Computed tomography as an initial study in suspected CAP

Mark Woodhead

A recently published paper discussed the use of computed tomography (CT) as an initial study in patients presenting with suspected community-acquired pneumonia (CAP). The results were encouraging but not game-changing. In your opinion, when could a clinician consider CT in an outpatient presenting with symptoms of CAP?

Mark Woodhead: I would not rush to making a specific recommendation at the moment. This is one study in one particular population. It is interesting and very promising, but I think first of all it needs to be repeated in other populations to be sure that the results are transferrable to other populations. But also importantly, the end points of the study were related to diagnosis, not to outcomes of the patient. So while it is reasonable to speculate that the outcomes of the patients might have been improved by using the CT scan, we do not know that.

There is a considerable cost to using a CT scan, and there is also a radiation cost to the patient. It needs to be looked into in more detail with regard to outcomes to the patients and with regard to the cost involved and the practicality before one could make a clear recommendation. At this point in time, I would only say that CT is potentially a useful additional tool in the occasional circumstance where you have a patient where you are not sure, where the chest radiograph does not give you a clear answer, then doing a CT scan in addition might give added information.

See also
  • Idiopathic pulmonary fibrosis and troublesome cough What management would you recommend in a patient with IPF and troublesome cough? A study published some time ago suggested thalidomide was effective in the treatment of cough in patients with IPF. Is it used for this indication outside clinical trials?
  • Testing for latent TB infection in vaccinated populations In Poland, a significant proportion of cases of tuberculosis (TB) is latent TB infection, and most of the population has been vaccinated against TB. Is there still a place for tuberculin skin testing or should it be replaced with IGRAs?
  • Use of full-face masks and helmets Full-face masks or helmets are not used universally in everyday practice. What is your experience with using such devices? Do you use them often in your practice? Which patients would benefit most from this type of intervention?
  • Community-acquired pneumonia: current management A lecture by Prof. Mark Woodhead, from University of Manchester, UK, delivered at McMaster International Review Course in Internal Medicine in Kraków in May 2016.

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