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BMC Pulmonary Medicine Dec 2018Guidelines currently do not recommend the routine use of chest x-ray (CXR) in bronchiolitis. However, CXR is still performed in a high percentage of cases, mainly to... (Clinical Trial)
Clinical Trial Comparative Study
BACKGROUND
Guidelines currently do not recommend the routine use of chest x-ray (CXR) in bronchiolitis. However, CXR is still performed in a high percentage of cases, mainly to diagnose or rule out pneumonia. The inappropriate use of CXR results in children exposure to ionizing radiations and increased medical costs. Lung Ultrasound (LUS) has become an emerging diagnostic tool for diagnosing pneumonia in the last decades. The purpose of this study was to assess the diagnostic accuracy and reliability of LUS for the detection of pneumonia in hospitalized children with bronchiolitis and to evaluate the agreement between LUS and CXR in diagnosing pneumonia in these patients.
METHODS
We enrolled children admitted to our hospital in 2016-2017 with a diagnosis of bronchiolitis and undergone CXR because of clinical suspicion of concomitant pneumonia. LUS was performed in each child by a pediatrician blinded to the patient's clinical, laboratory and CXR findings. An exploratory analysis was done in the first 30 patients to evaluate the inter-observer agreement between a pediatrician and a radiologist who independently performed LUS. The diagnosis of pneumonia was established by an expert clinician based on the recommendations of the British Thoracic Society guidelines.
RESULTS
Eighty seven children with bronchiolitis were investigated. A final diagnosis of concomitant pneumonia was made in 25 patients. Sensitivity and specificity of LUS for the diagnosis of pneumonia were 100% and 83.9% respectively, with an area under-the-curve of 0.92, while CXR showed a sensitivity of 96% and specificity of 87.1%. When only consolidation > 1 cm was considered consistent with pneumonia, the specificity of LUS increased to 98.4% and the sensitivity decreased to 80.0%, with an area under-the-curve of 0.89. Cohen's kappa between pediatrician and radiologist sonologists in the first 30 patients showed an almost perfect agreement in diagnosing pneumonia by LUS (K 0.93).
CONCLUSIONS
This study shows the good accuracy of LUS in diagnosing pneumonia in children with clinical bronchiolitis. When including only consolidation size > 1 cm, specificity of LUS was higher than CXR, avoiding the need to perform CXR in these patients. Added benefit of LUS included high inter-observer agreement.
TRIAL REGISTRATION
Identifier: NCT03280732 . Registered 12 September 2017 (retrospectively registered).
Topics: Bronchiolitis; Diagnosis, Differential; Dimensional Measurement Accuracy; Female; Humans; Infant; Infant, Newborn; Italy; Lung; Male; Pneumonia; Prospective Studies; Radiation Exposure; Radiography, Thoracic; Reproducibility of Results; Sensitivity and Specificity; Ultrasonography
PubMed: 30526548
DOI: 10.1186/s12890-018-0750-1 -
The Journal of the American Osteopathic... Feb 2016
Topics: Diagnosis, Differential; Humans; Male; Pneumorrhachis; Radiography, Thoracic; Tomography, X-Ray Computed; Young Adult
PubMed: 26830529
DOI: 10.7556/jaoa.2016.027 -
Thorax May 1964
Topics: Angiography; Arteriovenous Fistula; Chondroma; Hamartoma; Humans; Lung Neoplasms; Pulmonary Artery; Pulmonary Veins; Radiography, Thoracic
PubMed: 14143502
DOI: 10.1136/thx.19.3.236 -
Heart (British Cardiac Society) Jul 2022
Topics: Humans; Radiography, Thoracic
PubMed: 35831003
DOI: 10.1136/heartjnl-2022-320973 -
Journal of Veterinary Internal Medicine Jul 2021The best test between thoracic ultrasonography (TUS) and thoracic radiography (TR) or the best combination of tests (series or parallel) to detect active infectious...
BACKGROUND
The best test between thoracic ultrasonography (TUS) and thoracic radiography (TR) or the best combination of tests (series or parallel) to detect active infectious bronchopneumonia (BP) in hospitalized dairy calves remains unknown.
HYPOTHESIS/OBJECTIVES
To estimate performances of TUS and TR to detect active BP in hospitalized dairy calves and to determine the best strategy for using these tests based on a panel diagnosis method (PDM). Performances of TUS and TR were hypothesized to be equivalent.
ANIMALS
Fifty hospitalized dairy calves (≥7 days old; ≤100 kg; standing; pCO ≥ 53 mm Hg; any reason of presentation).
METHODS
Each calf prospectively and sequentially underwent physical examination, thoracic auscultation, blood analyses, and TUS and TR. Three blinded experts determined whether active BP was present/absent based on PDM. Krippendorff's alpha measured interexpert agreement. The sensitivities (Se) and specificities (Sp) of TUS and TR alone and in series or parallel were compared (McNemar's test; P < .05).
RESULTS
Interexpert agreement was moderate at 0.58 (95%CI: 0.42; 0.73). The Se and Sp of TUS were 0.84 (95%CI: 0.60; 0.97) and 0.74 (95%CI: 0.57; 0.86), respectively. The Se and Sp of TR were 0.89 (95%CI: 0.67; 0.99) and 0.58 (95%CI: 0.39; 0.75), respectively. No significant difference was found in the Se and Sp of TUS and TR when analyzed alone, in series or in parallel.
CONCLUSION
Thoracic ultrasonography or TR alone equally detected active BP in hospitalized dairy calves. Series or parallel analysis provided no additional benefit. Its ease of use and widespread accessibility support using TUS as a first-line test to detect active BP in hospitalized dairy calves.
Topics: Animals; Bronchopneumonia; Cattle; Cattle Diseases; Radiography, Thoracic; Sensitivity and Specificity; Ultrasonography
PubMed: 33993530
DOI: 10.1111/jvim.16157 -
The Korean Journal of Internal Medicine Sep 2019
Topics: Adult; Female; Genetic Predisposition to Disease; Heredity; Humans; Medical History Taking; Osteopetrosis; Pedigree; Phenotype; Predictive Value of Tests; Radiography, Thoracic; Tomography, X-Ray Computed
PubMed: 29761793
DOI: 10.3904/kjim.2018.026 -
Pediatric Radiology Oct 2017Diagnostic imaging plays a significant role in both the diagnosis and treatment of complications of pneumonia in children and chest radiography is the imaging modality... (Review)
Review
Diagnostic imaging plays a significant role in both the diagnosis and treatment of complications of pneumonia in children and chest radiography is the imaging modality of choice. Computed tomography (CT) on the other hand, is not currently a first-line imaging tool for children with suspected uncomplicated community-acquired pneumonia and is largely reserved for when complications of pneumonia are suspected or there is difficulty in differentiating pneumonia from other pathology. This review outlines the situations where CT needs to be considered in children with pneumonia, describes the imaging features of the parenchymal and pleural complications of pneumonia, discusses how CT may have a wider role in developing countries where human immunodeficiency virus (HIV) and tuberculosis are prevalent, makes note of the role of CT scanning for identifying missed foreign body aspiration and, lastly, addresses radiation concerns.
Topics: Child; Community-Acquired Infections; Humans; Pneumonia; Radiography, Thoracic; Tomography, X-Ray Computed
PubMed: 29043419
DOI: 10.1007/s00247-017-3891-0 -
PloS One 2018The purpose of this prospective study was to describe the normal anatomy and provide reference ranges for measurements of thoracic radiography on Squirrel monkeys (n =...
The purpose of this prospective study was to describe the normal anatomy and provide reference ranges for measurements of thoracic radiography on Squirrel monkeys (n = 13). Thoracic radiography is a common non-invasive diagnostic tool for both cardiac and non-cardiac thoracic structures. Furthermore cardiac disease is a common condition in captive primates. In this study, left-right lateral, right-left lateral and dorsoventral projections of 13 healthy Squirrel monkeys were reviewed during their annual health examinations. The mean Vertebral Heart Score on the left-right and right-left lateral projections were 8,98 ± 0,25 and 8,85 ± 0,35 respectively. The cardio-thoracic ratio on the dorsoventral projection was 0,68 ± 0,03. The trachea to inlet ratio was 0,33 ± 0,04. Other measurements are provided for the skeletal, cardiac and respiratory systems. Knowledge of the normal radiographic thoracic anatomy is fundamental in clinical as well as research settings for accurate diagnosis of diseases.
Topics: Animals; Early Diagnosis; Female; Heart; Heart Diseases; Male; Monkey Diseases; Prospective Studies; Radiography, Thoracic; Saimiri; Spine; Thorax; Trachea
PubMed: 30086141
DOI: 10.1371/journal.pone.0201646 -
Respiratory Care Mar 2012The bedside chest x-ray (CXR) is an indispensible diagnostic tool for monitoring seriously ill patients in the intensive care unit. The CXR often reveals abnormalities... (Review)
Review
The bedside chest x-ray (CXR) is an indispensible diagnostic tool for monitoring seriously ill patients in the intensive care unit. The CXR often reveals abnormalities that may not be detected clinically. In addition, bedside CXRs are an irreplaceable tool with which to detect the malposition of tubes and lines and to identify associated complications. Although the image quality is often limited, bedside CXRs still provide valuable diagnostic information. The interpretation of the bedside CXRs is often challenging, and requires extensive radiologic experience to avoid misinterpretation of the wide spectrum of pleural and pulmonary disease. The clinical information is of substantial value for the interpretation of the frequently nonspecific findings.
Topics: Catheterization, Central Venous; Chest Tubes; Critical Care; Humans; Intra-Aortic Balloon Pumping; Intubation, Intratracheal; Lung; Pneumonia; Pneumothorax; Point-of-Care Systems; Pulmonary Atelectasis; Pulmonary Edema; Radiography, Thoracic; Respiratory Distress Syndrome; Respiratory Tract Diseases
PubMed: 22391269
DOI: 10.4187/respcare.01712 -
American Journal of Veterinary Research Nov 2021To describe qualitative and quantitative cardiothoracic values in geriatric Sika deer (Cervus nippon) using digital radiography, 6-lead ECG (sECG), and smartphone-based...
OBJECTIVE
To describe qualitative and quantitative cardiothoracic values in geriatric Sika deer (Cervus nippon) using digital radiography, 6-lead ECG (sECG), and smartphone-based ECG (aECG).
ANIMALS
10 healthy geriatric Sika deer (9 females and 1 male).
PROCEDURES
Deer were chemically immobilized, thoracic radiographs were obtained, and inhalant anesthesia was initiated. An sECG and aECG were simultaneously recorded for each animal using the same ECG specifications. Results were compared between devices.
RESULTS
Radiographically, no deer had any cardiopulmonary abnormalities. Median (range) values for the most important cardiac measurements were 170 (153-193) mm for cardiac height, 135 (122-146) mm for cardiac width, 9 (8-9) for vertebral heart score, and 99 (69-124) mm for cardiosternal contact. All deer had a normal sinus rhythm with no pathological arrhythmias noted. A significant difference between sECG and aECG was identified for minimum heart rate (49 vs 51 beats/min, respectively), P wave duration (0.05 vs 0.03 seconds), P wave amplitude (0.28 vs 0.10 mV), PR interval (0.15 vs 0.12 seconds), and QT interval (0.39 vs 0.30 seconds).
CLINICAL RELEVANCE
Thoracic radiographs were suitable to evaluate basic cardiothoracic morphology in Sika deer. The aECG was useful for assessing heart rate and rhythm but, compared with sECG, proved no substitute for evaluating duration and amplitude of ECG waveforms.
Topics: Animals; Female; Male; Deer; Electrocardiography; Radiography, Thoracic; Smartphone
PubMed: 34843445
DOI: 10.2460/ajvr.21.08.0128