Contribuições da tomografia computadorizada de alta resolução do tórax na fase precoce da neutropenia febril pós-quimioterapia, Santa Casa de Belo Horizonte, 2006-7

Abstract

To determine the prevalence of lung findings suspected of infections in the early phase of neutropenic fever and analyze the associate risk factors, a transversal study was conducted at the oncology and radiology services of the Hospital Santa Casa de Belo Horizonte. Ethical approval was obtained from the institutional review board and informed consent was required. The study included 31 high resolution computed tomography studies performed in 26 neutropenic patients induced by chemotherapy with fever for less than 72 hours despite empiric antibiotic treatment from April 2005 to April 2006. All patients had normal chest radiographs. The high resolution computed tomography images were assessed for the presence and distribution of ground-glass opacities, nodules, consolidations, tree-in-bud patterns and halo sign and reviewed by three experienced independently radiologists. Agreement between observers was determined by the kappa test. Univariate statistical analysis of the risk factors was performed using Fishers exact and Mann- Whitney tests with a p value of less than 0,05 was considered statistically significant. Later a multivariate analysis was made using the CART tree. Overall, 11 (35%) of 31 high resolution computed tomography scans demonstrated abnormalities. Ground-glass opacities were present in 7 patients (63, 6 %), nodules in 6 (54, 5 %), focal consolidations in 4 (36, 3 %), three-in-bud pattern in 2 (18 %) and halo sign in 1 (9 %). Statistical analysis identified the presence of mucositis as an independent factor of absence of pulmonary abnormalities (p=0,001). The present study showed a high prevalence of suspected infections high resolution computed tomography findings in neutropenic patients with fever for less than 72 hours and normal chest radiographs. The incidences of pulmonary anormalities were similar in different groups except for patients without mucositis. These data suggest that high resolution computed tomography should be considered in the initial assessment of patients with fever and neutropenia, especially individuals without mucositis.