PURPOSE: To evaluate cases with a chief complaint of shortness of breath, Brain Natriuretic Peptide (BNP)levels more than 400 pg/ml, and to correlate the clinical diagnosis with the admitting chest radiograph findings.
METHODS: Retrospective chart review of 54 patients that had BNP levels greater than 400 pg/ml. The patients were divided into 3 different groups:diagnosis of congestive heart failure (CHF), no diagnosis of CHF, and a mixed diagnosis of CHF and another disease.The final reports by the interpreting radiologist of the emergency room chest radiographs(CXRs) were obtained. Interpretation of the CXRs were correlated to the diagnosis in the three groups.
RESULTS: There were 54 patients: 33 had a diagnosis of CHF, 16 had a mixed diagnosis of CHF and other diseases, and 5 had a diagnosis other than CHF. The mixed diagnosis group presented with 10 patients with pneumonia, 6 patients with chronic obstructive pulmonary disease, 2 patients with asthma, 1 patient with bronchitis, 1 patient with sepsis and one patient with gastrointestinal bleeding. Of the 5 patients without CHF, 4 had a diagnosis of pneumonia and one with atelectasis. Of the CHF only group, only 19/33 (57%) patients had an initial CXR revealing pulmonary vascular congestion. Of the mixed diagnosis group, only 5/10 (50%) patients diagnosed with pneumonia had infiltrates. Of the 6 patients with a diagnosis of chronic obstructive pulmonary disease only one had a chest radiograph showing hyperinflation. Of the 16 patients with a mixed diagnosis only 5 (31%) revealed initial chest radiographs with pulmonary vascular congestion. Of the 4 patients diagnosed with pneumonia alone only 2 patients had chest radiographs supporting the diagnosis.
CONCLUSION: In patients with a chief complaint of shortness of breath and BNP levels more than 400 pg/ml, admitting chest radiograph findings correlate poorly with a clinical diagnosis of CHF and other diseases.
CLINICAL IMPLICATIONS: The diagnosis of CHF alone or concurrently with other disease processes requires an integrative approach and not solely relying on admitting CXR findings or BNP levels.
DISCLOSURE: Fabrizio Monge, None.