title: Chest CT scans are frequently abnormal in asymptomatic patients with newly diagnosed acute myeloid leukemia.
abstract: Chest computed tomography (CT) findings of nodules, ground glass opacities, and consolidations are often interpreted as representing invasive fungal infection in individuals with febrile neutropenia. We assessed whether these CT findings were present in asymptomatic individuals with acute myeloid leukemia (AML) at low risk of invasive fungal disease. A retrospective study of consecutive asymptomatic adult patients with newly diagnosed AML over a 2-year period was performed at a tertiary care oncology center. Radiology reports of baseline chest CTs were reviewed. Of 145 CT scans, the majority (88%) had pulmonary abnormalities. Many (70%) had one or both of unspecified opacities (52%) and nodules (49%). Ground glass opacities (18%) and consolidations (12%) occurred less frequently. Radiologists suggested pneumonia as a possible diagnosis in 32% (n = 47) of scans. Chest CT may result in over-diagnosis of invasive fungal disease in individuals with febrile neutropenia if interpreted without correlation to the patients' clinical status.
authors.affiliation: a Department of Medicine , University of Toronto , Toronto , ON , Canada.
authors.forename: Janaki
authors.initials: J
authors.lastname: Vallipuram
authors.affiliation: b University Health Network , Toronto , ON , Canada.
authors.forename: Sidika
authors.initials: S
authors.lastname: Dhalla
authors.affiliation: a Department of Medicine , University of Toronto , Toronto , ON , Canada.|b University Health Network , Toronto , ON , Canada.|c Mount Sinai Hospital , Toronto , ON , Canada.|d Institute for Clinical Evaluative Sciences , Toronto , ON , Canada.|e University of Toronto Centre for Quality Improvement and Patient Safety , Toronto , ON , Canada.
authors.forename: Chaim M
authors.initials: CM
authors.lastname: Bell
authors.affiliation: b University Health Network , Toronto , ON , Canada.|f Leslie Dan Faculty of Pharmacy , University of Toronto , Toronto , ON , Canada.
authors.forename: Linda
authors.initials: L
authors.lastname: Dresser
authors.affiliation: c Mount Sinai Hospital , Toronto , ON , Canada.
authors.forename: Heekyung
authors.initials: H
authors.lastname: Han
authors.affiliation: a Department of Medicine , University of Toronto , Toronto , ON , Canada.|b University Health Network , Toronto , ON , Canada.
authors.forename: Shahid
authors.initials: S
authors.lastname: Husain
authors.affiliation: a Department of Medicine , University of Toronto , Toronto , ON , Canada.|b University Health Network , Toronto , ON , Canada.|g Department of Medical Oncology , Princess Margaret Cancer Centre , Toronto , ON , Canada.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Minden
authors.affiliation: b University Health Network , Toronto , ON , Canada.|h Joint Department of Medical Imaging , University of Toronto , Toronto , ON , Canada.
authors.forename: Narinder S
authors.initials: NS
authors.lastname: Paul
authors.affiliation: b University Health Network , Toronto , ON , Canada.|f Leslie Dan Faculty of Pharmacy , University of Toronto , Toronto , ON , Canada.
authors.forename: Miranda
authors.initials: M
authors.lastname: So
authors.affiliation: c Mount Sinai Hospital , Toronto , ON , Canada.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Steinberg
authors.affiliation: i Schulich School of Business , Toronto , ON , Canada.
authors.forename: Mayuran
authors.initials: M
authors.lastname: Vallipuram
authors.affiliation: b University Health Network , Toronto , ON , Canada.|f Leslie Dan Faculty of Pharmacy , University of Toronto , Toronto , ON , Canada.
authors.forename: Gary
authors.initials: G
authors.lastname: Wong
authors.affiliation: a Department of Medicine , University of Toronto , Toronto , ON , Canada.|b University Health Network , Toronto , ON , Canada.|c Mount Sinai Hospital , Toronto , ON , Canada.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Morris
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D013909:Thorax / Q000473:pathology*; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: AML; chest CT; febrile neutropenia; invasive fungal infection; nodules and opacities