The primary role of imaging examinations is to confirm the diagnosis of pneumonia. Imaging examinations are indispensable for the management of CAP. The causative pathogens of atypical pneumonia include Mycoplasma pneumoniae, Chlamydophila pneumoniae, various viruses and Legionella pneumophila. Pneumonia with relatively mild clinical symptoms, atypical clinical symptoms such as arthralgia, skin rash or headache, or lack of leukocytosis is referred to as atypical pneumonia. Tests for pathogens include sputum culture, blood culture (in case of suspected sepsis), various antigen tests including pharyngeal swab test for influenza viruses or urine antigen tests for Legionella pneumophila and Streptococcus pneumoniae, antibody tests, gram stain, paired serum tests and cold agglutination test. Laboratory data usually show an elevation of white blood cell count, C reactive protein and erythrocyte sedimentation rate. When clinical findings are suggestive of CAP, blood test, various tests for determining the causative pathogen and chest radiography are performed. Heckerling also suggested in another report that patients with an acute asthma attack or the absence of abnormal auscultatory findings should not undergo chest radiography because the probability of pneumonia is low in these settings. According to their nomogram for determining the probability of having pneumonia, when assuming a 10% prevalence of pneumonia in the patient population, if these five criteria are met, the probability of pneumonia reaches 70%. Heckerling et al proposed 5 criteria that suggest infectious pneumonia: temperature > 37.8 ☌, pulse > 100 beats/min, crackles, decreased breath sounds and the absence of asthma. Chest pain is indicative of associated pleuritis. Patients with CAP usually complain of fever, cough, sputum, difficulty breathing or chest pain. In this article, we discuss the roles of imaging examinations, and illustrate characteristic imaging findings of several pathogens (Table (Table1), 1), some particular clinical conditions related to CAP (Table (Table2), 2), and differences between infectious pneumonia and non-infectious diseases (Table (Table3 3).Īppropriate clinical assessment is the first step for the diagnosis of CAP. In addition, imaging examinations sometimes offer clues for the differentiation between infectious pneumonia and noninfectious diseases. However, characteristic imaging findings of several pathogens are sometimes suggestive of the diagnosis of specific pneumonia. They manifest as pneumonia in various forms, and their imaging findings are often nonspecific. The pathogens of CAP include a wide variety of microbes, including not only ordinary bacteria but also mycobacteria, viruses, or fungi. The third term, nursing home acquired pneumonia that is acquired in the nursing home, has recently been proposed, which has intermediate characteristics between community-acquired and hospital-acquired pneumonia. This term is opposed to hospital-acquired pneumonia (synonym for nosocomial pneumonia), which is infected in the hospital (24 h later after the hospitalization). Community-acquired pneumonia (CAP) is defined as infectious pneumonia that is acquired in the social community.
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