Pneumonia with negative chest radiography in early childhood: is it a real phenomenon or diagnostic error?

Background. The existence of community-acquired pneumonia with negative chest radiography (CAPNR) as a clinical phenomenon remains disputable until now. This phenomenon is deemed to occur in subjects with dehydration, neutropenia, diminished immune response. In case of CAPNR the possibility of diagnostic error and ensuing irrational use of antimicrobial drugs is fairly high.

Objective. The study aimed at establishing the validity of diagnosis of pneumonia with negative chest radiography in children, using a comparative evaluation of clinical and laboratory criteria amid positive and negative results of radiological diagnosis of pneumonia.

Methods. A one-time study was conducted which included analysis of medical documents selected by continuous sampling method, and comparison of children with CAPNR versus children with radiologically confirmed pneumonia. The comparison was based on analysis of medical histories, clinical pictures and results of paraclinical investigations.

Results. A total of 35 medical histories have been analyzed (mean age of patients – 1.7 ± 0.2 years), of which 17 children were assigned to group 1 (CAPNR group) and 18 children to group 2 (pneumonia with positive radiography). Most clinical and laboratory signs in early childhood were similar for children with CAPNR and children with radiologically confirmed pneumonia. Veritable differences in terms of respiratory symptoms have been found for children with CAPNR, namely, expiratory dyspnea in 35.29% of children with CAPNR versus none in the comparator group (p < 0.05), respiratory rate (RR) — 33 ± 7.2/min versus 28 ± 7.3/ min in the comparator group (p < 0.05), and auscultatory findings showing predominantly diminished breath sounds on the right-hand side. Complete blood count showed differences in granulocyte counts — 70 ± 12.6% in the CAPNR group versus 62.9 ± 16.8% in the comparator group (p < 0.05). A combination of the majority of classical symptoms of community-acquired pneumonia has been rarely observed in either group (5.9% and 11.1%, respectively).

Conclusion. Particular features of the CAPNR did not allow us to speak out with confidence in favor or against the diagnosis of community-acquired pneumonia (CAP) in patient groups. The conduct of prospective studies looking into the etiology of pneumonia, using radiologic and ultrasound diagnosis and analyzing clinical and laboratory particulars of CAP would be a worthwhile undertaking. Without radiographic identification of infiltrative changes the diagnosis of CAP remains problematic.

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