Conventional chest radiography in the initial assessment of adult cancer patients with fever and neutropenia.

Infection continues to be a leading cause of morbidity and mortality in patients with neoplastic disorders who are treated with myelosuppressive chemotherapy.1 In a granulocytopenic patient, fever may be the first and only sign of infection.2 Other clinical signs and symptoms that often indicate an infectious process may be blunted or missing in the presence of neutropenia. Thus, treating all febrile neutropenic patients with broad-spectrum antibiotics has become the standard of care. Initial evaluation of such patients usually includes a complete history, physical examination, blood culture, urinalysis, urine culture, and chest radiography.3 Some investigators advocate routine chest radiography to detect signs and symptoms of pneumonia that may be absent in the neutropenic host despite the presence of a consolidate pneumonic process.2 Others report that the yield of abnormal findings on a diagnostic chest radiograph in febrile neutropenic children is low in the absence of clinical signs of pneumonia.4-6