Chest
Volume 94, Issue 2, August 1988, Pages 316-320
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Chest Roentgenogram in Pulmonary Tuberculosis: New Data on an Old Test

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The utility of routine admission chest roentgenograms (CXRs) was evaluated in detecting pulmonary tuberculosis and the relationship between roentgenographic patterns and the likelihood of finding acid-fast bacilli (AFB) on sputum smear. Of 58 patients whose chief complaints were unrelated to pulmonary tuberculosis, the CXR suggested tuberculosis in 52 cases (90 percent). In 45 cases, the emergency room physician failed to elicit the patients respiratory symptoms and did not consider tuberculosis as a diagnostic possibility. In 18 individuals, the diagnosis was missed in the emergency room because of failure to obtain a CXR. Among patients whose roentgenograms showed cavitation or extensive alveolar infiltrate, sputum smears showed AFB in 98 percent of cases. If alveolar infiltrate was absent, or if the roentgenographic pattern was not that of adult reactivation disease, sputum smears revealed AFB in only one half of the cases. We conclude that routine admission CXRs are useful in hospitals serving populations where tuberculosis is still common, and the probability of detecting AFB on sputum smear is greatly influenced by the roentgenographic findings.

Section snippets

MATERIALS AND METHOD

From June 1984 through March 1985, 30,963 adults were admitted to the medical and surgical services of the Los Angeles County-University of Southern California Medical Center. During this period, 192 of these patients were found to have culture-proven pulmonary tuberculosis, an incidence of 6.2 cases per 1,000 adult admissions. In three cases, the CXR could not be located, and in one case, the hospital chart was unavailable. A standardized history, physical examination, and CXR were obtained

RESULTS

Seventy eight patients were Hispanic, 52 were black, 35 were white, 17 were Asian, and six were Native American. One hundred fifty-three patients were men and 35 women. The median age was 38 years, with a range of 17 to 91 years.

The frequencies of symptoms in our study population are shown in Table 1. Cough and weight loss occurred most commonly and only 5 percent of patients had neither respiratory nor systemic symptoms when specifically questioned. One hundred thirty patients (69 percent) had

Routine Admission Chest X-Ray Films

Though unusual roentgenographic patterns in tuberculosis have recently been emphasized in the literature,4, 5 the typical findings of reactivation disease are still seen in most adults with tuberculosis.6, 7 These findings characteristically include upper lobe infiltrates and/or cavitation. Lower lung field tuberculosis, defined as pulmonary involvement confined to the area below an imaginary horizontal line drawn across the hila and including the parahilar regions,8 is seen in a minority of

ACKNOWLEDGMENT

We would like to thank Dr. Om Sharma for critically reviewing the manuscript, the Mycobacteriology Laboratory staff for their assistance, and Jane Sindayen for her expert help in preparation of the manuscript.

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    Manuscript received August 17; revision accepted November 23.

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