Mandeep Kang MD, Abstract Co-Author: Nothing to Disclose

Debasis Deoghuria MD, Abstract Co-Author: Nothing to Disclose

Madhu Gulati MD, Abstract Co-Author: Nothing to Disclose

Subhash Varma MD, Abstract Co-Author: Nothing to Disclose

Dheeraj Gupta MD, Abstract Co-Author: Nothing to Disclose

Ram Prakash Galwa MD, Presenter: Nothing to Disclose

Niranjan Khandelwal MD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

Fever is of grave concern in the management of patients(pts) with neutropenia with early detection of a focus of infection being the major goal. As pneumonia is the most common focus, chest imaging is of vital importance. This prospective study was undertaken to assess the usefulness of HRCT in early detection and characterization of pulmonary abnormalities in febrile neutropenia.

104 consecutive pts(M:F::75:29; age range-11-66yrs, mean age 39.7yrs) with fever of 38.2ºC or more with an absolute neutrophil count <500/µl underwent HRCT chest. The images were interpreted by two chest radiologists and conclusion drawn by consensus. HRCT diagnosis was compared with final diagnosis based on ancillary investigations and clinical response to therapy.

HRCT could detect pulmonary abnormalities in 94 pts(90.38%) with air-space consolidation being the most common finding(n=57), followed by ground-glass opacities(GGO)(n=49) and nodules(n=39). HRCT could correctly characterize the lesions in 83 pts(88.29%). Presence of random or pleural-based nodules >10mm with/without surrounding GGO or cavitations was sensitive(95%) and specific(96.7%) for fungal infection(n=19), while small(1-4mm) random or centrilobular nodules with tree-in-bud appearance were highly sensitive(90%) and specific(97.02%) for tuberculosis(n=9). Diagnosis of pyogenic infection(n=39) based on presence of air-space consolidation, pleural effusion, GGO or centrilobular nodules showed a sensitivity of 84.78% and specificity of 93.1%, while patchy or diffuse GGO, interstitial thickening and/or air-space consolidation showed high sensitivity(86.7%) and specificity(96.8%) for pneumocystis jiroveci pneumonia(n=13). Analysis of the results at three points during the study showed significant improvement in interpretation of HRCT findings.

HRCT chest should be performed in all febrile neutropenic pts as it can not only detect but also characterize pulmonary lesions allowing initiation of specific therapy even before laboratory confirmation.

HRCT is a highly efficacious tool allowing early diagnosis and initiation of therapy and should form an integral part in the diagnostic algorithm for febrile neutropenia.

Kang, M, Deoghuria, D, Gulati, M, Varma, S, Gupta, D, Galwa, R, Khandelwal, N, et al, , et al, , Role of HRCT Chest in the Detection and Characterization of Pulmonary Abnormalities in Patients with Febrile Neutropenia.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5010658.html