The value of chest X ray in asymptomatic young adults with positive PPD test

The value of chest radiograph in the management of asymptomatic tuberculin positive (> 10mm) individuals is controversial. We reviewed the results from two centers in Beirut: The Employment Health Program at Makassed General Hospital (MGH) in 1984 and the Visa Applicants Program at the American University of Beirut Medical Center (AUB-MC) 1990-1991. All subjects were free of symptoms and their physical examination was unrevealing. At MGH, out of 450 PPD tests, 46 (10.2%) were positive and chest-x-rayed. Forty-four (95.6%) were reported as normal, one had a chronic inflammation and one had metastasis. At AUB-MC, 67 PPD positive persons were x-rayed, of whom 65 (97%) were normal and the remainder two showed inactive granulomatous disease. No active tuberculosis case was detected. Isoniazid (INH) prophylaxis is recommended in the above selected group of subjects. We conclude that routine chest radiograph is of no significant value in the management of asymptomatic positive skin reactors, age group (16-35). A larger study is being undertaken for further delineating the usefulness, as well as the cost effectiveness of routine chest X ray being done on the above mentioned groups of individuals in our population.