Related Experiment Video
Updated: Jul 23, 2025
Imaging Features of Systemic Sclerosis-Associated Interstitial Lung Disease
Published on: June 16, 2020
Predictive power of chest radiography for infectious or inflammatory lung disease
Nate C Hull1, Paul G Thacker1, Richard Paul Boesch2
1Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
Insights
Chest X-rays (CXR) are not reliable for excluding pediatric lung inflammation or infection, despite being inexpensive and low-radiation. A normal CXR has limited ability to rule out these conditions in children with chronic respiratory symptoms.
Area of Science:
- Pediatric Pulmonology
- Diagnostic Imaging
- Infectious Disease
Background:
- Chronic cough, recurrent infections, and dysphagia are common in children.
- These symptoms often do not correlate with significant inflammatory lung disease.
- Bronchoalveolar lavage (BAL) is definitive but invasive and costly; Chest X-rays (CXR) are accessible alternatives.
Purpose of the Study:
- To evaluate the accuracy of Chest X-rays (CXR) in predicting or excluding infectious or inflammatory lung disease in pediatric patients.
- To determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CXR compared to BAL findings.
Main Methods:
- Retrospective cohort study of pediatric patients undergoing flexible bronchoscopy (FFB) with BAL within two weeks of a CXR.
- Blinded review of CXR images by two senior pediatric radiologists for inflammatory findings.
- Calculation of diagnostic accuracy metrics for CXR against BAL results.
Main Results:
- Out of 344 subjects, 77% had positive CXR findings.
- CXR sensitivity for BAL inflammation/infection was high (84.7-90.9%).
- CXR demonstrated lower specificity and PPV, with NPV ranging from 65.0% to 87.5% for inflammation or infection.
Conclusions:
- Chest X-rays (CXR) are valuable for detecting signs of lung inflammation or infection in children.
- However, a normal CXR has limited utility in excluding active inflammatory or infectious lung disease.
- CXR should be interpreted cautiously in pediatric patients with concerning respiratory symptoms.
Objective:
Children frequently present with chronic cough, recurrent respiratory infections, and dysphagia. These symptoms are poor predictors of significant inflammatory lung disease, such as from chronic aspiration. Bronchoalveolar lavage (BAL) is the gold standard for identification of lung infection and airway inflammation but is expensive and requires sedation. Chest X-rays (CXR) are inexpensive, low-radiation tests that do not require sedations and can document findings associated with infectious or inflammatory lung disease. The accuracy of CXR to predict or exclude infectious or inflammatory lung disease has not been directly evaluated and is unknown.
Methods:
Retrospective cohort of all pediatric patients who underwent FFB with BAL within 2 weeks of a CXR. Blinded CXR images reviewed for findings consistent with inflammatory disease by two senior pediatric radiologists. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for CXR to identify significant inflammation and/or infection on BAL were calculated.
Results:
Three hundred and forty-four subjects included. Two hundred and sixty-three had positive CXR (77%), 183 had inflammatory BAL (53%), and 110 had infection (32%). The sensitivity of CXR changes for BAL inflammation, infection, and either inflammation or infection was 84.7, 90.9, and 85.3, respectively. The PPV of CXR was 58.9, 38.0, and 59.7. The NPV of CXR was 65.0, 87.5, and 66.3.
Conclusions:
Although CXR are inexpensive, do not require sedation, and are of low radiation dose, the ability of an entirely normal CXR to exclude active inflammatory or infectious lung disease is limited.
More Related Videos
08:05Lung CT Segmentation to Identify Consolidations and Ground Glass Areas for Quantitative Assesment of SARS-CoV Pneumonia
Published on: December 19, 2020
02:09Multi-modal Pulmonary Imaging: Using Complementary Information from CT and Hyperpolarized 129Xe MRI to Evaluate Lung Structure-Function
Published on: April 12, 2024
Related Concept Videos
01:30Pneumonia III: Complications and Assessment
01:27Pneumothorax-II
Clinical Manifestations:
01:30Radiological Investigation II: MRI and Ventilation Perfusion Scan
Magnetic Resonance Imaging (MRI) and Ventilation Perfusion Scans are two radiological investigations that offer detailed diagnostic images of the body, particularly lung structures.
MRI
MRI uses magnetic fields and radiofrequency signals to distinguish between normal and abnormal tissues. This technology provides a more detailed diagnostic image than CT scans, enabling it to characterize pulmonary nodules, stage bronchogenic carcinoma, and evaluate inflammatory activity in...
01:20Imaging Studies for Cardiovascular System III: X-Ray
Definition and Purpose
An X-ray, or radiograph, is a non-invasive method that uses ionizing radiation to take images of internal structures. It is mainly used in cardiac imaging to examine the heart, lungs, and major blood vessels, aiming to identify abnormalities in the heart's size, shape, and position, such as heart failure, congenital defects, and vascular...
01:26Pulmonary Tuberculosis IV
Several diagnostic approaches are used to detect TB. The conventional method is the Tuberculin Skin Test (TST), also known as the Mantoux test. However, this method has...
01:30Radiological Investigation I: X-ray and CT