Early Radiologic Diagnosis of Pulmonary Infection in Febrile Neutropenic Patients: A Comparison of Serial Chest Radiography and Single CT Chest

Objective. The purpose of this study is to compare the early radiologic diagnosis of pulmonary infection between serial chest radiography (chest film) and single chest computed tomography (CT chest) in the first seven days of febrile neutropenia. Methods. This study included 78 patients with hematologic malignancies who developed 107 episodes of febrile neutropenia from January 2012 to October 2017 and had a chest film performed within the first seven days. Demographic and radiographic data were retrospectively reviewed. Three radiologists independently and blindly evaluated chest films and CT chests. The sensitivity, specificity, and correlation of chest film with absolute neutrophil count were carried out. Results. A total of 222 chest films were performed during this period and found thirty-nine episodes (36.4%) of radiographic active pulmonary infection. The diagnosis of clinical positive for pulmonary infection is 44.8% (48/107). Sensitivity, specificity, positive predictive value, and negative predictive value of serial chest film in the early radiologic diagnosis of pulmonary infection are 50%, 74%, 61%, and 64%, respectively. The false-positive rate was 14%, and the false-negative rate was 22%. For single CT chest examinations, twenty-six studies were assessed, and 42.3% was indicative of radiographic active pulmonary infection. Sensitivity, specificity, positive predictive value, and negative predictive value of CT chest in the early radiologic diagnosis of pulmonary infection are 91%, 40%, 53%, and 86%, respectively. The false-positive rate was 60%. The absolute neutrophil count was not useful for predicting radiographic active pulmonary infection. Conclusion. Serial chest film for early radiologic diagnosis of pulmonary infection within the first seven days of febrile neutropenia has lower sensitivity with higher specificity as compared to a single CT chest. Conversely, CT chest may not only have a higher sensitivity in determining early pulmonary infection but also has a higher rate of false-positives.

Rare clinical manifestation of community-acquired pneumonia

A 71-year-old patient was admitted due to fever and persistent (>48 hours) hiccups. History and physical examination were not instructive. Lab tests were not specific, showing an inflammatory response. Chest film did not demonstrate opacities. The patient was treated with chlorpromazine with no relief. Fever and hiccups persisted, and therefore neck and chest CT was performed revealing a right lower lobe infiltrate, a finding consistent with pneumonia. Antibiotics were initiated and within 48 hours fever and hiccups resolved and patient recovered. Although hiccups are rarely described as a clinical manifestation of community acquired pneumonia, one should consider this diagnosis in a patient with unexplained fever.

Inflammatory Pericardial Pseudocyst Secondary to Atrial Myocardial Perforation: A Rare Complication following Transvenous Pacemaker Implantation

Pericardial cyst is an uncommon clinical-pathological entity, most often a congenital condition. We describe a case of an acquired iatrogenic pericardial pseudocyst following permanent pacemaker implantation secondary to atrial myocardial perforation. Diagnosis was achieved by a plain chest film, echocardiography, and computed tomography and confirmed intraoperatively. The pseudocyst was resected via a midline sternotomy approach. The patient recovered uneventfully. In a follow-up of 18 months, the patient is doing well.

Comparative effectiveness of a mnemonic-use approach vs. self-study to interpret a lateral chest X-ray

The chest X-ray is the most commonly performed medical imaging study; however, the lateral chest film intimidates many physicians and medical students. The lateral view is more difficult to interpret than the frontal view but provides important information that is either not visible or not as evident on frontal view, and inability to read it may lead to missed diagnoses and more expensive imaging. The objective of this study was to assess a novel mnemonic-based approach to teaching medical students to proficiently read a lateral film using a prospective pilot study. A clinical faculty radiologist taught two groups of second-year medical students to read a lateral chest X-ray. One group learned a novel mnemonic-based method (MUM), and the other cohort performed directed web-based self-study (STMM). Each cohort was given a pre- and postassessment, and their performance was analyzed. A total of n = 29 students participated with n = 14 being taught the mnemonic method. The MUM group significantly ( P = 0.001) improved their score vs. the STMM group This study demonstrates students can quickly and effectively learn to read a lateral chest film using this novel mnemonic.