Pneumonia in Febrile Neutropenic Patients and in Bone Marrow and Blood Stem-Cell Transplant Recipients: Use of High-Resolution Computed Tomography

To obtain statistical data on the use of high-resolution computed tomography (HRCT) for early detection of pneumonia in febrile neutropenic patients with unknown focus of infection. One hundred eighty-eight HRCT studies were performed prospectively in 112 neutropenic patients with fever of unknown o...

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Bibliographic Details
Published in:	Journal of clinical oncology Vol. 17; no. 3; pp. 796 - 805
Main Authors:	HEUSSEL, C. P, KAUCZOR, H.-U, HEUSSEL, G. E, FISCHER, B, BEGRICH, M, MILDENBERGER, P, THELEN, M
Format:	Journal Article
Language:	English
Published:	Baltimore, MD American Society of Clinical Oncology 01-03-1999 Lippincott Williams & Wilkins
Subjects:	Adult Aged Aged, 80 and over Algorithms Biological and medical sciences Bone Marrow Transplantation Bronchoalveolar Lavage Fluid - microbiology Female Fever of Unknown Origin - diagnostic imaging Fever of Unknown Origin - etiology Hematopoietic Stem Cell Transplantation Humans Investigative techniques, diagnostic techniques (general aspects) Leukemia, Myeloid, Acute - complications Lung - diagnostic imaging Male Medical sciences Middle Aged Neutropenia - chemically induced Neutropenia - diagnostic imaging Pneumonia - complications Pneumonia - diagnostic imaging Pneumonia - microbiology Predictive Value of Tests Prospective Studies Radiodiagnosis. Nmr imagery. Nmr spectrometry Respiratory system Tomography, X-Ray Computed - methods Human Lung disease High resolution Pneumonia Statistical analysis Leukopenia Radiodiagnosis Respiratory disease Stem cell Hematopoietic cell Homograft Hemopathy Fever Blood Medical imagery Complication Graft Early Computerized axial tomography Diagnosis Neutropenia
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Summary:	To obtain statistical data on the use of high-resolution computed tomography (HRCT) for early detection of pneumonia in febrile neutropenic patients with unknown focus of infection. One hundred eighty-eight HRCT studies were performed prospectively in 112 neutropenic patients with fever of unknown origin persisting for more than 48 hours despite empiric antibiotic treatment. Fifty-four of these studies were performed in transplant recipients. All patients had normal chest roentgenograms. If pneumonia was detected by HRCT, guided bronchoalveolar lavage was recommended. Evidence of pneumonia on chest roentgenograms during follow-up and micro-organisms detected during follow-up were regarded as documentation of pneumonia. Of the 188 HRCT studies, 112 (60%) showed pneumonia and 76 were normal. Documentation of pneumonia was possible in 61 cases by chest roentgenography or micro-organism detection (54%) (P < 10(-6)). Sensitivity of HRCT was 87% (88% in transplant recipients), specificity was 57% (67%), and the negative predictive value was 88% (97%). A time gain of 5 days was achieved by the additional use of HRCT compared to an exclusive use of chest roentgenography. The high frequency of inflammatory pulmonary disease after a suspicious HRCT scan (> 50%) proves that pneumonia is not excluded by a normal chest roentgenogram. Given the significantly longer duration of febrile episodes in transplant recipients, HRCT findings are particularly relevant in this subgroup. Patients with normal HRCT scans, particularly transplant recipients, have a low risk of pneumonia during follow-up. All neutropenic patients with fever of unknown origin and normal chest roentgenograms should undergo HRCT.
ISSN:	0732-183X 1527-7755
DOI:	10.1200/JCO.1999.17.3.796