest radiographs, which is very easy to be confused. On the other hand, lung tumors, especially The early diagnosis of lung cancer is related to the patient’s life safety, and once the diagnosis of tuberculosis is established, it requires planned long-term anti-tuberculosis treatment. Therefore, pneumonia, tuberculosis and lung cancer are common and easily confused with each other, and their treatment and prognosis are completely different. Because it is different, clinicians have heavy responsibilities and must make timely and careful identification.

1. Tuberculosis Infiltrating tuberculosis or acute caseous pneumonia The symptoms, signs and X-ray manifestations are very similar to general pneumonia, because it is essentially an inflammation. Therefore, the differential diagnosis is very difficult until the pathogenic bacteria are clearly found. The main difference is that the general health status of pulmonary tuberculosis patients is mostly poor (this is mainly evident in patients with acute caseous pulmonary tuberculosis), and the course of the disease is longer. The characteristics of the lesions that can be shown on the chest X-ray are: the old and the new are different, and even contain calcification points. It usually occurs in the posterior segment of the upper lobe and the dorsal segment of the lower lobe. There may be disseminated lesions. X-ray follow-up shows that the lesions will not dissipate, but new disseminated lesions or cavities may appear. Clinically, pneumonia usually occurs frequently in the middle and lower lobe, and the shadow density is uniform. Of course, the above differences are for clinical reference only, not absolute. In clinical practice, it is often while actively searching for pathogens, that is, conducting experimental anti-infective treatments first, and closely observing the dynamic changes of the condition and lung shadows. Once acid-fast bacilli (including sputum smear and culture) are found, the diagnosis of tuberculosis is established. However, clinically, some patients often find it difficult to confirm the diagnosis of the pathogen even if they are repeatedly searched. At this time, if ordinary anti-infective treatment is ineffective, and tuberculosis is highly suspected clinically, the effectiveness of anti-tuberculosis treatment can also be tested to confirm the existence of tuberculosis.

2. Lung cancer According to data reports, about 25% of lung cancers clinically appear in the form of lung inflammation. When early lung cancer or lung cancer lesions are small and complicated by obstructive pneumonia, the X-ray signs are often confused with pneumonia. The main point of clinical identification is that lung cancer patients are generally older, often have a history of smoking, have irritating cough and blood in the sputum, but the toxicity symptoms are not obvious or not commensurate with the X-ray findings. Repeatedly searching for cancer cells from sputum exfoliated cells is an economical, simple and reliable non-invasive diagnostic method. X-ray tomography and chest CT examination can help to understand the internal structural characteristics of the lesion. In clinical practice, the most helpful thing is to perform fiberoptic bronchoscopy or biopsy followed by pathological examination. At the same time as the relevant examinations, antibiotics can also be used for experimental treatment. The chest X-ray should be rechecked in a short period of time. If the lesion does not dissipate for a long time, or even expand or new inflammation and atelectasis appear, the possibility of lung cancer is high. Many patients cannot rule out the diagnosis of lung cancer even after the above methods. At this time, exploratory thoracotomy can be considered to avoid losing the precious opportunity for early diagnosis of lung cancer.

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