Chest Radiography Examination Research Articles

Estimation of Heights and Body Masses of Tuberculosis Patients in the Canadian Fluoroscopy Cohort Study for Use in Individual Dosimetry.

This paper documents the estimation of mean heights and body masses, by age and sex, used in development of organ-specific dose conversion coefficients for external radiation for a historical cohort of about 64,000 patients from the Canadian Fluoroscopy Cohort Study. Patients were exposed to repeated fluoroscopy and chest radiography examinations in the course of treatment for tuberculosis in residential medical facilities throughout Canada between 1930 and 1969. Using Canadian national survey data and extensive literature review, mean heights and masses were obtained for the White population of Canada during the time period of interest, and the differences in mean body mass between tuberculosis patients and the general population were estimated. Results in terms of mean height and body mass of Canadian tuberculosis patients, with uncertainties, are reported for selected age groups (children of ages 1, 5, 10, and 15 y and adults age 20+) and for both sexes. Use of estimated average heights and body masses by age and sex permits the adjustment of computerized phantoms for body mass for a given age, thereby increasing the relevance of the organ-specific dose conversion coefficients for the cohort and improving the accuracy of the resulting estimated organ doses.

Lung ultrasound patterns in paediatric pneumonia in Mozambique and Pakistan.

ObjectiveImproved pneumonia diagnostics are needed, particularly in resource-constrained settings. Lung ultrasound (LUS) is a promising point-of-care imaging technology for diagnosing pneumonia. The objective was to explore LUS patterns associated with paediatric pneumonia.MethodsWe conducted a prospective, observational study among children aged 2 to 23 months with World Health Organization Integrated Management of Childhood Illness chest-indrawing pneumonia and among children without fast breathing, chest indrawing or fever (no pneumonia cohort) at two district hospitals in Mozambique and Pakistan. We assessed LUS and chest radiograph (CXR) examinations, and viral and bacterial nasopharyngeal carriage, and performed a secondary analysis of LUS patterns.ResultsLUS demonstrated a range of distinctive patterns that differed between children with and without pneumonia and between children in Mozambique versus Pakistan. The presence of LUS consolidation or interstitial patterns was more common in children with chest-indrawing pneumonia than in those without pneumonia. Consolidations were also more common among those with only bacterial but no viral carriage detected (50.0%) than among those with both (13.0%) and those with only virus detected (8.3%; p=0.03). LUS showed high interrater reliability among expert LUS interpreters for overall determination of pneumonia (κ=0.915), consolidation (κ=0.915) and interstitial patterns (κ=0.901), but interrater reliability between LUS and CXR for detecting consolidations was poor (κ=0.159, Pakistan) to fair (κ=0.453, Mozambique).DiscussionPattern recognition was discordant between LUS and CXR imaging modalities. Further research is needed to define and standardise LUS patterns associated with paediatric pneumonia and to evaluate the potential value of LUS as a reference standard.

Fork Rib: A Rare Musculoskeletal Etiology of Chest Pain

Chest pain is a common clinical presentation in daily practice. Musculoskeletal origin is a rare etiology of chest pain, compared to a cardiorespiratory problem and often underrecognized. Fork-rib or bifid-rib is a rare anomaly which uncommonly present with clinical symptoms since in most cases fork-rib incidentally found during cadaveric dissection. Here we report a 27 years old man presenting with chest pain and radiographic examination showing bifid rib of the fifth left rib, without any abnormalities from physical examination and electrocardiography. The patient treated with intravenous painkiller and anticonvulsants. Fork-rib should be considered as a differential diagnosis for chest pain of musculoskeletal origin especially in young adults or chest pain precede with minor trauma.Â

CXXC5 variant in an immunodeficient patient with a progressive loss of hematopoietic cells

Partial loss of function variant in CXXC5 identified in an immunodeficient patient with progressive bone marrow failure, corrected by bone marrow transplant.

A Characteristic Chest Radiographic Pattern in the Setting of the COVID-19 Pandemic.

PurposeTo determine the utility of chest radiography in aiding clinical diagnosis of coronavirus disease 2019 (COVID-19) utilizing reverse-transcription polymerase chain reaction (RT-PCR) as the standard of comparison.Materials and MethodsA retrospective study was performed of persons under investigation for COVID-19 presenting to this institution during the exponential growth phase of the COVID-19 outbreak in New Orleans (March 13–25, 2020). Three hundred seventy-six in-hospital chest radiographic examinations for 366 individual patients were reviewed along with concurrent RT-PCR tests. Two experienced radiologists categorized each chest radiograph as characteristic, nonspecific, or negative in appearance for COVID-19, utilizing well-documented COVID-19 imaging patterns. Chest radiograph categorization was compared against RT-PCR results to determine the utility of chest radiography in diagnosing COVID-19.ResultsOf the 366 patients, the study consisted of 178 male (49%) and 188 female (51%) patients with a mean age of 52.7 years (range, 17 to 98 years). Of the 376 chest radiographic examinations, 37 (10%) exhibited the characteristic COVID-19 appearance; 215 (57%) exhibited the nonspecific appearance; and 124 (33%) were considered negative for a pulmonary abnormality. Of the 376 RT-PCR tests evaluated, 200 (53%) were positive and 176 (47%) were negative. RT-PCR tests took an average of 2.5 days ± 0.7 to provide results. Sensitivity and specificity for correctly identifying COVID-19 with a characteristic chest radiographic pattern was 15.5% (31/200) and 96.6% (170/176), with a positive predictive value and negative predictive value of 83.8% (31/37) and 50.1% (170/339), respectively.ConclusionThe presence of patchy and/or confluent, bandlike ground-glass opacity or consolidation in a peripheral and mid to lower lung zone distribution on a chest radiograph obtained in the setting of pandemic COVID-19 was highly suggestive of severe acute respiratory syndrome coronavirus 2 infection and should be used in conjunction with clinical judgment to make a diagnosis.© RSNA, 2020

Optimasi Faktor Eksposi pada Pemeriksaan Radiografi Thorax menggunakan Computed Radiography

Concerning radiation safety must meet several radiation protection requirements which include justification or utilization of nuclear power, dose limitation, optimization of protection, and radiation safety. The purpose of this study was to determine the optimization of the exposure factor selection and determine the radiation dose received by the patient based on the selection of exposure factors on the thorax examination. The author observed the use of exposure factors on chest radiographic examination with a sample of 60 people. The design of this study uses the correlational method. The independent variables in this study are age, body weight, object thickness, kV, and mAs. Dependent variable exposure to radiation dose on chest examination. The conclusion of this study is the dose exposure level is influenced by age, object thickness, weight, and use of exposure factors which will then be obtained by the DRL (Diagnostic Reference Level) value.

Organ Doses from Chest Radiographs in Tuberculosis Patients in Canada and Their Uncertainties in Periods from 1930 to 1969

This paper describes a study to estimate absorbed doses to various organs from film-based chest radiographs and their uncertainties in the periods 1930 to 1948, 1949 to 1955, and 1956 to 1969. Estimated organ doses will be used in new analyses of risks of cancer and other diseases in tuberculosis patients in Canada who had chest fluoroscopic and radiographic examinations in those periods. In this paper, doses to lungs, female breast, active bone marrow, and heart from a single chest radiograph in adults and children of ages 1, 5, 10, and 15 y in the Canadian cohort and their uncertainties are estimated using (1) data on the tube voltage (kV), total filtration (mm Al), tube-current exposure-time product (mA s), and tube output (mR [mA s]−1) in each period; (2) assumptions about patient orientation, distance from the source to the skin of a patient, and film size; and (3) new calculations of sex- and age-specific organ dose conversion coefficients (organ doses per dose in air at skin entrance). Variations in estimated doses to each organ across the three periods are less than 20% in adults and up to about 30% at younger ages. Uncertainties in estimated organ doses are about a factor of 2 to 3 in adults and up to a factor of 4 at younger ages and are due mainly to uncertainties in the tube voltage and tube-current exposure-time product.

Restricting Daily Chest Radiography in the Intensive Care Unit: Implementing Evidence-Based Medicine to Decrease Utilizationt.

PurposeIn this study, the authors applied evidence-based medicine to decrease the utilization of routine chest radiography in adult intensive care units and used time-driven activity-based costing to demonstrate cost savings.MethodsA multidisciplinary team was formed with representatives from radiology, surgery, internal medicine, and nursing. The process of performing a portable chest radiographic examination was mapped, and time trials were performed by the radiology technologists and radiology resident. This information was used to determine the cost of performing portable intensive care unit (ICU) chest radiographic studies. The clinical team changed resident education, ordering protocols, and workflows to discontinue the use of routine daily chest radiography, emphasizing that it should be ordered only in specific situations, such as on admission or after central line placement. In addition, as a balancing measure, the team tracked complications such as unplanned extubations and ventilator days.ResultsChanging ordering practices in the adult ICUs to align with established evidence-based guidelines resulted in a 37% decrease in the utilization of portable chest radiography between June and December, without a concomitant increase in unplanned extubations or ventilator days. In addition, a proportionate cost savings was realized, as demonstrated by the application of time-driven activity-based costing.ConclusionsThis performance improvement initiative successfully increased the value of care delivered to ICU patients by aligning institutional clinical practice with evidence-based medicine. This resulted in decreased utilization and the cost associated with delivering care without a concomitant increase in complications.

Case report: uniportal video-assisted thoracoscopic resection of a solitary fibrous tumor preoperatively predicted visceral pleura origin using dynamic chest radiography

BackgroundDynamic chest radiography (DCR) is a flat-panel detector (FPD)-based functional X-ray imaging, which is performed as an additional examination in chest radiography. DCR provides objective and quantifiable information, such as diaphragm movement, pulmonary ventilation and circulation, and is reasonable for detecting tumor invasion or adhesion.Case presentationWe present a case of Solitary Fibrous Tumor of Pleura (SFTP), preoperatively predicted visceral pleura origin using Dynamic chest radiography (DCR) and surgically resected through single-access (uniportal) video-assisted thoracoscopic surgery (UVATS).ConclusionsUVATS may be a suitable surgical option for pedunculated SFTPs. Dynamic chest radiography provides information, such as tumor invasion or adhesion and helpful for predicting origin of the tumor.

Nilai Contrast to Noise Ratio (CNR) Radiograf Thorax PA antara menggunakan Grid dengan tanpa Menggunakan Grid

Background: Chest radiographic examination often does not use a grid even though the thorax is an object that has a thickness of more than 10 cm so it must use a grid. This study aims to determine the differences and the degree of change in Contrast to Noise Ratio on PA radiographs between using a grid and without using a grid.Methods: This type of research is a pre-experimental quantitative. The research subject is a radiological image of PA thorax made using the grid (50 patients) and without using the grid (patient). The image is analyzed by pixel value using Dicom softwareResults: There is a difference in contrast values on the PA radiographs between those using the Grid and without using the Grid (p-value 0.001). The average value of the contrast on the chest radiograph using a Grid is 2283.60, while the one without using a Grid is 1878.58. Noise value also shows that there is a difference between chest radiographs of PA images using Grid without using Grid (p-value = 0.001). The average thorax photo noise using Grid is 25.32, paired using Grid is 17.84. Statistical test on the value of Contrast to Noise Ratio (CNR) shows that there is a difference between radiographs of PA chest radiography using Grid without Grid (p-value 0.001). The average CNR radiograph of the PA thorax PA using Grid is 100.79, while the CNR value of the radiograph of thorax PA without using Grid is 125.62.Conclusions: There is a Contrast difference between using a grid and without using a grid (p-value 0.001). There is a Noise difference in PA radiographs between using a grid and without using a grid (p-value = 0.001). There is a difference in Contrast to Noise Ratio on the PA chest radiograph between using a grid and without using a grid (p-value 0.001).

Artificial Intelligence Algorithm Detecting Lung Infection in Supine Chest Radiographs of Critically Ill Patients With a Diagnostic Accuracy Similar to Board-Certified Radiologists.

Interpretation of lung opacities in ICU supine chest radiographs remains challenging. We evaluated a prototype artificial intelligence algorithm to classify basal lung opacities according to underlying pathologies. Retrospective study. The deep neural network was trained on two publicly available datasets including 297,541 images of 86,876 patients. One hundred sixty-six patients received both supine chest radiograph and CT scans (reference standard) within 90 minutes without any intervention in between. Algorithm accuracy was referenced to board-certified radiologists who evaluated supine chest radiographs according to side-separate reading scores for pneumonia and effusion (0 = absent, 1 = possible, and 2 = highly suspected). Radiologists were blinded to the supine chest radiograph findings during CT interpretation. Performances of radiologists and the artificial intelligence algorithm were quantified by receiver-operating characteristic curve analysis. Diagnostic metrics (sensitivity, specificity, positive predictive value, negative predictive value, and accuracy) were calculated based on different receiver-operating characteristic operating points. Regarding pneumonia detection, radiologists achieved a maximum diagnostic accuracy of up to 0.87 (95% CI, 0.78-0.93) when considering only the supine chest radiograph reading score 2 as positive for pneumonia. Radiologist's maximum sensitivity up to 0.87 (95% CI, 0.76-0.94) was achieved by additionally rating the supine chest radiograph reading score 1 as positive for pneumonia and taking previous examinations into account. Radiologic assessment essentially achieved nonsignificantly higher results compared with the artificial intelligence algorithm: artificial intelligence-area under the receiver-operating characteristic curve of 0.737 (0.659-0.815) versus radiologist's area under the receiver-operating characteristic curve of 0.779 (0.723-0.836), diagnostic metrics of receiver-operating characteristic operating points did not significantly differ. Regarding the detection of pleural effusions, there was no significant performance difference between radiologist's and artificial intelligence algorithm: artificial intelligence-area under the receiver-operating characteristic curve of 0.740 (0.662-0.817) versus radiologist's area under the receiver-operating characteristic curve of 0.698 (0.646-0.749) with similar diagnostic metrics for receiver-operating characteristic operating points. Considering the minor level of performance differences between the algorithm and radiologists, we regard artificial intelligence as a promising clinical decision support tool for supine chest radiograph examinations in the clinical routine with high potential to reduce the number of missed findings in an artificial intelligence-assisted reading setting.

The Prevalence of Chest Radiography Abnormalities Suggestive of Inactive Tuberculosis and Their Burden of Tuberculosis Infection Among Rural Residents: A Population-Based Screening Study

Background: Individuals with chest radiography indicating inactive tuberculosis (TB) has been suggested to be one of the high risk populations for developing active TB from latent infection. The burden of this specific population and their TB infection status has been rarely studied in China. Method: We conducted a population-based screening study to investigate the prevalence of inactive TB radiographic abnormalities and their current TB infection status among rural residents. Chest radiography examination and Interferon Gamma Release Assay (IGRA) testing were performed for all eligible rural residents with record of anti-TB treatment. While for participants without recorded previous TB, IGRA testing was conducted only for those with radiographic abnormalities indicating inactive TB (i.e. fibrosis, calcification, nodule, and pleural incrassation). Findings: A total of 46,041 rural residents voluntarily participated in the study. Around two thirds (70·39%, 1,583/2,249) of participants with anti-TB treatment records showed hint of inactive TB lesions, while it was 6·87% (3,008/43,792) for those without treatment history. Among participants with inactive TB lesions, IGRA positivity was 54.15% (855/1,579) and 28·77% (862/2,996) for those with and without anti-TB treatment records, respectively. IGRA positivity was found to be varied with respect to the type of inactive abnormalities. Interpretation: Individuals with inactive TB lesions and their remarkably high prevalence of TB infection should be attached more attention for preventing occurrence of active TB in high burden areas like China. Funding: This work was supported by the National Science and Technology Major Project of China [2017ZX10201302-002], the CAMS Innovation Fund for Medical Sciences [2016-I2M-1-013] and [2019-I2M-2-005]. Declaration of Interests: All co-authors declare that we have no conflicts of interest. Ethics Approval Statement: The ethics committees of the Institute of Pathogen Biology and the Chinese Academy of Medical Sciences approved the study protocol with approval number of IPB-2018-1.

Frequency and Distribution of Chest Radiographic Findings in Patients Positive for COVID-19.

BackgroundCurrent COVID-19 radiological literature is dominated by CT and a detailed description of chest x-ray (CXR) appearances in relation to the disease time course is lacking.PurposeTo describe the time course and severity of the CXR findings of COVID-19 and correlate these with real time reverse transcription polymerase chain reaction (RT-PCR) testing for SARS-Cov-2 nucleic acid.Materials and MethodsRetrospective study of COVID-19 patients with RT-PCR confirmation and CXRs admitted across 4 hospitals evaluated between January and March 2020. Baseline and serial CXRs (total 255 CXRs) were reviewed along with RT-PCRs. Correlation with concurrent CTs (total 28 CTs) was made when available. Two radiologists scored each CXR in consensus for: consolidation, ground glass opacity (GGO), location and pleural fluid. A severity index was determined for each lung. The lung scores were summed to produce the final severity score.ResultsThere were 64 patients (26 men, mean age 56±19 years). Of these, 58, 44 and 38 patients had positive initial RT-PCR (91%, [CI: 81-96%]), abnormal baseline CXR (69%, [CI: 56-80%]) and positive initial RT-PCR with abnormal baseline CXR (59 [CI:46-71%]) respectively. Six patients (9%) showed CXR abnormalities before eventually testing positive on RT-PCR. Sensitivity of initial RT-PCR (91% [95% CI: 83-97%]) was higher than baseline CXR (69% [95% CI: 56-80%]) (p = 0.009). Radiographic (mean 6 ± 5 days) and virologic recovery (mean 8 ± 6 days) were not significantly different (p= 0.33). Consolidation was the most common finding (30/64, 47%), followed by GGO (21/64, 33%). CXR abnormalities had a peripheral (26/64, 41%) and lower zone distribution (32/64, 50%) with bilateral involvement (32/64, 50%). Pleural effusion was uncommon (2/64, 3%). The severity of CXR findings peaked at 10-12 days from the date of symptom onset.ConclusionChest x-ray findings in COVID-19 patients frequently showed bilateral lower zone consolidation which peaked at 10-12 days from symptom onset.

Decision rule to predict pneumonia in children presented with acute febrile respiratory illness.

It is a frequent challenge for physicians to identify pneumonia in patients with acute febrile respiratory symptoms, particularly in stable pediatric patients without respiratory distress. A decision rule is required to assist judgement on the need of ordering a chest radiograph. This was a multicenter prospective study in 3 emergency departments. Children younger than 6years old with an acute onset of fever and respiratory symptoms were recruited. Split sample method was adopted for derivation and validation of the Pediatric Acute Febrile Respiratory Illness rule (PAFRI Rule). PAFRI was derived from logistic regression with weighting based on adjusted odds ratios. Out of 967 children evaluated, 530 had taken chest radiograph examination, with 91 demonstrated evidence of pneumonia on radiograph. PAFRI Rule was derived from logistic regression with 5 weighed predictors: duration of fever <3days (0 points), 3-4days (2 points), 5-6days (4 points), ≥7days (5 points), chills (2 points), nasal symptoms (-2 points), abnormal chest examination (3 points), SpO2 ≤96% or tachypnea (3 points). The Area under ROC curve of the PAFRI Rule, the Bilkis Decision Rule and Bilkis Simpler Rule were 0.733, 0.600 and 0.579 respectively. A PAFRI score of ≥0 gives a sensitivity of 91.7% and negative predictive value of 97.7%. PAFRI rule can be used as a reference tool for guiding the need for taking Chest radiograph examination for pediatric patients. While promising, the PAFRI rule requires further validation. It is often a challenge for physicians to identify pneumonia in children acutely febrile with respiratory symptoms, particularly in those who are stable without respiratory distress. The decision to order chest radiograph was based on clinical assessment with heterogenous practice. A valid and verified clinical prediction rule for ordering chest radiograph examination for stable febrile children without signs of respiratory distress would therefore assist in management of this group of patients. The PAFRI rule, based on parameters from clinical bedside assessment, can be used as a reference tool for guiding the need for referral to emergency department or taking use of chest radiograph for pediatric patients, and triaging for higher priority of clinical care.

Radiographic manifestations of COVID-19 pneumonia: Initial experience from an epicenter in North-West, Nigeria

Background: COVID-19, a zoonotic disease caused by severe acute respiratory syndrome coronavirus-2, is responsible for the pandemic of 2020. Despite the availability and usefulness of chest radiographs (CXR) in diagnosis and monitoring of suspected as well as infected patients with COVID-19, there is paucity of studies about imaging findings in COVID-19 from Sub-Saharan Africa including Nigeria. Aim: This study aims to describe the findings and correlates of chest radiographic appearances in COVID-19 pneumonia at Kano, Nigeria. Materials and Methods: This was a retrospective study conducted at radiology units of four radiology diagnostic facilities that were very active during the peak period of the pandemic in Kano metropolis. All patients with confirmed COVID-19 infection and also underwent chest radiographic examinations at these facilities were included. The findings considered in the evaluation were the presence or absence and the type of pulmonary or pleural lesions/abnormality, and their distribution; including their association with demographics and clinical presentations. Statistical analysis was performed using SPSS version 23.0. Results: Of 125 patients, 98 (78.4%) were male. The mean age was 57.3 ± 12 years. One hundred and one (80.8%) of them had abnormal chest radiographic findings. These patients showed significant higher occurrences of anosmia than those with normal CXRs (P < 0.05). The occurrence of ground-glass opacity in both lower zones was significantly seen in 43 (62.3%) patients between 40 and 60 years and in 40 (85%) of those older than 60. Anosmia and age were respectively the only symptoms that independently predict if the COVID-19 patient may likely present with the abnormal CXRs or not (0.175 [0.057–0.542] P = 0.002; 3.7 [1.423–9.622] P = 0.007). Conclusions: Majority of our patients presents with abnormalities on CXRs. Older age, anosmia were the major predictors of chest radiographic abnormalities, which were mainly bilateral asymmetric lower zones ground glass opacities.

2903. Post PCV13 Dynamics of NonVaccine Serotype (NVT): Disproportionate Increase of the Additional PCV20 Candidate Serotypes in Respiratory and Invasive Disease in Young Children

BackgroundPCV13 implementation in children resulted in a substantial decline in carriage of and disease by vaccine serotypes (VT13). However, disease caused by non-PCV13 serotypes (NVT) is still relatively prevalent and even increasing, leading to an effort to develop a 20-valent vaccine (PCV20), containing the additional 7 serotypes: 8, 10A, 11A, 12F, 15B/C, 22F, 33F (VT20-13). We assessed dynamics of VT13, VT20-13, and non-PCV20 (NVT20) in nasopharyngeal carriage, respiratory infections, and IPD in children < 2 years following PCV13 implementation.MethodsMultiple prospective, population-based surveillance projects, conducted in Israel between 2009 and 2017 were used. We studied isolates from IPD; otitis media (OM); conjunctivitis; carriage in healthy children; carriage during lower respiratory tract infections with chest radiography examination (LRI); and carriage during non-LRI illnesses. We added data from healthy children in the community since 2011. Prevalence rate ratios were calculated, comparing VT13, VT20-13 and NVT20 rates in late-PCV13 (2015–2017) vs. early-PCV (2009–2011) periods.ResultsOverall, 9,089 episodes were recorded. VT13 declined significantly in all 6 groups by 75–86% (Figures 1 and 2). Proportions of VT20-13 significantly increased in all groups, excluding conjunctivitis. The highest increases were observed in IPD, OM, and carriage during LRI. In 2015–2017, VT20-13 consisted 24%, 23%, and 19% of carriage in healthy children, carriage in non-LRI illness, and conjunctivitis, respectively, vs. 51%, 33%, and 32% in IPD, OM, and carriage during LRI. VT20-13 rapidly became the leading fraction in IPD. NVT20 proportions increased in all groups.Conclusion(1) PCV13 implementation resulted in a substantial increase in NVT carriage and disease; (2) In IPD, VT20-13 became the dominant group; (3) The increases in the proportion of VT20-13 seen in OM and carriage during LRI was significantly higher than in conjunctivitis and in carriage without LRI. Disclosures All Authors: No reported Disclosures.

Severe thermal injury of larynx in a child following accidental ingestion of hot tea

Thermal injury to the upper respiratory tract caused by aspiration of hot liquids resulting in laryngeal edema and subsequent obstruction of the airway is commonly not seen in the pediatric population. Unlike adults, children are more prone for subglottic injury, swelling and resulting obstruction of the airway due to the smaller size of the trachea and relatively large epiglottis. Examination of the airway with laryngoscopy hence should be recommended in all patients with inhalational and aspiration burn injury as it will help in guiding airway management and preventing development of complications. Authors report a case of a 3-year-old male child with accidental ingestion of just made hot tea. Upon presentation there was severe stridor and signs of respiratory distress requiring emergency intubation. Direct laryngoscopy revealed glottic edema and ulcer. Upper GI endoscopy showed erythematous arytenoids, esophagus and stomach showing few erythematous flat lesions. Chest radiographic examination showed bilateral para cardiac and perihilar inhomogeneous opacities suggestive of aspiration pneumonitis. The child was gradually weaned and extubated on day three of admission. Ingestion of hot liquids can cause airway and esophageal thermal burns. Rapid diagnosis and treatment are essential in management of inhalational and aspiration burn injury to reduce the morbidity, mortality and long-term sequelae in these patients. Children are more prone for burn accidents due to their curious and exploratory behavior and their inability to perceive the hazards. Since most of the pediatric burn accidents happen at home, parents should be offered education about prevention of burn and advised on how to manage and treat minor burn injuries and to watch for any warning signs in which case to rush to the nearest hospital.

The Clinical Utility of Chest Radiography for Identifying Pneumonia: Accounting for Diagnostic Uncertainty in Radiology Reports.

OBJECTIVE. Currently, chest radiography is the first-line imaging test for identifying pneumonia; chest CT is considered the reference standard. The purpose of this study was to calculate the statistical measures of performance of chest radiography for identifying pneumonia when taking into account uncertain results of both chest radiography and CT examinations. MATERIALS AND METHODS. Statistical measures of performance of chest radiography, using CT as the reference standard, were calculated with 95% CIs by varying uncertain radiology report impressions of both chest radiography and CT to all negative or all positive. The resulting scenarios were as follows: scenario 1, uncertain chest radiography and CT impressions are considered positive for pneumonia; scenario 2, uncertain chest radiography impressions are positive but uncertain CT impressions are negative; scenario 3, uncertain chest radiography impressions are negative and uncertain CT impressions are positive; scenario 4, uncertain chest radiography and CT impressions are negative; and scenario 5, uncertain chest radiography and CT impressions are excluded. RESULTS. A retrospective analysis of 2411 patient visits revealed the prevalence of uncertain radiology report impressions to be 31.8% for chest radiography and 21.7% for CT. Scenario 1 yielded the following performance values: sensitivity, 51.9%; specificity, 71.3%; PPV, 59.4%; and NPV, 64.5%. Scenario 2 produced the following performance values: sensitivity, 59.6%; specificity, 67.1%; PPV, 59.6%; and NPV, 67.1%. Scenario 3 showed the following performance values: sensitivity, 13.4%; specificity, 97.7%; PPV, 82.6%; and NPV, 58.1%. Scenario 4 yielded the following performance values: sensitivity, 19.6%; specificity, 96.4%; PPV, 81.6%; and NPV, 59.5%. Scenario 5 produced the following performance values: sensitivity, 32.7%; specificity, 96.8%; PPV, 89.2%; and NPV, 63.8%. CONCLUSION. Uncertain chest radiography results for the evaluation of pneumonia are prevalent. A chest radiography impression using the strongest language in support of a pneumonia diagnosis is useful to rule in pneumonia radiographically, but a negative result performs poorly at ruling out disease.

Perbandingan Diagnosis Klinis dan Radiologis Pneumocystis Carinii Pneumonia pada Pasien HIV/AIDS di RSUP Sanglah Denpasar

Background: Pneumocystis carinii pneumonia (PCP) is a lung infection caused by fungus Pneumocystis carinii. More than half (70 - 80%) of people with AIDS get at least one episode of PCP on their clinical course, with mortality ranging from 10% to 40%. Usually, there is no abnormality in pulmonary physical examination. Chest radiographic examination is one of the non-invasive examinations to make the diagnosis of PCP. Radiographic examination may find an abnormal picture or normal picture.Purpose: To compare the diagnosis of PCP in HIV/AIDS patients made by clinical versus radiology examination at Sanglah Hospital.Method: Type of this research is descriptive cross sectional study. The number of samples in this study were 51 samples obtained by total sampling technique. Data obtained from secondary data is from medical record.Result: After univariate and bivariate analyze, from 51 samples, 68.8% of the samples were radiologic diagnose with PCP and 76.5% were clinical diagnose with PCP. From bivariate analysis 82.9% were diagnosed PCP radiologically and clinically.Conclusion: Thorax imaging is a good imaging modality in early diagnosis and excludes the differential diagnosis of PCP.

Use of Chest Radiography Examination as a Probe for Pneumococcal Conjugate Vaccine Impact on Lower Respiratory Tract Infections in Young Children.

Community-acquired alveolar pneumonia (CAAP) is considered a bacterial disease, mainly pneumococcal. CAAP rates markedly declined following 7- and 13-valent pneumococcal conjugate vaccine (PCV) introductions worldwide. In contrast, non-CAAP lower respiratory tract infections (NA-LRIs) are generally not considered pneumococcal diseases. We assessed CAAP, NA-LRIs, and overall visits with chest radiograph (CXR) examination rates in the pediatric emergency room in southern Israel before and after PCV implementation. This was an ongoing, prospective observational study. Our hospital serves a captive population of approximately 75 000 children aged <5 years, enabling incidence calculation. PCV7 and PCV13 were implemented in Israel in July 2009 and November 2010, respectively. All CXRs were analyzed according to the World Health Organization Standardization of Interpretation. We calculated CAAP, NA-LRI, and CXR examinations annual incidences from 2004 to 2017 and incidence rate ratios comparing the PCV13 (2014-2017) with the pre-PCV (2004-2008) periods. Overall, 72 746 CXR examinations were recorded: 14% CAAP and 86% NA-LRI. CAAP, NA-LRI, and CXR examination visit rates declined by 49%, 34%, and 37%, respectively. This pattern was seen in Jewish and Bedouin children (the 2 ethnically distinct populations), with steeper declines observed among Jewish children and children aged >12 months. PCV7/PCV13 implementation resulted in a marked decline in CAAP and overall visits with CXR examination rates in young children. Overall, approximately 14 750 hospital visits with CXR were prevented annually per 100 000 population aged <5 years. These findings suggest that although NA-LRIs are usually not considered pneumococcal, many can be prevented by PCVs.Pneumococcal conjugate vaccine (PCV7/PCV13) implementation resulted in significant declines in community-acquired alveolar pneumonia (CAAP) and overall chest radiography examination rates in young children. Although non-CAAP lower respiratory tract infections are usually not considered pneumococcal, many can be prevented by PCVs.