Bronchoscopy guided by high-resolution computed tomography for the diagnosis of pulmonary infections in patients with hematologic malignancies and normal plain chest X-ray.

Abstract

BACKGROUND AND OBJECTIVES:

High-resolution computed tomography (HRCT) of the chest is able to demonstrate the presence of pulmonary infiltrates in febrile neutropenic patients with normal chest X-rays. Fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) is a safe procedure for the etiological diagnosis of pulmonary infiltrates in oncohematologic patients. The objective of this study was to determine the diagnostic yield and subsequent therapeutic changes of a protected BAL (p-BAL) guided by HRCT in febrile oncohematologic patients unresponsive to broad-spectrum antibiotics with a normal chest X-ray.

DESIGN AND METHODS:

Twenty-two episodes from 20 oncohematologic patients were included: group A, 9 episodes (8 patients) with no respiratory symptoms and group B, 13 episodes (12 patients) with signs or symptoms of pulmonary infection. HRCT and p-BAL were performed in all episodes within the first 24 hours.

RESULTS:

HRCT showed abnormalities in all 22 episodes (bilateral abnormalities in 14 of the 22 episodes [64%]) and the most frequent pattern was ground-glass infiltrate (7 out of 22 episodes). An infectious agent was isolated in 12 of the 22 episodes, 5 in group A and 7 in group B with a diagnostic yield of 54%. Antimicrobial therapy was modified in 12 of the 22 episodes (54%): 5 in group A and 7 in group B. In 6 episodes, treatment was changed according to HRCT results and in the remaining 6 due to positive microbiologic results. Modifications in empirical therapy were associated with a favorable response in 44% episodes of group A and in 31% of group B.

INTERPRETATION AND CONCLUSIONS:

Oncohematologic patients with fever of unknown origin unresponsive to empirical antibiotics and with a normal chest X-ray can be candidates to undergo a HRCT. This subgroup of high-risk patients can benefit from a combined strategy consisting of BAL guided by a previous HRCT.

• Authors: E Rámila, A Sureda, R Martino, A Santamaría, T Franquet, C Puzo, J Montesinos, G Perea, J Sierra
• Journal: Haematologica (Haematologica) Vol. 85 Issue 9 Pg. 961-6 (Sep 2000) ISSN: 0390-6078 [Print] Italy
• PMID: 10980635 (Publication Type: Journal Article)

Chemical References

• Anti-Infective Agents
• Antineoplastic Agents

Topics

• Adolescent
• Adult
• Aged
• Anti-Infective Agents (therapeutic use)
• Antineoplastic Agents (adverse effects, therapeutic use)
• Bronchoscopy
• Female
• Fever (etiology, microbiology)
• Hematologic Neoplasms (complications, microbiology, therapy)
• Humans
• Male
• Middle Aged
• Neutropenia (chemically induced)
• Radiography, Thoracic (methods)
• Respiratory Tract Infections (diagnosis, diagnostic imaging, drug therapy, etiology)
• Tomography, X-Ray Computed (methods)