Contributions of high resolution computed tomography on early phase of febrile neutropenia induced by chemotherapy

Abstract

20546 Background: This study was conducted in order to determine the prevalence of lung findings in the early phase of febrile neutropenia with normal chest radiographs (NCR) and to analyze the associate risk groups. Methods: Ethical approval and informed consent were obtained. 31 High Resolution Computed Tomographies (HRCT) were performed on 27 neutropenic patients with less than 72 hours of fever despite of empiric antibiotic treatment, from May 2006 to May 2007. All patients had NCR. The presence and distribution of focal consolidation (FC), ground-glass opacities (GGO), nodules (N), tree-in-bud pattern (TIBP) and halo sign (HS) were assessed by three radiologists. Statistical analysis of the risk factors was performed using Fisher’s exact and Mann-Whitney tests; a p value of less than 0.05 was considered statistically significant. Results: Five (16.1%) patients had respiratory symptoms, 12 (38.7%) had mucositis, 23 (74.2%) had hematological malignancy (HM). 15 patients (48.3%) had HM in complete remission, 8 (25.8%) had HM without control and 8 (25.8%) had solid tumor with or without control.11 (35%) of 31 HRCT scans demonstrated abnormalities: GGO were present in 7 (22%) patients, N in 6 (19%), FC in 4 (12%), TIBP in 2 (6%) and HS in 1 (3%) patients. Successful treatment with initial antibiotics schedule was achieved in 35.5% and no response in 9.7%. Univariant analysis identified the absence of mucositis as an independent factor of presence of pulmonary abnormalities (p=0.001). Conclusions: A high frequency of inflammatory reactions was found in neutropenic patients with less than 72 hours of fever and NCR. The incidences of pulmonary abnormalities are similar in different groups except in patients without mucositis. HRCT should be considered in the initial assessment of patients with fever and neutropenia, mainly in absence of mucositis. No significant financial relationships to disclose.