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
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