To assess the diagnostic value of thoracic computer tomography scans in comparison with portable chest radiographs in intensive care unit patients.
Images obtained in 109 consecutive thoracic computer tomography (CT) examinations, the associated bedside chest radiographs and medical records in the intensive care unit (ICU) of an institution (Interfaith Medical Center, Brooklyn) were retrospectively reviewed. CT findings were compared with concurrent bedside chest radiographic findings.
Of the 109 thoracic CT-scans of the patients, 63.6% were females, 36.4% were males, the patient’s age ranges from 18-94 years with 46.7% were more than 65 years old, 58% were blacks and 55.2% of patients admitted to the ICU had dyspnea. In 70 patients (64.2%), thoracic CT revealed additional findings, in comparison with the corresponding bedside radiographs. In 25 (23%) of the 109 CT examinations had at least one new clinically important finding. These important new findings most often were (a) mediastinal Lymphadenopathy (b) malignancies that were detected, staged, or evaluated; (c) pericardial effusions; (d) unsuspected pneumonia; or (e) aneurysm. In 36 cases (33%), pleural effusions could only be visualized by CT. In 8 out of 109 (7.3%) and 7 out of 109 (6.4%) masses and mediastinal Lymphadenopathy, respectively, were detected by CT-scans only. In 10 out of 109 (10.2%) normal portable chest radiographs CT scan revealed infiltrates and effusions and these CT findings resulted in changes in clinical management of these patients. There were no significant complications during transport or (CT) examination.
Thoracic (CT) may provide significant information in addition to plain chest radiographs, particularly in cases of unsuspected pneumonia, malignancies and effusions causing change in the management of ICU-patients. (CT) of the chest offers improved resolution and sensitivity for evaluating chest pathologic conditions compared with other imaging techniques and has a strong impact on patient management in critical-care medicine.
This study highlighted the importance of thoracic(CT) in the management of critically ill patients compared with the portable chest radiographs.
Arshad Ali, None.