scholarly journals The Diagnostic Yield and Clinical Impact of a Chest X-Ray after Percutaneous Dilatational Tracheostomy: A Prospective Cohort Study

2007 ◽  
Vol 35 (3) ◽  
pp. 393-397 ◽  
Author(s):  
S. H. Haddad ◽  
A. S. Aldawood ◽  
Y. M. Arabi
Keyword(s):  
Diagnostic Yield ◽  
Perioperative Complications ◽  
Percutaneous Dilatational Tracheostomy ◽  
Chest Physiotherapy ◽  
Radiographic Findings ◽  
X Ray ◽  
Dilatational Tracheostomy ◽  
New Finding ◽  
Chest X Ray ◽  
Tube Malposition

A chest X-ray (CXR) is routinely performed after percutaneous dilatational tracheostomy (PDT). The purpose of this study was to evaluate the diagnostic yield of routine CXR following PDT and its impact on patient management and to identify predictors of post-PDT CXR changes. Two-hundred-and-thirty-nine patients who underwent PDT in a 21-bed intensive care unit were included prospectively in the study. The following data were collected: patient demographics, APACHE III scores, pre-PDT FiO2 and PEEP, PDT technique, perioperative complications and the use of bronchoscopic guidance. We compared post-PDT CXR with the last pre-PDT CXR. We documented any post-PDT new radiographic findings including atelectasis, pneumothorax, pneumomediastinum, surgical emphysema, pulmonary infiltrates or tracheostomy tube malposition. We also recorded management modifications based on post-PDT radiographic changes, including increased PEEP, chest physiotherapy, therapeutic bronchoscopy or chest tube insertion. Atelectasis was the only new finding detected on post-PDT CXRs of 24 (10%) patients. The new radiographic findings resulted in a total of 14 modifications of management in 10 (4%) patients including increased PEEP in six, chest physiotherapy in six and bronchoscopy in two patients. Trauma and pre-PDT PEEP >5 cmH2O were independent predictors of post-PDT CXR changes. Routine CXR following PDT has a low diagnostic yield, detecting mainly atelectasis and leading to a change in the management in only a minority of patients. Routine CXR after apparently uncomplicated PDT performed by an experienced operator may not be necessary and selective use may improve its diagnostic yield. Further studies are required to validate the safety of selective versus routine post-PDT CXR.

scholarly journals Sputum smear positivity grade and chest X-ray findings in tuberculosis: A cross-sectional study

2021 ◽  
Author(s):  
R. Behzadmehr ◽  
E. Nejadkehkha
Keyword(s):  
Cross Sectional Study ◽  
Health Concern ◽  
Sputum Smear ◽  
P Value ◽  
Sectional Study ◽  
Cross Sectional ◽  
Radiographic Findings ◽  
X Ray ◽  
High Prevalence ◽  
Chest X Ray

Despite many advances in the diagnosis, screening, and rapid treatment of tuberculosis, it is still a public health concern in the world. Due to the importance of this issue in diagnosis and reduction of transmission of infection and treatment of the disease especially where this study is conducted due to the high prevalence of tuberculosis, this study was done to determine The relationship between sputum smear positivity grade and chest X-ray findings in pulmonary tuberculosis patients in a hospital in southeast of Iran. This cross-sectional study was performed on all patients with pulmonary TB referencing the health centers in Zabol city, southeast of Iran from 1 January 2015 to 30 December 2020. Sputum smear and radiographic findings of the chest X-ray were evaluated. Data was collected using a form of information and finally analyzed by SPSS 22. Out of 101 patients examined in the present study, 71 were women and 30 were men. The mean age of the patients was 62.68 ± 13.61 years. The frequency of opacity in patients with grades 1, 2, and 3 was 71.4, 78.5, and 76.5%, respectively. Frequency of cavitation in patients with Grade 1, 2 and 3 was 11.5%, 28.5% and 52.9% respectively (P value 0.001). The frequency of reticulonodular presentations in patients with grade 1, 2, and 3 was 24.2, 7.1, and 0%, respectively.  In general, the results of this study showed that, with increasing grading of smears (1+, 2+, and 3+), the frequency of cavitation presentation increased significantly and the frequency of reticulonodular presentations decreased significantly. In general, the results of this study showed that, with increasing grading of smears (, the frequency of Cavitation presentation increased significantly and the frequency of reticulonodular presentations decreased significantly. The findings of the present study can help physicians better diagnose TB.

Routine Chest X-ray after Percutaneous Tracheostomy is Unnecessary

2005 ◽  
Vol 71 (1) ◽  
pp. 51-53 ◽  
Author(s):  
Francesca Hoehne ◽  
Maria Ozaeta ◽  
Ray Chung
Keyword(s):  
Medical Center ◽  
Percutaneous Tracheostomy ◽  
Ventilatory Support ◽  
Retrospective Chart Review ◽  
Trauma Patients ◽  
Common Procedure ◽  
X Ray ◽  
Chest X Ray ◽  
Tube Malposition ◽  
Routine Chest

Percutaneous tracheostomy (PT) is an increasingly common procedure in the management of critically ill patients. Current practice for both open and percutaneous tracheostomies is a post-procedure chest X-ray to rule out potentially life-threatening complications such as a pneumothorax or tube malposition. Our study evaluated the utility of chest X-ray after PT. A retrospective chart review was conducted for patients undergoing PT at Kern Medical Center between January 1999 and December 2003. Charts were reviewed for age, sex, and clinical outcome as well as the radiologist's interpretation of the postprocedure chest X-ray. A total of 73 procedures were completed in 47 men and 26 women. The majority of the tracheostomies were in trauma patients who needed prolonged ventilatory support. There were no complications identified on postprocedure chest X-ray. A single patient was converted to an open procedure secondary to bleeding. We conclude that routine chest X-ray after PT is unnecessary.

Acute Pulmonary Toxicity By Mycophenolate Mofetil (MMF) after Haploidentical Stem Cell Transplant (SCT)

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5860-5860 ◽  
Author(s):  
Rohtesh S. Mehta ◽  
Jonathan Brammer ◽  
Elizabeth J Shpall ◽  
Richard E. Champlin
Keyword(s):  
Mycophenolate Mofetil ◽  
Pulmonary Fibrosis ◽  
Pulmonary Toxicity ◽  
Conflicts Of Interest ◽  
Chronic Phase ◽  
Cell Transplant ◽  
Radiographic Findings ◽  
X Ray ◽  
Post Transplant ◽  
Chest X Ray

Abstract CASE A 49-year old Hispanic male diagnosed with chronic phase CML in 2008 was referred for a SCT for progressive TKI-refractory disease. In May, 2014, he received a haploidentical SCT following treatment with melphalan 140mg/m2 and fludarabine 40mg/m2. GVHD prophylaxis was provided by post-transplant cyclophosphamide 50mg/kg IV on days 3 and 4, tacrolimus 0.015 mg/kg IV and MMF 15mg/kg PO tid. Bacterial, fungal and viral prophylaxis included levofloxacin, voriconazole and valacyclovir respectively. On transplant day 11, he developed asymptomatic neutropenic fever and was started on IV vancomycin and cefepime. The fevers abated by day 14, but he developed acute dyspnea and hypoxia requiring intermittent BiPAP treatment. A CAT scan showed new bilateral lung patchy ground-glass opacities [Figure 1] compared to the baseline chest X-ray. Bronchoscopy could not be performed due to the tenuous respiratory status. MMF was held and methylprednisolone (MP) 1gm/kg IV daily was started for concerns of pulmonary toxicity. His symptoms improved and the chest x-ray normalized within a few days. MMF was resumed at same dose and MP dose was reduced to 0.5 mg/kg/day; within four days there was a rapid recurrence of the pulmonary symptoms and re-emergence of diffuse airspace opacities. MMF was held again and MP was increased to the original dose, resulting in resolution of his symptoms and the radiographic findings within days. During this period, he was afebrile, infectious work-up (including comprehensive viral, bacterial and fungal testing) was negative and no RBC antibodies were detected. Table 1 summarizes his disease course. DISCUSSION To the best of our knowledge, this is the first reported case of potential MMF-related pulmonary toxicity after SCT, although similar associations have been reported in a few cases after renal and cardiac transplants.(1-4) The causal relationship of MMF-induced toxicity in our case is suggested by the temporal association, exclusion of other plausible causes, and temporal re-emergence when challenged again, and subsequent resolution of symptoms and x-ray findings with discontinuation of MMF. The underlying mechanism is unknown, although genetic polymorphisms in UGT, an enzyme involved in its metabolism, may explain unexpected toxicities – a phenomenon known to enhance toxicities of various drugs metabolized by this enzyme. (5) CONCLUSION MMF should be considered as a potential etiology of post-transplant acute pulmonary toxicity in patients undergoing hematopoietic transplantation. REFERENCES: 1. Gorgan M, Bockorny B, et al. Pulmonary hemorrhage with capillaritis secondary to mycophenolate mofetil in a heart-transplant patient. Arch Pathol Lab Med. 2013;137(11):1684-7. 2. Gross DC, Sasaki TM, et al. Acute respiratory failure and pulmonary fibrosis secondary to administration of mycophenolate mofetil. Transplantation. 1997;64(11):1607-9. 3. Morrissey P, Gohh R, et al. Pulmonary fibrosis secondary to administration of mycophenolate mofetil. Transplantation. 1998;65(10):1414. 4. Reynolds BC, Paton JY, et al. Reversible chronic pulmonary fibrosis associated with MMF in a pediatric patient: a case report. Pediatr Transplant. 2008;12(2):228-31. 5. Burchell B, Soars M, et al. Drug-mediated toxicity caused by genetic deficiency of UDP-glucuronosyltransferases. Toxicol Lett. 2000;112-113:333-40. Figure 1 Figure 1. Figure 2 Figure 2. Disclosures No relevant conflicts of interest to declare.

scholarly journals Study of Clinical and Biochemical Parameters of Type 2 Diabetic Subjects with Pulmonary Tuberculosis

2014 ◽  
Vol 4 (1) ◽  
pp. 5-8
Author(s):  
F Afsana ◽  
SNAA Jamil ◽  
ZA Latif
Keyword(s):  
Pulmonary Tuberculosis ◽  
Biochemical Parameters ◽  
Complete Blood Count ◽  
Radiological Finding ◽  
X Rays ◽  
Radiographic Findings ◽  
Bacteriological Culture ◽  
X Ray ◽  
Chest X Ray

Aims: Type 2 DM is a global epidemic and recognized as a threat to pulmonary tuberculosis (PTB) control worldwide especially in developing countries. When tuberculosis is diagnosed in diabetic subjects both can be affected in term of clinical presentation and course of disease. The aim of the study was to evaluate the demographic, clinical and biochemical parameters of newly detected PTB patients with type 2 diabetes. Methods: Seventy two diabetic subjects with newly detected PTB attending outpatient department, BIRDEM were studied. Patients with fever, cough, hemoptysis and/or weight loss were interviewed by a structured questionnaire. After thorough clinical examination, blood sugar, complete blood count (CBC), ESR, sputum for bacteriological culture and acid fast bacilli (AFB) (3 samples), X-ray chest were done. The diagnosis of PTB was based on a positive sputum AFB test, a suggestive CBC report or typical radiographic findings with high clinical probability. Diagnosed PTB cases were included in the study. All patients were followed up at least at1st, 3rd and 6th month of antitubercular therapy. Result: Mean age of study subjects was 46(19-75) years. The study subjects do not have past history of tuberculosis. Most of the study subjects (98.6%) were on insulin for treatment of diabetes. Mean body mass index (BMI) was 19.9kg/m². Mean ESR (mm in 1st hour) was 94.5 with 60% subjects having ESR >100. Sputum for bacteriological culture revealed no growth in 77.3% patients. Chest X-ray revealed cavity in 47.2%, opacity in 40.3%, both opacity and cavity in 5.6 %, pleural effusion in 5.6% and 5.5% had no detectable lesion. All patients were sputum AFB positive and among them 73.6% (n=53) had AFB positive in all 3 samples. Most of the patients (n=62, 86.6%) become sputum AFB negative after one month of treatment initiation. Rest 10 subjects (13.4%) become sputum negative in 2 months follow up and all of these patients had cavitary lesions in chest X-rays. A good number of the patients (98%) with positive x-ray finding showed radiological improvement after 2 months of antitubercular treatment. All the patients completed their therapy without any interruption for 6 months. Conclusion: Pulmonary cavity and opacity is the commonest radiological finding among study subjects. Sputum positivity for AFB is a good diagnostic tool for PTB in diabetic subjects. Subjects with cavitary lesion in chest X-ray become sputum negative than others. DOI: http://dx.doi.org/10.3329/birdem.v4i1.18545 Birdem Med J 2014; 4(1): 5-8

scholarly journals Discordance Between Radiologic Findings and Molecular Testing in Patients With Underlying Hematologic Malignancy and Coronavirus Disease 2019

2020 ◽  
Vol 7 (9) ◽  
Author(s):  
Mohammed Raja ◽  
Yoichiro Natori ◽  
Aditya Chandorkar ◽  
Jose F Camargo ◽  
Jacques Simkins ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Clinical Presentation ◽  
Hematologic Malignancy ◽  
Severe Disease ◽  
Molecular Testing ◽  
Radiographic Findings ◽  
X Ray ◽  
Radiologic Findings ◽  
Immunosuppressed Patients ◽  
Chest X Ray

Abstract Severe acute respiratory syndrome coronavirus 2 is associated with severe disease in patients with hematologic malignancy. We report a series of patients with underlying hematologic malignancy and coronavirus disease of 2019 with discrepancy between radiographic findings and molecular testing. Initial chest x-ray findings should raise suspicion in immunosuppressed patients with typical clinical presentation even with negative initial testing.

scholarly journals Early chest X-ray in persons with presumptive tuberculosis increases Xpert® MTB/RIF diagnostic yield and efficiency

2020 ◽  
Vol 10 (1) ◽  
pp. 17-20
Author(s):  
Z. Nadiah ◽  
R. C. Koesoemadinata ◽  
S. M. McAllister ◽  
G. Putriyani ◽  
L. Chaidir ◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Diagnostic Yield ◽  
Content Type ◽  
X Ray ◽  
Acid Fast Bacilli ◽  
Number Needed To Screen ◽  
Sputum Microscopy ◽  
Chest X Ray

Adult presumptive tuberculosis (TB) patients (n = 1690) were screened for TB using a questionnaire, chest X-ray (CXR) and sputum microscopy for acid-fast bacilli (AFB); <named-content content-type="genus-species">Mycobacterium tuberculosis</named-content> culture was performed for 74% of the patients and Xpert® MTB/RIF was done for 17.2%. Among patients recruited, 943 (55.8%) were diagnosed with TB, of whom 870 (92.3%) were bacteriologically confirmed and 73 (7.7%) were clinically diagnosed on the basis of CXR. Using CXR prior to culture or Xpert testing reduces the number needed to screen from 7.6 to 5.0. Using CXR to triage for culture or Xpert testing reduces the number of missed cases and increases the efficiency of culture and Xpert testing.

scholarly journals Pulmonary paracoccidoidomycosis: radiology and clinical-epidemiological evaluation

2010 ◽  
Vol 43 (6) ◽  
pp. 651-656 ◽  
Author(s):  
Ricardo Miguel Costa de Freitas ◽  
Renata Prado ◽  
Fábio Luis Silva do Prado ◽  
Ivie Braga de Paula ◽  
Marco Túlio Alves Figueiredo ◽  
...  
Keyword(s):  
Statistical Difference ◽  
Radiological Finding ◽  
General Rule ◽  
Signs And Symptoms ◽  
Adult Males ◽  
Radiographic Findings ◽  
X Ray ◽  
Rural Workers ◽  
Chest X Ray ◽  
Group 1

INTRODUCTION: The purpose of this study was to compare respiratory signs and symptoms between patients with and without chest X-ray abnormalities in order to establish the meaning of radiographic findings in pulmonary PCM diagnosis. METHODS: The epidemiological, clinical and radiological lung findings of 44 patients with paracoccidiodomycosis (PCM) were evaluated. Patients were divided into two groups of 23 and 21 individuals according to the presence (group 1) or absence (group 2) of chest X-ray abnormalities, respectively, and their clinical data was analyzed with the aid of statistical tools. RESULTS: As a general rule, patients were rural workers, young adult males and smokers - group 1 and 2, respectively: males (91.3% and 66.7%); mean age (44.4 and 27.9 year-old); smoking (34.7% and 71.4 %); acute/subacute presentation (38.1% and 21.7%); chronic presentation (61.9% and 78.3%). The most frequent respiratory manifestations were - group 1 and 2, respectively: cough (25% and 11.4%) and dyspnea (22.7% and 6.8%). No statistical difference was observed in pulmonary signs and symptoms between patients with or without radiographic abnormalities. The most frequent radiological finding was nodular (23.8%) or nodular-fibrous (19%), bilateral (90.5%) and diffuse infiltrates (85.7%). CONCLUSIONS: Absence of statistical difference in pulmonary signs and symptoms between these two groups of patients with PCM indicates clinical-radiological dissociation. A simplified classification of radiological lung PCM findings is suggested, based on correlation of these data and current literature review.

scholarly journals Chest X-Ray Findings and Temporal Lung Changes in Patients with COVID-19 Pneumonia

2020 ◽  
Author(s):  
Liqa A Rousan ◽  
Eyhab Elobeid ◽  
Musaab Karrar ◽  
Yousef Khader
Keyword(s):  
Ct Scan ◽  
Chest Ct ◽  
Common Finding ◽  
X Rays ◽  
Radiographic Findings ◽  
X Ray ◽  
Abnormal Chest ◽  
Chest X Ray ◽  
Chest Ct Scan

Abstract Background: Chest CT scan and chest x-rays show characteristic radiographic findings in patients with COVID-19 pneumonia. Chest x-ray can be used in diagnosis and follow up in patients with COVID-19 pneumonia. The study aims at describing the chest x-ray findings and temporal radiographic changes in COVID-19 patients.Methods: From March 15 to April 20, 2020 patients with positive reverse transcription polymerase chain reaction (RT-PCR) for COVID-19 were retrospectively studied. Patients’ demographics, clinical characteristics, and chest x-ray findings were reported. Radiographic findings were correlated with the course of the illness and patients’ symptoms.Results: A total of 88 patients (50 (56.8%) females and 38 (43.2%) males) were admitted to the hospital with confirmed COVID-19 pneumonia. Their age ranged from 3-80 years (35.2 ±18.2 years). 48/88 (45%) were symptomatic, only 13/88 (45.5%) showed abnormal chest x-ray findings. A total of 190 chest x-rays were obtained for the 88 patients with a total of 59/190 (31%) abnormal chest x-rays. The most common finding on chest x-rays was peripheral ground glass opacities (GGO) affecting the lower lobes. In the course of illness, the GGO progressed into consolidations peaking around 6-11 days (GGO 70%, consolidations 30%). The consolidations regressed into GGO towards the later phase of the illness at 12-17 days (GGO 80%, consolidations 10%). There was increase in the frequency of normal chest x-rays from 9% at days 6- 11 up to 33% after 18 days indicating a healing phase. The majority (12/13, 92.3%) of patients with abnormal chest x-rays were symptomatic (P=0.005).Conclusion: The chest x-ray findings were similar to those reported on chest CT scan in patients with COVID-19, Chest x-ray can be used in diagnosis and follow up in patients with COVID-19 pneumonia.

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