Why good? - thrombolyser

[ArchivalUser]

cxr show infilterate.........what ct will suggest new thing?.............
we want to diagnose infection....and we need sputum to culture it......

[ArchivalUser]

Sputum induction is indicated in this clinical scenario. This patient is significantly immunosuppressed and therefore at increased risk for pneumocystis infection. Her new-onset dyspnea, new pulmonary infiltrates visible on chest radiography, and increase in lactate dehydrogenase levels raise clinical suspicion for this condition. Lactate dehydrogenase measurement has a sensitivity of 83% to 100% for Pneumocystis jiroveci infection, although these findings do not have much specificity. Infection with this organism is therefore much less likely in a patient with a decreased lactate dehydrogenase level. Chest radiography in patients with P. jiroveci infection may be normal or reveal localized or lobular infiltrates; nodules; and, rarely, cavities. However, bilateral diffuse reticular opacities are the most typical finding.

Sputum induction is an inexpensive, noninvasive method of definitively establishing a diagnosis of pneumocystis pneumonia in this patient, who appears clinically stable. In a meta-analysis of diagnostic studies for pneumocystis infection, sputum induction was shown to have a 55.5% sensitivity and a 98.6% specificity for this condition.

Because there are no findings of heart failure on examination or radiography, echocardiography is not indicated. No further studies are indicated to establish a diagnosis of pneumocystis pneumonia in patients with positive findings on sputum analysis, but bronchoalveolar lavage may be helpful in patients with normal sputum findings. However, sputum analysis is less costly and invasive compared with bronchoalveolar lavage and therefore should be performed first. High-resolution CT is helpful in identifying pulmonary abnormalities in patients with high clinical suspicion for pneumocystis pneumonia or active Wegener's granulomatosis with pulmonary involvement despite normal findings on chest radiography and to support the need to proceed with further diagnostic studies.

In addition to sputum induction and chest radiography, measurement of arterial blood gases to determine oxygen saturation and the alveolar“arterial (A“a) oxygen gradient is indicated. Mild, moderate, and severe disease are characterized by an A“a oxygen gradient 70 mm Hg; an A“a oxygen gradient of 35 mm Hg to 45 mm Hg and PaO2>70 mm Hg; and an A“a oxygen gradient >45 mm Hg and PaO2

[ArchivalUser]

hope, this helps.
It was reported in the mid-1980s that the examination of sputum induced by the inhalation of hypertonic saline solution was frequently diagnostic for Pneumocystis carinii pneumonia.1 Since then, this diagnostic method has generally become the first employed when Pneumocystis carinii pneumonia is suspected.25 Kirsch et al. (1990), studying 62 patients with possible aids-associated Pneumocystis carinii pneumonia to determine the diagnostic usefulness of sputum analysis, found that sputum analysis is a sensitive, specific, rapid and low-cost technique for the diagnosis of Pneumocystis carinii pneumonia.24

[ArchivalUser]

loso it says next step not best step......