Correlate Clinically For Infection On Chest X-ray

Correlate clinically is occasionally used by radiologists to tell the referring physician that the imaging finding needs to be correlated with the clinical presentation of the patient. This is sometimes used in chest X-rays as many of the imaging findings are not very specific to a single disease process.

For example, a white area superimposed on the dark of the lungs is usually abnormal. Unfortunately, it is often not clear from one X-ray whether this is a new abnormality. Whether it represents an infection, mass, scarring, lung collapse, or one of many additional findings.

A radiologist may therefore describe an area on the chest X-ray as abnormal and give a range of possibilities such as pneumonia, atelectasis or lung collapse, or even cancer. Therefore the radiologist may tell the referring doctor to correlate clinically. That is, correlate the white area on the chest X-ray with how the patient is doing.

If the patient is a healthy 20 year old with cough and fever, then it is most likely a pneumonia. A 60 year old with a lifelong history of smoking and chronic cough may have a cancer of the lung. A 40 year old who had an X-ray before surgery and has no symptoms may have scarring, especially if the white area has been stable for years.

Of course, depending on the appearance of the white spot on X-ray, the radiologist may favor one diagnosis over another. But chest X-ray findings can look non specific for one disease. Pneumonia, cancer, scarring and other processes may all look similar. Any prior studies will help the radiologist. If the finding is new, then it is more likely to be significant like pneumonia. An old chronic spot in the lungs may represent scarring from prior infection.

Therefore, the radiologist will in some cases present a differential diagnosis or a list of possibilities. He will instruct the referring doctor to correlate clinically. That is, take the imaging finding and see what best fits the patient’s clinical symptoms.

In some cases, a CT scan may be done to take a better look. Sometimes a follow up X-ray may be done. This is common for a pneumonia since this will clear with antibiotics while a cancer will not. Therefore, a chest X-ray by itself can not provide a clear diagnosis on its own in some cases. Your clinical doctor will often use the chest X-ray finding as one more piece of information that will help him get to the correct diagnosis. It’s important to remember to treat the patient not the imaging finding.

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