Objective: To determine the prevalence of alternative diagnoses based on chest CT angiography (CTA) in patients with suspected pulmonary thromboembolism (PTE) who tested negative for PTE, as well as whether those alternative diagnoses had been considered prior to the CTA. Methods: This was a cross-sectional, retrospective study involving 191 adult patients undergoing CTA for suspected PTE between September of 2009 and May of 2012. Chest X-rays and CTAs were reviewed to determine whether the findings suggested an alternative diagnosis in the cases not diagnosed as PTE. Data on symptoms, risk factors, comorbidities, length of hospital stay, and mortality were collected. Results: On the basis of the CTA findings, PTE was diagnosed in 47 cases (24.6%). Among the 144 patients not diagnosed with PTE via CTA, the findings were abnormal in 120 (83.3%). Such findings were consistent with an alternative diagnosis that explained the symptoms in 75 patients (39.3%). Among those 75 cases, there were only 39 (20.4%) in which the same alterations had not been previously detected on chest X-rays. The most common alternative diagnosis, made solely on the basis of the CTA findings, was pneumonia (identified in 20 cases). Symptoms, risk factors, comorbidities, and the in-hospital mortality rate did not differ significantly between the patients with and without PTE. However, the median hospital stay was significantly longer in the patients with PTE than in those without (18.0 and 9.5 days, respectively; p = 0.001). Conclusions: Our results indicate that chest CTA is useful in cases of suspected PTE, because it can confirm the diagnosis and reveal findings consistent with an alternative diagnosis in a significant number of patients.

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Objective This study aimed to describe the clinical and laboratory findings of patients diagnosed with pleural tuberculosis (PT) at two tertiary university hospitals in Southern Brazil. Methods Patients below 18 years of age admitted to the study hospitals were retrospectively evaluated. Medical and epidemiological history, tuberculin skin test (TST) results, radiological and pathological findings, and pleural fluid (PF) analysis were retrieved from health records. Results Ninety-two patients with PT were identified during the study period. Among them, 51 (55%) were males. The mean age was 10.9 years old. Twenty-one percent was represented by children aged six years or less. The most common symptoms were fever (88%), cough (72%) and chest pain (70%). The time between the onset of symptoms and diagnosis varied between 2 and 300 days, with a median of 16 days. Unilateral pleural effusion was described in 96% of the cases. Lymphocyte predominance was found in 90% of PF samples. The adenosine deaminase dosage of PF was greater than 40 U/L in 85% of the patients. Prior diagnosis of community acquired pneumonia and antibiotic use were observed in 76% of the cases. Conclusion We suggest consider the diagnosis of PT in children and adolescents with the following characteristics: fever, cough and thoracic pain as presenting symptoms; history of contact with tuberculosis; Mantoux test 10 mm; unilateral pleural effusion; lymphocytes predominance in PF sample; pleural fluid ADA greater than 40 U/L and poor response to antibiotics prescribed for community-acquired pneumonia.

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