International Journal of Gerontology
Volume 3, Issue 3 , Pages 185-187, September 2009

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

  • Wei-De Tsai
    • ,
  • Hsin-Tang Chen

      Affiliations

    • Corresponding Author InformationCorrespondence to: Dr Hsin-Tang Chen, Department of Emergency Medicine, Mackay Memorial Hospital, 92, Chung-Shan North Road, 92, Section 2, Taipei 10100, Taiwan
    • ,
  • Wen-Han Chang

Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan

Accepted 23 June 2009.

Article Outline

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

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Fee C , Weber EJ , Maak CA , et al.   Effect of emergency department crowding on time to antibiotics in patients admitted with community-acquired pneumonia . Ann Emerg Med . 2007;50:501–509
  2. Donowitz GR , Cox HL . Bacterial community-acquired pneumonia in older patients . Clin Geriatr Med . 2007;23:515–534
  3. Al Aseri Z . Accuracy of chest radiograph interpretation by emergency physicians . Emerg Radiol . 2009;16:111–114
  4. Hash R , Stephens J , Laurens M , et al.   The relationship between volume status, hydration, and radiographic findings in the diagnosis of community-acquired pneumonia . J Fam Pract . 2000;49:833–837
  5. Basi SK , Marrie TJ , Huang JQ , et al.   Patients admitted to hospital with suspected pneumonia and normal chest radiographs: epidemiology, microbiology, and outcomes . Am J Med . 2004;117:305–311
  6. Syrjala H , Broas M , Suramo I , et al.   High-resolution computed tomography for the diagnosis of community-acquired pneumonia . Clin Infect Dis . 1998;27:358–363
  7. Tan Kendrick AP , Ling H , Subramaniam R , et al.   The value of early CT in complicated childhood pneumonia . Pediatr Radiol . 2002;32:16–21
  8. Heussel CP , Kauczor HU , Heussel GE , et al.   Pneumonia in febrile neutropenic patients and in bone marrow and blood stem-cell transplant recipients: use of highresolution computed tomography . J Clin Oncol . 1999;17:796–805
  9. Richards PJ , Riddell L , Reznek RH , et al.   High resolution computed tomography in HIV patients with suspected Pneumocystis carinii pneumonia and a normal chest radiograph . Clin Radiol . 1996;51:689–693
  10. O'Brien WT , Rohweder DA , Lattin GE , et al.   Clinical indicators of radiographic findings in patients with suspected community-acquired pneumonia: who needs a chest x-ray? . J Am Coll Radiol . 2006;3:703–706

PII: S1873-9598(09)70045-6

doi:10.1016/S1873-9598(09)70045-6

International Journal of Gerontology
Volume 3, Issue 3 , Pages 185-187, September 2009

Article Tools