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Background <p>Obesity poses unique diagnostic challenges in medical imaging due to technical limitations that impair image quality. In emergency and urgent care settings, chest radiography (CXR) remains the first-line investigation for suspected pneumonia despite its reduced sensitivity in obese patients. This study aimed to compare the diagnostic yield of CXR and chest computed tomography (CT) in obese and non-obese patients with suspected pneumonia and to assess the impact of CT findings on antimicrobial management.</p> Methods <p>A retrospective chart review was conducted at a community-based teaching hospital in Central Massachusetts from July 2022 to July 2024. Adult patients (&gt;18 years) who underwent both CXR and chest CT within 72 hours for suspected pneumonia were included. Patients were categorized as obese (BMI ≥30 kg/m<sup>2</sup>) or non-obese (BMI &lt; 30 kg/m<sup>2</sup>). Radiology reports were classified as positive, negative, or inconclusive for pneumonia. Using CT as the reference, CXR results were evaluated for diagnostic concordance, sensitivity, and specificity. The effect of CT findings on antibiotic initiation or discontinuation was also analyzed.</p> Results <p>Among 940 screened patients, 320 met inclusion criteria; 202 (63.1%) were obese. Mean age was 65.3 ± 16.8 years, and mean BMI was 33.0 ± 9.3 kg/m<sup>2</sup>. Concordance between CXR and CT was 55.4% in obese versus 69.5% in non-obese patients. Sensitivity of CXR for pneumonia was lower in obese (67.1%) than non-obese (80.9%) patients, while specificity remained comparable across groups. Chest CT provided significant diagnostic benefit in 44% of obese versus 29.7% of non-obese patients. Antibiotics were empirically initiated in 76.5% of cases; CT results led to discontinuation in 7% of obese and 4.5% of non-obese patients.</p> Conclusion <p>Chest CT demonstrates superior diagnostic accuracy over CXR for pneumonia, particularly in obese patients. Exclusive reliance on CXR may result in misdiagnosis or inappropriate antibiotic use. CT should be considered the preferred imaging modality for obese patients with suspected pneumonia.</p> Graphical Abstract <p></p>

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Diagnostic accuracy of chest radiograph versus computed tomography for suspected pneumonia in obese patients

  • 期刊论文

  • 发表日期：

    2026年2月5日

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  • Arunava Saha,
  • Shari Mitra,
  • Sirshendu Chaudhuri,
  • Alwyn Rapose

摘要

Background

Obesity poses unique diagnostic challenges in medical imaging due to technical limitations that impair image quality. In emergency and urgent care settings, chest radiography (CXR) remains the first-line investigation for suspected pneumonia despite its reduced sensitivity in obese patients. This study aimed to compare the diagnostic yield of CXR and chest computed tomography (CT) in obese and non-obese patients with suspected pneumonia and to assess the impact of CT findings on antimicrobial management.

Methods

A retrospective chart review was conducted at a community-based teaching hospital in Central Massachusetts from July 2022 to July 2024. Adult patients (>18 years) who underwent both CXR and chest CT within 72 hours for suspected pneumonia were included. Patients were categorized as obese (BMI ≥30 kg/m2) or non-obese (BMI < 30 kg/m2). Radiology reports were classified as positive, negative, or inconclusive for pneumonia. Using CT as the reference, CXR results were evaluated for diagnostic concordance, sensitivity, and specificity. The effect of CT findings on antibiotic initiation or discontinuation was also analyzed.

Results

Among 940 screened patients, 320 met inclusion criteria; 202 (63.1%) were obese. Mean age was 65.3 ± 16.8 years, and mean BMI was 33.0 ± 9.3 kg/m2. Concordance between CXR and CT was 55.4% in obese versus 69.5% in non-obese patients. Sensitivity of CXR for pneumonia was lower in obese (67.1%) than non-obese (80.9%) patients, while specificity remained comparable across groups. Chest CT provided significant diagnostic benefit in 44% of obese versus 29.7% of non-obese patients. Antibiotics were empirically initiated in 76.5% of cases; CT results led to discontinuation in 7% of obese and 4.5% of non-obese patients.

Conclusion

Chest CT demonstrates superior diagnostic accuracy over CXR for pneumonia, particularly in obese patients. Exclusive reliance on CXR may result in misdiagnosis or inappropriate antibiotic use. CT should be considered the preferred imaging modality for obese patients with suspected pneumonia.

Graphical Abstract