High discordance of chest x-ray and computed tomography for detection of pulmonary opacities in ED patients: implications for diagnosing pneumonia

Abstract

Objective To evaluate the diagnostic performance of chest x-ray (CXR) compared to computed tomography (CT) for detection of pulmonary opacities in adult emergency department (ED) patients. Methods We conducted an observational cross sectional study of adult patients presenting to 12 EDs in the United States from July 1, 2003 through November 30, 2006 who underwent both CXR and chest CT for routine clinical care. CXRs and CT scans performed on the same patient were matched. CXRs and CT scans were interpreted by attending radiologists and classified as containing pulmonary opacities if the final radiologist report noted opacity, infiltrate, consolidation, pneumonia, or bronchopneumonia. Using CT as a criterion standard, the diagnostic test characteristics of CXR to detect pulmonary opacities were calculated. Results The study cohort included 3,423 patients. Shortness of breath, chest pain and cough were the most common complaints, with 96.1% of subjects reporting at least one of these symptoms. Pulmonary opacities were visualized on 309 (9.0%) CXRs and 191 (5.6 %) CT scans. CXR test characteristics for detection of pulmonary opacities included: sensitivity 43.5% (95% CI: 36.4%–50.8%); specificity 93.0% (95% CI: 92.1%–93.9%); positive predictive value 26.9% (95% CI: 22.1%–32.2%); and negative predictive value 96.5% (95% CI: 95.8%–97.1%). Conclusion In this multicenter cohort of adult ED patients with acute cardiopulmonary symptoms, CXR demonstrated poor sensitivity and positive predictive value for detecting pulmonary opacities. Reliance on CXR to identify pneumonia may lead to significant rates of misdiagnosis.

Imaging Evaluation of Pulmonary Infections in A Tertiary Care Centre of North Western India

“…In the study conducted by SS Atwal et al 7 most common age group was 31-40 years (53.33%) with male predominance (71%).In the present study, fever (99.2%) was the most common clinical feature followed by cough with sputum (89.2%). In the study conducted by Wesley H. Self et al 8 shortness of breath, chest pain and cough were the most common presenting complaints, Similarly in the study conducted by Kang et al, 9 fever, dyspnea and dry cough were the predominant symptoms.In the present study, on CT scan consolidation was predominantly observed inmycobacterial TB (85.14%) followed by pyogenic bacterial (12.16%) and fungal infections (2.27%) while in the study conducted by Kang et al, 9 on HRCT consolidation was noted in predominantly in pyogenic bacterial infections (56%), followed by fungal infections (26%) and tubercular infections (10.5%).In the present study, cavitation was predominantly present in mycobacterial (90%) followed by bacterial (6.7%) and fungal infections (3.3%), while in the study conducted by SS Atwal et al 7 cavitation was present in 21.4% of mycobacterial infections. Whereas in study by Naseem et al 10 , cavitation was observed in 76% cases of tuberculosis.In the present study, pleural effusion was present in 25% of bacterial, 72.73% of mycobacterial and 2.27% of fungal infections amongst study population.…”

Cost‐effectiveness of Quantitative Pretest Probability Intended to Reduce Unnecessary Medical Radiation Exposure in Emergency Department Patients With Chest Pain and Dyspnea

“…While there is some literature on the diagnosis of pneumonia on CT scan, there is little literature on diagnosis of pneumothorax or cancer either in terms of missed cases or improved outcomes. 41 Fifth, we did not consider the transition to other chronic conditions associated with diagnosis of PE and MI, including chronic thromboembolic pulmonary hypertension, postthrombotic syndrome, and congestive heart failure, and we did not explicitly model the economic and quality-of-life loss related to false-positive testing. Similarly, with respect to increased risk of cancer imposed by ionizing radiation, the model only considered QALYs lost to death from cancer and costs associated with cancer in the last year of life.…”

Community-Acquired Pneumonia with Negative Chest Radiography Findings: Clinical and Radiological Features

“…Thus, when clinicians rely on CR for the diagnosis of pneumonia, there is a potential risk of the diagnosis being delayed or missed [4, 5]. Delayed diagnosis and management of pneumonia may lead to significant morbidity and mortality [5]. Chest computed tomography (CT) has been reported to be superior to CR for the visualization of lung parenchymal lesions and pleural abnormalities observed in pneumonia [1, 5-8].…”

“…Although chest radiography (CR) has traditionally been used as the initial imaging modality for the evaluation of pneumonia [2], its interobserver agreement for the diagnosis of pneumonia is not perfect [3]. Thus, when clinicians rely on CR for the diagnosis of pneumonia, there is a potential risk of the diagnosis being delayed or missed [4, 5]. Delayed diagnosis and management of pneumonia may lead to significant morbidity and mortality [5].…”