![]() ![]() We hypothesized that CAP patients with negative CR findings might have clinical features distinct from those with positive CR findings. A very recent study has suggested that the pathogens, disease severity, and outcomes are similar between these two groups of patients. The location of pneumonic lesions in community-acquired pneumonia (CAP) patients with negative CR findings is different from the location in patients with positive CR findings. Another study showed that in bedridden patients with pneumonia, the diagnostic accuracy of CR is low. ![]() Several studies have demonstrated that in some patients with pneumonia, the disease can be identified on chest CT but not on CR images. Given that CT provides additional benefits for the diagnosis of pneumonia and facilitates its characterization, it is likely to be helpful when pneumonia on CR cannot be diagnosed definitively from CR. CT images can also detect comorbid thoracic or pulmonary conditions. In addition, CT images may be helpful in suggesting specific causative agents of pneumonia and excluding noninfectious diseases although their roles are limited. Chest computed tomography (CT) has been reported to be superior to CR for the visualization of lung parenchymal lesions and pleural abnormalities observed in pneumonia. Delayed diagnosis and management of pneumonia may lead to significant morbidity and mortality. Thus, when clinicians rely on CR for the diagnosis of pneumonia, there is a potential risk of the diagnosis being delayed or missed. ![]() Although chest radiography (CR) has traditionally been used as the initial imaging modality for the evaluation of pneumonia, its interobserver agreement for the diagnosis of pneumonia is not perfect. The diagnosis of pneumonia is based on clinical symptoms or signs of lower respiratory tract infection and the presence of a new infiltrate on imaging studies that cannot be explained by any other cause. Chest CT scan should be considered in suspected CAP patients with a negative CR, especially in bedridden patients. Conclusions: CAP patients with negative CR findings are characterized by lower blood levels of inflammatory markers, a higher incidence of aspiration pneumonia, and a lower incidence of complicated parapneumonic effusion or empyema than those with positive CR findings. Despite shorter length of hospital stay in the negative CR group, 30-day and in-hospital mortalities were similar between the two groups. On CT, the negative CR group exhibited higher rates of GGO- and bronchiolitis-predominant patterns and a lower rate of consolidation pattern. The negative CR group was characterized by a higher frequency of aspiration pneumonia, lower incidences of complicated parapneumonic effusion or empyema and pleural drainage, and lower blood levels of inflammatory markers than the control group. Negative CR findings could be attributed to the location of the lesions (e.g., those located in the dependent lung) and CT pattern with a low attenuation, such as ground-glass opacity (GGO). Results: Of 1,925 patients, 94 patients (4.9%) were included in the negative CR group. Methods: We retrospectively compared the clinical characteristics, etiological agents, treatment outcomes, and CT findings between CAP patients with negative CR and positive CT findings (negative CR group) and those with positive CR as well as CT findings (control group). Objectives: The present study aimed to investigate the clinical and radiological features of these patients. Background: Data regarding community-acquired pneumonia (CAP) identified on chest computed tomography (CT) but not on chest radiography (CR) are limited. ![]()
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