Chest radiography findings of COVID-19 pneumonia: a specific pattern for a confident differential diagnosis

Background Chest radiography (CR) patterns for the diagnosis of COVID-19 have been established. However, they were not ideated comparing CR features with those of other pulmonary diseases. Purpose To create the most accurate COVID-19 pneumonia pattern comparing CR findings of COVID-19 and non-COVID-19 pulmonary diseases and to test the model against the British Society of Thoracic Imaging (BSTI) criteria. Material and Methods CR of COVID-19 and non-COVID-19 pulmonary diseases, admitted to the emergency department, were evaluated. Assessed features were interstitial opacities, ground glass opacities, and/or consolidations and the predominant lung alteration. We also assessed uni-/bilaterality, location (upper/middle/lower), and distribution (peripheral/perihilar), as well as pleural effusion and perihilar vessels blurring. A binary logistic regression was adopted to obtain the most accurate CR COVID-19 pattern, and sensitivity and specificity were computed. The newly defined pattern was compared to BSTI criteria. Results CR of 274 patients were evaluated (146 COVID-19, 128 non-COVID-19). The most accurate COVID-19 pneumonia pattern consisted of four features: bilateral alterations (Expß=2.8, P=0.002), peripheral distribution of the predominant (Expß=2.3, P=0.013), no pleural effusion (Expß=0.4, P=0.009), and perihilar vessels’ contour not blurred (Expß=0.3, P=0.002). The pattern showed 49% sensitivity, 81% specificity, and 64% accuracy, while BSTI criteria showed 51%, 77%, and 63%, respectively. Conclusion Bilaterality, peripheral distribution of the predominant lung alteration, no pleural effusion, and perihilar vessels contour not blurred determine the most accurate COVID-19 pneumonia pattern. Lower field involvement, proposed by BSTI criteria, was not a distinctive finding. The BSTI criteria has lower specificity.

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Comparison of chest X-ray interpretation by Emergency Department clinicians and radiologists in suspected COVID-19 infection: a retrospective cohort study

BJR|Open ◽

10.1259/bjro.20200020 ◽

2020 ◽

Vol 2 (1) ◽

pp. 20200020

Author(s):

Oliver J Kemp ◽

Daniel J Watson ◽

Carla L Swanson-Low ◽

James A Cameron ◽

Johannes Von Vopelius-Feldt

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Large Scale ◽

British Society ◽

X Rays ◽

Rater Agreement ◽

Thoracic Imaging ◽

Roc Area

Objectives: We describe the inter-rater agreement between Emergency Department (ED) clinicians and reporting radiologists in the interpretation of chest X-rays (CXRs) in patients presenting to ED with suspected COVID-19. Methods: We undertook a retrospective cohort study of patients with suspected COVID-19. We compared ED clinicians’ and radiologists’ interpretation of the CXRs according to British Society of Thoracic Imaging (BSTI) guidelines, using the area under the receiver operator curve (ROC area). Results: CXRs of 152 cases with suspected COVID-19 infection were included. Sensitivity and specificity for ‘classic’ COVID-19 CXR findings reported by ED clinician was 84 and 83%, respectively, with a ROC area of 0.84 (95%CI 0.77 to 0.90). Accuracy improved with ED clinicians’ experience, with ROC areas of 0.73 (95%CI 0.45 to 1.00), 0.81 (95%CI 0.73 to 0.89), 1.00 (95%CI 1.00 to 1.00) and 0.90 (95%CI 0.70 to 1.00) for foundation year doctors, senior house officers, higher speciality trainees and ED consultants, respectively (p < 0.001). Conclusions: ED clinicians demonstrated moderate inter-rater agreement with reporting radiologists according to the BSTI COVID-19 classifications. The improvement in accuracy with ED clinician experience suggests training of junior ED clinicians in the interpretation of COVID-19 related CXRs might be beneficial. Large-scale survey studies might be useful in the further evaluation of this topic. Advances in knowledge: This is the first study to examine inter-rater agreement between ED clinicians and radiologists in regards to COVID-19 CXR interpretation. Further service configurations such as 24-hr hot reporting of CXRs can be guided by these data, as well as an ongoing, nationwide follow-up study.

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Bilateral pleural effusion and pulmonary edema diagnosed by emergency department point-of-care ultrasound (POCUS) in a patient with severe undifferentiated dyspnea

Visual Journal of Emergency Medicine ◽

10.1016/j.visj.2021.101030 ◽

2021 ◽

Vol 23 ◽

pp. 101030

Author(s):

Diana Montero Montero ◽

Donavan Ginest ◽

Robyn Hoelle

Keyword(s):

Emergency Department ◽

Pleural Effusion ◽

Pulmonary Edema ◽

Point Of Care ◽

Bilateral Pleural Effusion ◽

Point Of Care Ultrasound

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Reported and unreported potentially important incidental findings in urgent nonenhanced abdominal CT for renal colic

Medical Principles and Practice ◽

10.1159/000515852 ◽

2021 ◽

Author(s):

Elena Belloni ◽

Stefania Tentoni ◽

Ilaria Fiorina ◽

Chandra Bortolotto ◽

Olivia Bottinelli ◽

...

Keyword(s):

Emergency Department ◽

Health Status ◽

Pleural Effusion ◽

Incidental Findings ◽

Renal Colic ◽

Legal Issues ◽

Abdominal Ct ◽

Significant Difference ◽

Original Report ◽

The Difference

PURPOSE: To retrospectively evaluate the prevalence of reported and unreported potentially important incidental findings in consecutive nonenhanced abdominal CTs performed specifically for renal colic in the urgent setting. METHOD: One radiologist, blinded to the finalized report, retrospectively re-evaluated nonenhanced abdominal CTs performed from January through December 2017 on adult patients from the Emergency Department with the specific request of urgent evaluation for renal colic, searching for potentially important incidental findings. RESULTS: The CTs of 312 patients were included in the study. Thirty-eight findings were reported in 38 different CTs, whereas the re-evaluation added 47 unreported findings in 47 different CTs, adding to total of 85 findings (27%). The difference in the proportion of reported and unreported potentially important incidental findings between the original report and re-evaluation was significant (P<.001). No significant difference was found between the age of patients with and without reported findings. The proportion of potentially important findings did not vary significantly among the three shifts neither in the original report nor in the re-evaluation. The most frequent findings, both reported and unreported, were pleural effusion, lymphadenopaties and liver nodules. CONCLUSIONS: Potentially important additional findings are frequently present in urgent nonenhanced abdominal CTs performed for renal colic, and many are not described in the finalized reports. Radiologists should take care not to under report potentially important incidental findings even in the urgent setting because of the possible consequences on the patient’s health status and in order to avoid legal issues, while satisfying the need for timely and efficient reporting.

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Ultrasonographic Applications in the Thorax

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405618666211224115249 ◽

2021 ◽

Vol 18 ◽

Author(s):

Mehmet Zeki Gunluoglu ◽

Tugrul Ormeci ◽

Selva Sen

Keyword(s):

Emergency Department ◽

Intensive Care ◽

Pleural Effusion ◽

Respiratory System ◽

Ease Of Use ◽

Endobronchial Ultrasound ◽

Access Price ◽

Wide Range ◽

Diagnostic Sensitivity And Specificity ◽

Fast Access

Abstract: Rapid developments and increasing technological knowledge have changed perspectives on ultrasonography. Previously, ultrasonography was used to evaluate chest wall pathologies, to distinguish between pleural effusion and consolidation, to evacuate pleural effusion, or to evaluate diaphragm movement. Today, it is also used in a wide range of pleural and parenchymal diseases. Ultrasonography is not just used in the emergency department and the intensive care units. It is also utilized in many clinical branches dealing with the respiratory system—due to its ease of use, fast access, price advantage, non-radiation exposure, higher diagnostic sensitivity, and specificity in many clinical situations—and has become a part of the examination. In this review, we have assessed not just transthoracic ultrasonography but also more focal and targeted sonographic applications, such as the endobronchial ultrasound and esophageal ultrasound.

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Derivation of a clinical decision rule for chest radiography in emergency department patients with chest pain and possible acute coronary syndrome

CJEM ◽

10.1017/s148180350001215x ◽

2010 ◽

Vol 12 (02) ◽

pp. 128-134 ◽

Cited By ~ 7

Author(s):

Erik P. Hess ◽

Jeffrey J. Perry ◽

Pam Ladouceur ◽

George A. Wells ◽

Ian G. Stiell

Keyword(s):

Heart Failure ◽

Emergency Department ◽

Congestive Heart Failure ◽

Chest Pain ◽

Chest Radiography ◽

Clinical Decision ◽

Chest Radiographs ◽

Clinical Decision Rule ◽

Coronary Syndrome ◽

History Of

ABSTRACTObjective:We derived a clinical decision rule to determine which emergency department (ED) patients with chest pain and possible acute coronary syndrome (ACS) require chest radiography.Methods:We prospectively enrolled patients over 24 years of age with a primary complaint of chest pain and possible ACS over a 6-month period. Emergency physicians completed standardized clinical assessments and ordered chest radiographs as appropriate. Two blinded investigators independently classified chest radiographs as “normal,” “abnormal not requiring intervention” and “abnormal requiring intervention,” based on review of the radiology report and the medical record. The primary outcome was abnormality of chest radiographs requiring acute intervention. Analyses included interrater reliability assessment (with κ statistics), univariate analyses and recursive partitioning.Results:We enrolled 529 patients during the study period between Jul. 1, 2007, and Dec. 31, 2007. Patients had a mean age of 59.9 years, 60.3% were male, 4.0% had a history of congestive heart failure and 21.9% had a history of acute myocardial infarction. Only 2.1% (95% confidence interval [CI] 1.1%–3.8%) of patients had radiographic abnormality of the chest requiring acute intervention. The κ statistic for chest radiograph classification was 0.81 (95% CI 0.66–0.95). We derived the following rule: patients can forgo chest radiography if they have no history of congestive heart failure, no history of smoking and no abnormalities on lung auscultation. The rule was 100% sensitive (95% CI 32.0%–10.4%) and 36.1% specific (95% CI 32.0%–40.4%).Conclusion:This rule has potential to reduce health care costs and enhance ED patient flow. It requires validation in an independent patient population before introduction into clinical practice.

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Thoracic imaging

Oxford Textbook of Medicine ◽

10.1093/med/9780199204854.003.180302_update_001 ◽

2010 ◽

pp. 3200-3215

Author(s):

Susan J. Copley ◽

David M. Hansell

Keyword(s):

Radiation Dose ◽

Clinical Picture ◽

Chest Radiography ◽

Thoracic Disease ◽

Thoracic Imaging ◽

Radiographic Findings ◽

Optimal Technique ◽

Lower Radiation Dose

Radiographic findings should always be interpreted in conjunction with the clinical picture. Chest radiography—this remains the commonest technique in the investigation of suspected thoracic disease. Advantages are cost, availability, and a significantly lower radiation dose than CT, but even with optimal technique nearly one-third of the lungs are partially obscured by the overlying mediastinum, diaphragm, and ribs....

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A UK-wide British Society of Thoracic Imaging COVID-19 imaging repository and database: design, rationale and implications for education and research

Clinical Radiology ◽

10.1016/j.crad.2020.03.005 ◽

2020 ◽

Vol 75 (5) ◽

pp. 326-328 ◽

Cited By ~ 9

Author(s):

S.S. Hare ◽

J.C.L. Rodrigues ◽

J. Jacob ◽

A. Edey ◽

A. Devaraj ◽

...

Keyword(s):

Database Design ◽

British Society ◽

Design Rationale ◽

Thoracic Imaging

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Deep Learning for Chest Radiography in the Emergency Department

Radiology ◽

10.1148/radiol.2019192079 ◽

2019 ◽

Vol 293 (3) ◽

pp. 581-582 ◽

Cited By ~ 1

Author(s):

Felipe Munera ◽

Juan C. Infante

Keyword(s):

Emergency Department ◽

Deep Learning ◽

Chest Radiography

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Prevalence of pneumonia in children under 12 years of age who undergo abdominal radiography in the emergency department

CJEM ◽

10.1017/s1481803500015293 ◽

2007 ◽

Vol 9 (05) ◽

pp. 347-351 ◽

Cited By ~ 6

Author(s):

Valérie Homier ◽

Colette Bellavance ◽

Marianne Xhignesse

Keyword(s):

Emergency Department ◽

Abdominal Pain ◽

Chest Radiograph ◽

Chest Radiography ◽

Acute Abdominal Pain ◽

Tertiary Care ◽

Abdominal Radiograph ◽

Upper Respiratory Tract ◽

Abdominal Radiography ◽

X Ray

ABSTRACT Objective: Pneumonia is a well-known cause of acute abdominal pain in children. However, the utility of chest radiography in this setting is controversial. We sought to determine the prevalence of pneumonia in children under 12 years of age who had abdominal pain and underwent abdominal radiography when visiting an emergency department (ED). We also aimed to describe the signs and symptoms of children diagnosed with pneumonia in this context. Methods: We conducted a retrospective analysis of electronic data from ED visits to a tertiary care centre by children 12 years of age and under who were seen between June 1, 2001, and June 30, 2003, and who underwent both an abdominal and a chest radiograph during the same visit, or an abdominal x-ray at a first visit as well as a chest x-ray in the 10 days following the initial visit. Results: Of 1584 visits studied, 30 cases of pneumonia were identified, for a prevalence of 1.89% (95% confidence interval 1.22%–1.56%). If chest radiography had been limited to children who presented with fever, cough and symptoms of an upper respiratory tract infection (URTI), the diagnosis of pneumonia would have been missed in only 2/1584 visits (0.13%). Conclusion: Children aged 12 years and under presenting to the ED with acute abdominal pain and in whom an abdominal radiograph is requested need only undergo a chest radiograph in the presence of cough, fever or other symptoms of a URTI.

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