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Chest Infections |

Prevalence and Risk Factors of Cavitary Lung Lesions in a Metropolitan Hospital at San Juan Puerto Rico FREE TO VIEW

Kelvin Rivera Manzano, MD
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San Juan City Hospital, Bayamon, PR


Chest. 2015;148(4_MeetingAbstracts):143A. doi:10.1378/chest.2228866
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Abstract

SESSION TITLE: Chest Infections Posters: Tuberculosis

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Lung cavity is defined as an air-filled space within the lung surrounded by a wall. Wall thickness may be accurately disclosed by computed tomography if not apparent on chest radiography. For purposes of this study, a cavitary lung lesion will be defined as any radiographic opacity with an internal area of lucency, regardless of wall thickness.

METHODS: Retrospective study of medical records reviewed. The prevalence of cavitary lung lesions was screened in patients with pneumonia, pulmonary tuberculosis, pneumocystis jiroveci pneumonia, COPD, interstitial lung disease, lung cancer or metastatic disease. Additionally, risk factors were measured including; HIV, intravenous drug abusers, cigarette smoking, ethnicity, homeless, age and gender. Inclusion criteria were as follows; patients from 21 years and older with chest radiography or computer tomography scan and one of the above diagnoses. Statistical method used was pearson chi square test, fisher exact test.

RESULTS: The prevalence of cavitary lung lesions was 46.5% (n=60). Pulmonary tuberculosis with 38.33% (n=23), pneumonia 30% (n=18), primary lung cancer or metastasis 18.33% (n=11) and non-infectious with 13.3% (n=8). The risk factors were pulmonary tuberculosis with an odds ratio (OR) 5.50 and confidence interval (2.15, 14.07); cigarette OR 2.86 (1.38, 5.92); ethnicity (patient from Dominican Republic), OR 3.20 (1.14, 8.94); IV drug abusers OR 1.47 (0.58, 3.70); homeless OR 1.16 (0.32, 4.23) and HIV positive OR 0.79 (0.37, 1.68).

CONCLUSIONS: Pulmonary tuberculosis had the highest prevalence of cavitary lung lesions and was a statistical significant risk factor. Other risk factors were cigarette smoking and ethnicity. Cigarette smoking is likely related by the predisposition of tobacco for emphysematous changes in the lung. Ethnicity may be explained by the fact that most of the patients with pulmonary tuberculosis were from Dominican Republic. This country is considered an endemic area for tuberculosis by the World Health Organization.

CLINICAL IMPLICATIONS: Not all that causes cavitary lung disease is pulmonary tuberculosis and not all that is pulmonary tuberculosis causes cavitary lung disease however this etiology has the highest prevalence. Clinicians must be capable of differentiating no-infectious process from other infectious like pulmonary tuberculosis as first encounter with a patient with lung cavity to minimize adverse outcomes. Spreading the bacillus is one of the adverse outcomes that could be prevented early if safety precautions are taken.

DISCLOSURE: The following authors have nothing to disclose: Kelvin Rivera Manzano

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