Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea.
Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea,
Respiration. 2019;97(6):508-517. doi: 10.1159/000495068. Epub 2019 Jan 9.
Data regarding community-acquired pneumonia (CAP) identified on chest computed tomography (CT) but not on chest radiography (CR) are limited.
The present study aimed to investigate the clinical and radiological features of these patients.
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).
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.
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 para-pneumonic 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.
胸部计算机断层扫描（CT）而非胸部 X 光（CR）检出的社区获得性肺炎（CAP）数据有限。
本研究旨在探讨这些患者的临床和影像学特征。
我们回顾性比较了 CR 阴性但 CT 阳性（CR 阴性组）与 CR 和 CT 均阳性（对照组）的 CAP 患者的临床特征、病原体、治疗结局和 CT 表现。
在 1925 名患者中，94 名（4.9%）患者纳入 CR 阴性组。CR 阴性结果可归因于病变部位（如位于肺下叶的病变）和低衰减 CT 模式，如磨玻璃影（GGO）。与对照组相比，CR 阴性组更常发生吸入性肺炎，并发脓胸或胸腔积脓及引流的发生率较低，炎症标志物血水平较低。在 CT 上，CR 阴性组 GGO 和细支气管炎为主型的比例较高，实变型的比例较低。尽管 CR 阴性组的住院时间较短，但两组 30 天和住院死亡率相似。
与 CR 阳性结果的 CAP 患者相比，CR 阴性结果的 CAP 患者炎症标志物血水平较低，更常发生吸入性肺炎，并发脓胸或胸腔积脓的发生率较低。对于 CR 阴性疑似 CAP 患者，尤其是卧床患者，应考虑进行胸部 CT 扫描。
