Summary of Recommendations Variant 1: A chest radiograph is usually appropriate for the initial imaging of immunocompetent patients presenting with ARI and a negative physical examination, normal vital signs, and no other risk factors. Variant 2: A chest radiograph is usually appropriate for the initial imaging of immunocompetent patients presenting with ARI and positive physical examination, abnormal vital signs, organic brain disease, or other risk factors. Variant 3: Chest CT without IV contrast is usually appropriate for imaging immunocompetent patients with ARI and positive physical examination, abnormal vital signs, organic brain disease or other risk factors and a negative or equivocal initial chest radiograph. 10 Variant 4: Chest CT, with or without IV contrast, is usually appropriate for imaging immunocompetent patients with PNA complicated by suspected parapneumonic effusion or abscess on initial chest radiograph and MRI may be appropriate in this scenario. Variant 5: Imaging is usually not appropriate for the initial workup of immunocompetent patients presenting with an uncomplicated acute asthma exacerbation (no suspicion of PNA or pneumothorax) but a chest radiograph may be appropriate. Variant 6: A chest radiograph is usually appropriate for the initial imaging of immunocompetent patients presenting with a complicated acute asthma exacerbation (suspected PNA or pneumothorax). Variant 7: A chest radiograph is usually appropriate for the initial imaging of an uncomplicated acute COPD exacerbation in immunocompetent patients (no chest pain, fever, or leukocytosis, no history of coronary artery disease, or heart failure). Variant 8: A chest radiograph is usually appropriate for the initial imaging of complicated acute COPD exacerbation in immunocompetent patients (chest pain, fever, leukocytosis, or a history of coronary artery disease, or heart failure).
Acute Respiratory Illness in Immunocompetent Patients. Summary of Recommendations Variant 1: A chest radiograph is usually appropriate for the initial imaging of immunocompetent patients presenting with ARI and a negative physical examination, normal vital signs, and no other risk factors. Variant 2: A chest radiograph is usually appropriate for the initial imaging of immunocompetent patients presenting with ARI and positive physical examination, abnormal vital signs, organic brain disease, or other risk factors. Variant 3: Chest CT without IV contrast is usually appropriate for imaging immunocompetent patients with ARI and positive physical examination, abnormal vital signs, organic brain disease or other risk factors and a negative or equivocal initial chest radiograph. 10 Variant 4: Chest CT, with or without IV contrast, is usually appropriate for imaging immunocompetent patients with PNA complicated by suspected parapneumonic effusion or abscess on initial chest radiograph and MRI may be appropriate in this scenario. Variant 5: Imaging is usually not appropriate for the initial workup of immunocompetent patients presenting with an uncomplicated acute asthma exacerbation (no suspicion of PNA or pneumothorax) but a chest radiograph may be appropriate. Variant 6: A chest radiograph is usually appropriate for the initial imaging of immunocompetent patients presenting with a complicated acute asthma exacerbation (suspected PNA or pneumothorax). Variant 7: A chest radiograph is usually appropriate for the initial imaging of an uncomplicated acute COPD exacerbation in immunocompetent patients (no chest pain, fever, or leukocytosis, no history of coronary artery disease, or heart failure). Variant 8: A chest radiograph is usually appropriate for the initial imaging of complicated acute COPD exacerbation in immunocompetent patients (chest pain, fever, leukocytosis, or a history of coronary artery disease, or heart failure).