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Chest roentgenogram in pulmonary tuberculosis. New data on an old test
P F Barnes1, T D Verdegem, L A Vachon
1Department of Medicine, Los Angeles County, University of Southern California Medical Center.
Chest
|August 1, 1988
Summary
Routine chest roentgenograms (CXRs) effectively detect pulmonary tuberculosis in high-prevalence areas. Specific CXR patterns, like cavitation, significantly increase the likelihood of identifying acid-fast bacilli (AFB) in sputum smears.
Area of Science:
- Medical Imaging
- Infectious Diseases
- Pulmonology
Background:
- Pulmonary tuberculosis (TB) diagnosis can be challenging, especially when initial symptoms are unrelated to respiratory illness.
- The role of routine admission chest roentgenograms (CXRs) in identifying TB requires further evaluation.
Purpose of the Study:
- To assess the utility of routine admission CXRs in detecting pulmonary tuberculosis.
- To determine the relationship between CXR patterns and the detection rate of acid-fast bacilli (AFB) on sputum smears.
Main Methods:
- Retrospective analysis of 58 patients with chief complaints unrelated to TB.
- Evaluation of CXR findings suggestive of TB and correlation with sputum smear results for AFB.
- Review of emergency room diagnostic processes, including symptom elicitation and CXR utilization.
Main Results:
- CXRs suggested TB in 90% of cases (52/58) where initial complaints were unrelated to TB.
- Tuberculosis was missed in the emergency room in 18 cases due to lack of CXR.
- Sputum smears showed AFB in 98% of cases with cavitation or extensive alveolar infiltrate on CXR, versus 50% in other patterns.
Conclusions:
- Routine admission CXRs are valuable for TB detection in hospitals serving TB-endemic populations.
- Roentgenographic findings significantly influence the probability of detecting AFB on sputum smears, guiding diagnostic efforts.