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Table 5 Diagnostic clues for COVID-19 mimicker

From: Imaging of COVID-19 simulators

Final diagnosis Diagnostic clues Number of cases
Clinical history Pleural/cardiac involvement Pulmonary parenchymal involvement Laboratory/biopsy
Bronchial asthma History of bronchial asthma   Emphysematous changes
Subpleural sparing
Peribronchial thickening
Centrilobular nodules due to superadded infection
Eosinophilic lung Churg-Strauss syndrome History of bronchial asthma, sinusitis Pleural effusion   Peripheral eosinophilia 1
Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome Clinical history, skin rash Pleural effusion   Peripheral eosinophilia 1
Loffler syndrome    Fleeting opacities Peripheral blood eosinophilia and high IgE level
Elevated eosinophilic count on bronchoalveolar lavage
H1N1     PCR test revealed HINI virus 1
ARDS Clinical criteria   Bilateral basal dense consolidation on a background of diffuse GGO in the non-dependent regions with bronchial dilatation in GGO and crazy paving appearance   3
Hypersensitivity pneumonitis Clinical history of exposure to antigen (Bird Fancier’s Disease)
Reproduction of symptoms following exposure
  Poorly defined centrilobular nodules
Headcheese lung in subacute phase
Lymphocytosis on bronchoalveolar lavage 4
RB-ILD History of smoking
No fever
  Ground-glass opacities and centrilobular nodules Bronchoalveolar lavage (BAL) findings (the presence of smokers’ macrophages and the absence of lymphocytosis)
Proved by biopsy
Amiodarone lung History of drug intake   Peripheral patches
Pulmonary nodules and septal thickening
Fiberoptic bronchoscopy with BAL and transbronchial biopsy 1
SLE with diffuse alveolar hemorrhage History of SLE, hemoptysis.   Upper lobe predominance, confluent consolidation sparing costophrenic angles and the lung periphery.   1
Trauma History of recent trauma Pneumothorax    5
Atypical bacterial infection Mycoplasma bronchopneumonia   Pleural effusion Peribronchial thickening, confined to lobes   1
Staph-penumonia    GGO peribronchial thickening and pneumatocele   1
Other bacterial pneumonia    Unilateral lung affection
Tree in bud
Alveolar sarcoid History of sarcoid
No fever
  Upper lobe affection, peribronchial thickening, mediastinal lymph nodes   1
Acute Interstitial Pneumonia Acute symptoms like ARDS   Bilateral asymmetric confluent GGO with consolidative patches more in the lower lobes Proved by transbronchial biopsy 1
Cryptogenic organizing pneumonia   Pleural effusion Atoll sign
Subpleural sparing
Confirmed by histopathological correlation 2
Pulmonary alveolar proteinosis    Asymmetric lung involvement with crazy paving appearance Confirmed by bronchoalveolar lavage 1
Metastatic Calcifications with renal failure History of renal failure   High-density centrilobular ground glass nodules with superadded infection   1
Cardiogenic pulmonary edema Clinical history Enlarged cardiac size +/− pericardial effusion, dilated pulmonary trunk, bilateral pleural effusion, Thickened interlobular septal, peri-lymphatic, and peribronchovascular thickening
Perihilar distribution of ground glass opacities (bat wing)