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


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.


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.
Rámila
E
E
Clinical Hematology Division; Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
Sureda
A
A
Martino
R
R
Santamaría
A
A
Franquet
T
T
Puzo
C
C
Montesinos
J
J
Perea
G
G
Sierra
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001999:Bronchoscopy; D005260:Female; D005334:Fever / Q000209:etiology / Q000382:microbiology; D019337:Hematologic Neoplasms / Q000150:complications* / Q000382:microbiology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced; D013902:Radiography, Thoracic / Q000379:methods; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology; D014057:Tomography, X-Ray Computed / Q000379:methods*
D000890:Anti-Infective Agents; D000970:Antineoplastic Agents