Don't Just Rely on X-Rays

​A woman in her 50s reported four days of left-sided pleuritic chest pain in her lower ribs. No other symptoms: no fever, trauma, shortness of breath, cough, or wheezing. It's COVID times, so who knows? A chest x-ray and labs were ordered. The x-ray appeared clear. Perhaps it was pleurisy. The white blood count was more than 17 mL! Still no fever: 99.2°F.Then the D-dimer came back elevated. A chest CT angiogram was obviously the next step. Maybe it was a pulmonary embolism.Surprise! It was pneumonia, and it wasn't a little one!Chest x-rays are used as a screening tool for pneumonia. They require less time, less radiation, and less effort. Every EP knows that ordering a CT scan increases the length of stay, but what every EP may not know is that the chest x-ray often does not tell the correct story.One study showed a "substantial discordance with respect to detection of pulmonary opacities between CXR and chest CT as interpreted by radiologists viewing the studies for routine clinical care. Only 43.5% of patients with opacities on CT had opacities noted on CXR. Furthermore, CXR findings interpreted as pulmonary opacities were frequently not reproduced on concurrent CT; only 26.9% of patients with a CXR interpreted as having pulmonary opacities had opacities recognized on CT." (Am J Emerg Med. 2013;31[2]:401; https://bit.ly/35HzCTt.)This case is an excellent reminder that one must be wary. Chest x-rays can be deceiving. Incre...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs