Table 2. Changes in the management of patients with false negative CXR.
| No. of patients (N=25) | Type of abnormal finding in thoracic CT scan | Modification of the diagnostic protocol | Final diagnosis | Modification of treatment | No. of patients with decrease of CC |
|---|---|---|---|---|---|
| 8 | Hiatal hernia | 24 hours multichannel impedance-pH monitoring | GERD | Prokinetic drug added to previous PPI therapy, considered as candidates for fundoplication surgery | 3/8 |
| 1 | Bronchial wall thickening, parenchymal opacities | Patient did not give consent to bronchoscopy | Chronic bronchitis | Antibiotic therapy with amoxicillin with clavulanic acid | 1/1 |
| 1 | Deformation of the trachea and bronchial wall | Bronchoscopy | Tracheobronchopathia osteochondroplastica | No change in treatment | |
| 1 | Multiple pulmonary nodules | Bronchoscopy | Breast cancer metastases to the lungs | Chemotherapy | |
| 1 | GGO | Bronchoscopy | GGO pulmonary nodules requiring further surveillance | Follow-up with CT No change in treatment | |
| 5 | Tree-in-bud opacity | Bronchoscopy | Exclusion of mycobacterial infection; chronic bronchitis associated with chronic rhinosinusitis | Intensification of treatment of chronic bronchitis and rhinosinusitis | 1/5 |
| 1 | Tree-in-bud opacity in patient diagnosed with asthma | Bronchoscopy | Exclusion of mycobacterial infection, patient with asthma, BALF eosinophilia (2%) | Intensification of asthma treatment | 1/1 |
| 1 | Tree-in-bud pattern bronchiectasis | Bronchoscopy | Non-tuberculous mycobacteria related pulmonary disease (M. intracellulare) | Pulmonary rehabilitation, treatment with mucolytics; patient refused antimycobacterial treatment | 1/1 |
| 1 | Multiple pulmonary nodules, parenchymal opacities, mediastinal lymphadenopathy | Bronchoscopy | Sarcoidosis | No specific treatment, further surveillance | |
| 2 | Bronchiectasis | Bronchiectasis | Pulmonary rehabilitation, treatment with mucolytics and antibiotics on exacerbations | 2/2 | |
| 1 | Reticular opacities, honeycombing, traction bronchiectasis | Bronchoscopy | ILD related to rheumatoid arthritis | Methotrexate | |
| 1 | Nodule with spiculated margins | Bronchoscopy | Indeterminate SPN | Follow-up with CT | |
| 1 | Injury of the diaphragm with secondary hernia | Posttraumatic injury of the diaphragm with secondary hernia | Thoracic surgery |
CXR, chest radiograph; CT, computed tomography; CC, chronic cough; GERD, gastroesophageal reflux disease; PPI, proton pump inhibitor; GGO, ground glass opacities; BALF, bronchoalveolar lavage fluid; ILD, interstitial lung disease; SPN, solitary pulmonary nodule.