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Original Articles: Clinical

Chest CT scans are frequently abnormal in asymptomatic patients with newly diagnosed acute myeloid leukemia

Janaki VallipuramDepartment of Medicine, University of Toronto, Toronto, ON, Canada;

Sidika DhallaUniversity Health Network, Toronto, ON, Canada;

Chaim M. BellDepartment of Medicine, University of Toronto, Toronto, ON, Canada; ;University Health Network, Toronto, ON, Canada; ;Mount Sinai Hospital, Toronto, ON, Canada; ;Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; ;University of Toronto Centre for Quality Improvement and Patient Safety, Toronto, ON, Canada;

Linda DresserUniversity Health Network, Toronto, ON, Canada; ;Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada;

Heekyung HanMount Sinai Hospital, Toronto, ON, Canada;

Shahid HusainDepartment of Medicine, University of Toronto, Toronto, ON, Canada; ;University Health Network, Toronto, ON, Canada;

Mark D. MindenDepartment of Medicine, University of Toronto, Toronto, ON, Canada; ;University Health Network, Toronto, ON, Canada; ;Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada;

Narinder S. PaulUniversity Health Network, Toronto, ON, Canada; ;Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada;

Miranda SoUniversity Health Network, Toronto, ON, Canada; ;Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada;

Marilyn SteinbergMount Sinai Hospital, Toronto, ON, Canada; Correspondence[email protected]

Mayuran VallipuramSchulich School of Business, Toronto, ON, Canada

Gary WongUniversity Health Network, Toronto, ON, Canada; ;Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada;

Andrew M. MorrisDepartment of Medicine, University of Toronto, Toronto, ON, Canada; ;University Health Network, Toronto, ON, Canada; ;Mount Sinai Hospital, Toronto, ON, Canada; Correspondence[email protected]

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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.

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Acknowledgements

This project was performed in collaboration with the Mount Sinai Hospital-University Health Network Antimicrobial Stewardship Program (MSH-UHN ASP). We are indebted to Gabriella Jacob, BSc, Laura Ovens, BSc, and Eric Lentz for their assistance with data collection. As well we are indebted, as always, to Anthony Bai, BHSc for his invaluable advice and assistance with data analysis. None of these persons received compensation for the work done.

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article at http://dx.doi.org/10.1080/10428194.2016.1213825.

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Chest CT scans are frequently abnormal in asymptomatic patients with newly diagnosed acute myeloid leukemia

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Chest CT scans are frequently abnormal in asymptomatic patients with newly diagnosed acute myeloid leukemia

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