ArticleEmergency radiology2026
Diagnostic accuracy of chest radiograph versus computed tomography for suspected pneumonia in obese patients.
Article in Emergency radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundObesity 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.
methodsA 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.
resultsAmong 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.
conclusionChest 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.
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