Utility of chest CT after a chest X-ray in patients presenting to the ED with non-traumatic thoracic emergencies

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Abstract

Background:

Chest radiography is the initial choice for thoracic imaging. However, the wide availability of computed tomography (CT) has led to a substantial increase in its use in the emergency department (ED). We evaluated the utility of chest CT after a chest X-ray in patients presenting to the ED with non-traumatic thoracic emergencies, and determined if the diagnosis and management decision changed after CT.

Methods:

The study enrolled 500 consecutive patients with both chest X-rays and CT who presented to the ED with non-traumatic complaints. Chest X-rays and CT images obtained within 12 h before any definitive treatment were randomly evaluated in consensus by two radiologists blinded to the clinical information.

Results:

The chest X-ray and CT image findings were concordant in 49.2% of the 500 patients and this concordance was negatively correlated with patient age. Leading diagnosis and management decisions based on the chest radiograph changed after CT in 35.4% of the study group and this finding was also correlated with age. In 55% of 205 patients, pneumonic infiltrations were undiagnosed with radiography. Pulmonary edema was the most specific (93.3%) and sensitive (85.4%) radiography finding. Posteroanterior chest radiographs taken in the upright position had higher concordance with CT than anteroposterior (AP) radiographs taken in the supine position.

Conclusions:

Chest CT may be an appropriate imaging choice in patients presenting to the ED for non-traumatic reasons, particularly for elderly patients and when the radiograph is taken with the AP technique in a supine position.

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