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The Value and Complications of Percutaneous Transthoracic Lung Aspiration for the Etiologic Diagnosis of Community-Acquired Pneumonia*

J. Anthony G. Scott, BM, BCh; Andrew J. Hall, BM, BS
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Affiliations: *From the Infectious Disease Epidemiology Unit (Dr. Hall), London School of Hygiene and Tropical Medicine, London, UK; and Wellcome Trust/Kenya Medical Research Institute (Dr. Scott), Centre for Geographic Medicine Research–Coast, Kilifi, Kenya.,  Currently at Center for Disease Control and Prevention, Atlanta, GA.

Correspondence to: J. Anthony G. Scott, BM, BCh, Wellcome Trust/Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, PO Box 230, Kilifi, Kenya; e-mail: Ascott@kilifi.mimcom.net



Chest. 1999;116(6):1716-1732. doi:10.1378/chest.116.6.1716
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Diagnosis of pneumonia is frustratingly incomplete, with most large studies failing to identify a causative organism in 33 to 45% of patients.13 Diagnosis by blood culture is highly specific, but the sensitivity of blood cultures for bacterial pneumonia is < 25%. An etiology can be obtained in undiagnosed cases by culture of sputum or from serologic diagnoses, but these techniques lack specificity or produce an unconvincing description with multiple pathogens.46 The most convincing evidence of etiology in observational studies of acute pneumonia is the demonstration of a single pathogen in the diseased tissue of the patient and the absence of this same organism from equivalent tissue in healthy control subjects. Percutaneous transthoracic aspiration of “lung juice” is the most acceptable and uncontaminated means of describing the microbiology of pneumonic lung antemortem, but the technique is not widely practiced because of the potential for adverse events. Here, we review the existing data on both the etiologic yield and the frequency of complications in order to evaluate the role of lung puncture in modern diagnostic studies.

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