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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