Hagaman Jared T, Rouan Gregory W, Shipley Ralph T, Panos Ralph J
Departments of Internal Medicine, University of Cincinnati, Ohio, USA.
Am J Med Sci. 2009 Apr;337(4):236-40. doi: 10.1097/MAJ.0b013e31818ad805.
: The clinical and epidemiological significance of community-acquired pneumonia (CAP) with a chest radiograph demonstrating no parenchymal infiltrate has not been studied. We determined the percentage of patients with a clinical diagnosis of CAP who did not have radiographic opacifications and compared this group with patients with CAP and radiographic infiltrates.
: Patients admitted with a diagnosis of CAP were identified. Clinical history, physical examination, laboratory studies, and microbiological cultures were reviewed in a random sample of 105 patients. Admission and subsequent chest radiographs were interpreted without knowledge of the clinical data.
: Twenty-one percent (22/105) of patients with a clinical diagnosis of CAP had negative chest radiographs at presentation. Demographic, clinical, and laboratory data were the same in both groups. Fifty-five percent of patients with initially negative chest radiographs who had follow-up studies developed an infiltrate within 48 hours.
: In patients admitted with a clinical diagnosis of CAP, the initial chest radiograph lacks sensitivity and may not demonstrate parenchymal opacifications in 21% of patients. Moreover, greater than half of patients admitted with a negative chest radiograph will develop radiographic infiltrates within 48 hours. Further studies are needed to develop evidence-based criteria for the diagnosis of CAP.
胸部X线片显示无实质浸润的社区获得性肺炎（CAP）的临床和流行病学意义尚未得到研究。我们确定了临床诊断为CAP但无影像学混浊的患者百分比，并将该组与有CAP且有影像学浸润的患者进行比较。
确定诊断为CAP的入院患者。对105例患者的随机样本进行临床病史、体格检查、实验室检查和微生物培养回顾。在不了解临床数据的情况下解读入院时及随后的胸部X线片。
临床诊断为CAP的患者中，21%（22/105）在就诊时胸部X线片为阴性。两组的人口统计学、临床和实验室数据相同。最初胸部X线片阴性且进行了随访研究的患者中，55%在48小时内出现浸润。
临床诊断为CAP的入院患者中，初始胸部X线片缺乏敏感性，21%的患者可能未显示实质混浊。此外，胸部X线片阴性的入院患者中，超过一半将在48小时内出现影像学浸润。需要进一步研究以制定基于证据的CAP诊断标准。
