Discordant Chest Radiographs—A Pitfall in Febrile Elderly Patients With Pneumonia

Summary 

A 77-year-old female presented to our emergency department (ED) with sudden onset of fever and general malaise for a week. She was initially seen by her family physician a few days prior to ED admission. She reported no respiratory tract symptoms. Both primary care and ED physicians ordered chest X-rays to check for atypical presentation of pneumonia; both chest X-rays were negative for pneumonia. An abdominal computed tomography (CT) scan was ordered after abdominal ultrasound screening with suspected liver abscess during her ED stay. Surprisingly, the CT scan revealed right lung parenchyma infiltrates rather than liver abscess. The chest radiograph remains the gold standard for diagnosing pneumonia, but clinicians should be aware that chest radiography does not provide 100% reliable pneumonia diagnosis, especially in elderly patients. Physicians may need to consider the CT scan, not for routine use but as an alternative tool for making the diagnosis if no clear source of fever is found.

Key Words:  chest X-rays , computed tomography , pneumonia

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