Chest radiography for predicting the cause of febrile illness among inpatients in Moshi, Tanzania.

AIM: To describe chest radiographic abnormalities and assess their usefulness for predicting causes of fever in a resource-limited setting. MATERIALS AND METHODS: Febrile patients were enrolled in Moshi, Tanzania, and chest radiographs were evaluated by radiologists in Tanzania and the United States. Radiologists were blinded to the results of extensive laboratory evaluations to determine the cause of fever. RESULTS: Of 870 febrile patients, 515 (59.2%) had a chest radiograph available; including 268 (66.5%) of the adolescents and adults, the remainder were infants and children. One hundred and nineteen (44.4%) adults and 51 (20.6%) children were human immunodeficiency virus (HIV)-infected. Among adults, radiographic abnormalities were present in 139 (51.9%), including 77 (28.7%) with homogeneous and heterogeneous lung opacities, 26 (9.7%) with lung nodules, 25 (9.3%) with pleural effusion, 23 (8.6%) with cardiomegaly, and 13 (4.9%) with lymphadenopathy. Among children, radiographic abnormalities were present in 87 (35.2%), including 76 (30.8%) with homogeneous and heterogeneous lung opacities and six (2.4%) with lymphadenopathy. Among adolescents and adults, the presence of opacities was predictive of Streptococcus pneumoniae and Coxiella burnetii, whereas the presence of pulmonary nodules was predictive of Histoplasma capsulatum and Cryptococcus neoformans. CONCLUSIONS: Chest radiograph abnormalities among febrile inpatients are common in northern Tanzania. Chest radiography is a useful adjunct for establishing an aetiologic diagnosis of febrile illness and may provide useful information for patient management, in particular for pneumococcal disease, Q fever, and fungal infections.

The impact of phantom CT scanning on surgery for the solitary pulmonary nodule.

A reliable preoperative method to distinguish benign from malignant peripheral solitary pulmonary nodules (SPNs) would be clinically valuable. New techniques using epoxy resin plastic models of the thorax combined with calcium carbonate (phantom) nodules to determine the density of SPN have been proposed as a partial solution to this problem. During the first 3 years that phantom computed tomography (CT) has been available, 50 consecutive patients in whom SPN was discovered on screening chest x-ray film and who were considered to be candidates for surgery were evaluated by this technique. Twenty patients (40%) clearly met the phantom CT criteria for benign nodules (more dense than the phantom nodule, at least 10% of the surface area uniformly calcified, round or oval lesions without spicules, and lesions less than 3.0 cm in diameter) and have been followed up without surgery (no change on periodic screening chest x-ray film or CT for as many as 36 months). Only one of these 20 patients would have met standard x-ray criteria for benign nodules. Thirty patients who had lesions with densities less than the phantom nodule underwent thoracotomy, and in 17 (57%) of these, the lesions were malignant. No patient in this study who had a benign reading on the phantom CT scan had a malignancy at surgery or during follow-up. We conclude that phantom CT scanning is a useful adjunct to standard technique (review of prior screening chest x-ray film) and may prevent unnecessary thoracotomy in a significant percentage of patients with SPN.

The role of plain films, CT, tomography, ultrasound, and percutaneous needle aspiration in the diagnosis of inflammatory lung disease.

Traditionally, plain film chest radiography has been the mainstay in the roentgenographic evaluation of infectious disease in the chest. Plain film tomography has augmented the chest radiograph in the detection of cavitation and in evaluation of the bronchial tree. Newer imaging modalities including ultrasound, which evaluates the pleural space, and computerized tomography (CT), which examines the lung parenchyma, mediastinum, pleura, and chest wall, have further aided in diagnosis. Finally, percutaneous aspiration of the lung or pleural space under radiologic guidance now allows specific diagnoses to be made more frequently and with fewer complications.