Pyrexia Of Unknown Origin

RADIOLOGICAL INVESTIGATIONS & SKIN TESTS

When the initial tests are

Radiological Modalities
Chest X-Ray X Plain X-Ray Abdomen X CT Abdomen  Nuclear Imaging  Echocardiography  MRI  Positron Emission Tomography (PET)  USG Abdomen  Intravenous Pyelogram


Chest X-Ray XChest radiography is indicated when the patient has tachypnea, retractions, focal auscultatory findings, or oxygen saturation level (SO2) on room air of less than 95%. Also, it should be obtained if WBC is >20,000. >20,000.

   

Pulmonary Tuberculosis Malignancies alignancies Pneumocystis carinii pneumonia Histoplasmosis

Computed Tomography


Chest CT:  Mediastinal mass Tuberculosis/Lymphoma/ Sarcoidosis  Dorsal Spine Spondylitis and disc space disease Abdominal CT: CT:  Useful to look for abdominal lymphoma, lymphoma, malignancies and most abscesses abscesses  Diagnostic yield is almost 19%  Clinical follow-up shows that only 1/32 followshows patients with normal scans had an intraintraabdominal cause for PUO

Echocardiography


Done if endocarditis or atrial myxoma is suspected

Duke criteria for endocarditis:  Endocarditis: 1-5% 1of all cases of PUO  Sensitivity 82%, specificity 99%

Magnetic Resonance Imaging (MRI)

Enlarged lymphnodes  Organomegaly (eg. Spleen)  Brain malignancies  Automimmune conditions  Spinal cord visualisation


Ultrasonography
Leg Dopplers: Dopplers: Deep Vein Thrombosis cause of FUO ~ 2-6% of pts pts Safe; Safe; easy to do; recommended do; Ultrasound Heart/Abdomen: Heart/Abdomen: To look for effusions, lymph nodes, effusions, hepatic and splenic lesions and pelvic masses.

Nuclear Imaging


For localizing inflammatory or infectious focus Technetium scans likely have best test characteristics overall and should be the test of choice (Specificity 93%, Sensitivity 40-75%) 40

  

Technetium studies: Acute infection and studies: inflammation of bones and soft tissue IndiumIndium-labeled WBC scans: Occult abscesses scans: Gallium scans: Occult inflammation Bone TC-scan: Skeletal Osteomyelitis TC-scan: Osteomyelitis

Gallium Scan


 

The site will be thermogenic if there is: will  Increased blood flow  Uptake by bacteria (Lactoferrin) (Lactoferrin)  Uptake by WBC Upt Sensitive but not specific Not adviced for abdomen or pelvis (False positivity) Effective in:  Chronic Infections Infections  Lymphoma

IndiumIndium-Labelled Leukocyte
  

 

Uptake by WBC Only for acute problems, less than 4 wks problems, wks Studies found Studies found the sensitivity for infective PUO as 25% and specificity as 100% Not sensitive enough Recommended for strongly suspected infective PUO if done within the initial 24 weeks False positives in: positives
 

Post-operative wound ost-operative Mastitis

SKIN MANIFESTATIONS

Skin manifestations include... Skin rashes Nodules

Embolic Skin Lesions Janeway Lesion

Skin tests


Tuberculin test: test:



Performed in patients for histoplasmosis & coccidiodomycosis. coccidiodomycosis. Test positive 4-6 weeks after 4infection/immunisation

Other skin tests:

 

Histoplasmin skin test Leishmanin skin test

Thank You....