Community-Acquired Pneumonia Visualized on CT Scans but Not Chest Radiographs

Upchurch, Cameron; Grijalva, Carlos G.; Wunderink, Richard G.; Williams, Derek J.; Waterer, Grant; Anderson, Evan J.; Zhu, Yuwei; Hart, Eric; Carroll, Frank E.; Bramley, Anna M.; Jain, Seema; Edwards, Kathryn M.; Self, Wesley H.

doi:10.1016/j.chest.2017.07.035

Cited by 77 publications

(66 citation statements)

References 31 publications

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“…In the present study, no abnormal findings suggestive of pneumonia were observed on CR in approximately 5% of hospitalized CAP patients, which was similar to the percentages (3–13%) in previous studies [1, 4, 7, 12]. The most common cause of negative CR findings in the present study was the location of the lesions in the dependent regions of the lungs, followed by GGO- or bronchiolitis-predominant pattern on CT and presence of lesions in the right middle lobe or lingula.…”

Section: Discussionsupporting

confidence: 78%

“…A previous study also suggested that CAP patients with negative CR and positive CT findings exhibited a lower blood procalcitonin level than those with positive CR findings [12]. We speculate that lower blood levels of inflammatory markers are associated with more localized and less dense lesions in CAP patients with negative CR findings.…”

Section: Discussionmentioning

confidence: 71%

“…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 [8]. A very recent study has suggested that the pathogens, disease severity, and outcomes are similar between these two groups of patients [12]. We hypothesized that CAP patients with negative CR findings might have clinical features distinct from those with positive CR findings.…”

Section: Introductionmentioning

confidence: 99%

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Community-Acquired Pneumonia with Negative Chest Radiography Findings: Clinical and Radiological Features

et al. 2019

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Background: Data regarding community-acquired pneumonia (CAP) identified on chest computed tomography (CT) but not on chest radiography (CR) are limited. Objectives: The present study aimed to investigate the clinical and radiological features of these patients. 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). Results: Of 1,925 patients, 94 patients (4.9%) were included in the negative CR 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). 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. On CT, the negative CR group exhibited higher rates of GGO- and bronchiolitis-predominant patterns and a lower rate of consolidation pattern. Despite shorter length of hospital stay in the negative CR group, 30-day and in-hospital mortalities were similar between the two groups. 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. Chest CT scan should be considered in suspected CAP patients with a negative CR, especially in bedridden patients.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 99%

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Community-Acquired Pneumonia with Negative Chest Radiography Findings: Clinical and Radiological Features

et al. 2019

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“…Although the clinical significance of an infiltrate seen on CT but not on chest radiographs is debated, a recent prospective surveillance study showed that illness severity, pathogens, and clinical outcomes were comparable between patients with CAP with an abnormal chest radiographs and those diagnosed by CT scan without an obvious infiltrate on radiographs. 30 If clinical suspicion for pneumonia remains high despite a negative chest radiograph, advanced imaging should be considered and empiric treatment initiated. CT scans may be better at visualizing certain areas of the lung, such as the upper lobes and lingula, and at elucidating interstitial infiltrates as seen with atypical pathogens.…”

Section: Diagnosis: Imagingmentioning

confidence: 99%

Community-Acquired Pneumonia

Rider

Frazee

2018

Emergency Medicine Clinics of North America

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“…The diagnosis is usually based on an abnormal chest radiograph (or increasingly lung ultrasound) in a patient with signs and symptoms of LRTI such as cough, fever, chest pain, sputum production, chills, sweats, and abnormal lung sounds . There are limited data regarding the accuracy of chest radiograph compared to a reference standard of chest computed tomography (CT), one study found sensitivity of 83% in a group of 280 patients with CAP confirmed by chest CT and another found a sensitivity of 90% in a group of 718 patients receiving both chest CT and chest X‐ray (CXR) . These studies were not able to calculate specificity.…”

mentioning

confidence: 99%

Accuracy of Biomarkers for the Diagnosis of Adult Community‐acquired Pneumonia: A Meta‐analysis

Ebell

Bentivegna

Cai

et al. 2020

Academic Emergency Medicine

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Background Biomarkers such as C‐reactive protein (CRP) and procalcitonin may help distinguish community‐acquired pneumonia (CAP) from other causes of lower respiratory tract infection. Methods We performed a systematic review of the literature to identify prospective studies evaluating the accuracy of a biomarker in patients with acute cough or suspected CAP. We performed parallel abstraction of data regarding study inclusion, characteristics, quality, and test accuracy. Study quality was evaluated using QUADAS‐2. Bivariate meta‐analysis was performed using the mada package in R, and summary receiver operating characteristic (ROC) curves were created. Results Fourteen studies met our inclusion and exclusion criteria; three were at low risk of bias and four at moderate risk of bias, largely due to failure to prespecify diagnostic thresholds. Considering all studies regardless of the cutoff used, CRP was most accurate (area under the ROC curve = 0.802), followed by leukocytosis (0.777) and procalcitonin (0.771). Lipopolysaccharide‐binding protein and fibrinogen are promising, but were only studied in a single report. For CRP and procalcitonin, the positive and negative likelihood ratios (LR+ and LR–, respectively) varied inversely based on the cutoff. For CRP, LR+ and LR− were 2.08 and 0.32 for a cutoff of 20 mg/L, 3.64 and 0.36 for a cutoff of 50 mg/L, and 5.89 and 0.47 for a cutoff of 100 mg/L. For procalcitonin, LR+ and LR− were 2.50 and 0.39 for a cutoff of 0.10 µg/L, 5.43 and 0.62 for a cutoff of 0.25 µg/L, and 8.25 and 0.76 for a cutoff of 0.50 µg/L. The combination of CRP >49.5 mg/L and procalcitonin >0.1 µg/L had LR+ of 2.24 and LR− of 0.44. Conclusions The best evidence supports CRP as the preferred biomarker for diagnosis of outpatient CAP given its accuracy, low cost, and point‐of‐care availability.

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Community-Acquired Pneumonia Visualized on CT Scans but Not Chest Radiographs

Cited by 77 publications

References 31 publications

Community-Acquired Pneumonia with Negative Chest Radiography Findings: Clinical and Radiological Features

Community-Acquired Pneumonia with Negative Chest Radiography Findings: Clinical and Radiological Features

Community-Acquired Pneumonia

Accuracy of Biomarkers for the Diagnosis of Adult Community‐acquired Pneumonia: A Meta‐analysis

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