OBJECTIVETo evaluate the value of clinical signs in the identification of Mycoplasma pneumonia in children's community acquired pneumonia.

METHODWe searched the Cochrane library, PubMed, CNKI, Wan Fang and VIP databases. According to the inclusion and exclusion criterias, we selected and extracted the related information in the literature. According to the QUADAS evaluation system, we established the quality evaluation standard to evaluate the quality of the included studies and analyzed the difference of the clinical manifestations between Mycoplasmae pneumoniae and non-Mycoplasma pneumoniae in children's community acquired pneumonia. We used the RevMan 5.3 software to do the meta-analysis and collected the data according to the requirements. We calculated the pooled sensitivities, specificities and 95%CIs. Then we calculated the negative and positive likelihood ratio, the ratio of the diagnosis and the pre-/post-test probabilities with 95% CIs.

RESULTA total of 11 articles were included in the literature. In summary, the cases of the clinical signs of true positive (TP) and false positive (FP) were as follows : chest pain: TP: 287, FP: 1090; rales: TP: 1906, FP: 6886; headache: TP: 590, FP: 2051; pleural effusion: TP: 10, FP: 16; consolidation: TP: 75, FP: 83; emphysema: TP: 443, FP: 116. The pooled sensitivity, the pooled specificity, the diagnostic ratio (DOR) and 95% CI were: chest pain: pooled sensitivity: 0.12, 95% CI: 0.10-0.13, pooled specificity: 0.89, 95% CI: 0.88-0.90, DOR: 1.05, 95% CI: 0.92-1.21; rales: pooled sensitivity: 0.66, 95% CI: 0.64, 0.67, pooled specificity: 0.36, 95% CI: 0.35, 0.37, DOR: 1.12, 95% CI: 1.02, 1.22; headache: pooled sensitivity: 0.23, 95% CI: 0.21-0.25, pooled specificity: 0.80, 95%CI: 0.79-0.80, DOR: 1.16, 95%CI: 1.05-1.29; pleural effusion: pooled sensitivity: 0.04, 95% CI: 0.02, 0.08, pooled specificity: 0.98, 95% CI: 0.96, 0.99, DOR: 1.28, 95% CI: 0.56, 2.89; consolidation: pooled sensitivity: 0.32, 95% CI: 0.26, 0.39, pooled specificity: 0.87, 95% CI: 0.84, 0.90, DOR: 1.88, 95% CI: 1.23, 2.90; emphysema: pooled sensitivity: 0.22, 95% CI: 0.17, 0.29, pooled specificity: 0.73, 95% CI: 0.69, 0.77, DOR: 1.05, 95% CI: 0.68, 1.61.

CONCLUSIONThe value of clinical symptoms and signs in the identification of mycoplasma pneumonia in children's community acquired pneumonia was not significant. Although the clinical symptoms/signs of chest pain, headache, rales and chest X-ray manifestations of pleural effusion, consolidation, emphysema could suggest Mycoplasma pneumoniae infection, the presence or absence of any clinical signs were not positive or negative indicators for the identification of Mycoplasma pneumoniae infections.

Chest Pain ; Child ; Community-Acquired Infections ; diagnosis ; Headache ; Humans ; Mycoplasma pneumoniae ; Pleural Effusion ; Pneumonia, Mycoplasma ; diagnosis ; Radiography, Thoracic ; Respiratory Sounds ; Sensitivity and Specificity

The development of cardiac CT has provided a non-invasive alternative to echocardiography, exercise electrocardiogram, and invasive angiography and cardiac CT continues to develop at an exponential speed even now. The appropriate use of cardiac CT may lead to improvements in the medical performances of physicians and can reduce medical costs which eventually contribute to better public health. However, until now, there has been no guideline regarding the appropriate use of cardiac CT in Korea. We intend to provide guidelines for the appropriate use of cardiac CT in heart diseases based on scientific data. The purpose of this guideline is to assist clinicians and other health professionals in the use of cardiac CT for diagnosis and treatment of heart diseases, especially in patients at high risk or suspected of heart disease.
Chest Pain/*diagnosis/radiography ; Exercise ; Heart/radiography ; Heart Diseases/diagnosis/*radiography ; Humans ; Republic of Korea ; Tomography, X-Ray Computed/instrumentation/*methods/*standards

A 56-year-old man presented to the Accident and Emergency Department with pleuritic chest pain of sudden onset. He gave a history of short-distance air travel ten days earlier. Chest radiograph showed a peripheral-based opacity in the right lower zone, which was not seen in a previous study done three months ago, suggestive of Hampton's hump. The D-dimer level was raised. Computed tomography pulmonary angiography confirmed the diagnosis of pulmonary embolism in a right lower lobe segmental branch, with adjacent collapsed lung, consistent with lung infarction. The patient was started on heparin injection with significant relief of his symptoms. The clinical and imaging features of pulmonary embolism are described, with emphasis on the historical radiographic signs and the current dual-energy computed tomography innovations.
Adult ; Aged ; Angiography ; Chest Pain ; Female ; Fibrin Fibrinogen Degradation Products ; metabolism ; Humans ; Lung ; diagnostic imaging ; Male ; Middle Aged ; Pulmonary Embolism ; diagnosis ; diagnostic imaging ; Radiography, Thoracic ; Tomography, X-Ray Computed

Cardiac magnetic resonance (CMR) imaging is now widely used in several fields of cardiovascular disease assessment due to recent technical developments. CMR can give physicians information that cannot be found with other imaging modalities. However, there is no guideline which is suitable for Korean people for the use of CMR. Therefore, we have prepared a Korean guideline for the appropriate utilization of CMR to guide Korean physicians, imaging specialists, medical associates and patients to improve the overall medical system performances. By addressing CMR usage and creating these guidelines we hope to contribute towards the promotion of public health. This guideline is a joint report of the Korean Society of Cardiology and the Korean Society of Radiology.
Cardiomyopathies/diagnosis/radiography ; Cardiotonic Agents/therapeutic use ; Chest Pain/complications/diagnosis/radiography ; Coronary Artery Bypass ; Coronary Artery Disease/*diagnosis/drug therapy/radiography ; Dobutamine/therapeutic use ; Echocardiography ; Heart Defects, Congenital/diagnosis/radiography ; Heart Failure/diagnosis/ultrasonography ; Humans ; *Magnetic Resonance Imaging ; Mucocutaneous Lymph Node Syndrome/complications/diagnosis ; Percutaneous Coronary Intervention ; Prognosis ; Risk Assessment ; Ventricular Function, Left/physiology

A 53-yr-old man underwent radiofrequency ablation to treat persistent atrial flutter. After the procedure, the chest pain was getting worse, and the electrocardiogram showed ST-segment elevation in inferior leads with reciprocal changes. Immediate coronary angiography showed total occlusion with thrombi at the distal portion of the right coronary artery, which was very close to the ablation site. Intervention with thrombus aspiration and balloon dilatation was successful, and the patient recovered without any kind of sequelae. Although the exact mechanism is obscure, the most likely explanation is a thermal injury to the vascular wall that ruptured into the lumen and formed thrombus. Vasospasm and thromboembolism can also be other possibilities. This case raise the alarm to cardiologists who perform radiofrequency ablation to treat various kinds of cardiac arrhythmias, in that myocardial infarction has been rarely considered one of the complications.
Acute Disease ; Angioplasty, Balloon, Coronary ; Atrial Flutter/*surgery ; Catheter Ablation/*adverse effects ; Chest Pain/etiology ; Coronary Occlusion/etiology ; Coronary Vessels/radiography ; Humans ; Male ; Middle Aged ; Myocardial Infarction/*diagnosis/etiology/therapy ; Thrombosis/surgery

OBJECTIVETo analyze the diagnosis, treatment and prognosis of spontaneous pneumomediastinum (SPM) in children.

METHODA retrospective analysis of the clinical data of 18 children diagnosed with SPM in Yuying Children's Hospital Affiliated to Wenzhou Medical University from December 2007 to February 2013 was performed. Information of the sequelae and recurrence of SPM was obtained by telephone follow-up. SPM was diagnosed according to Versteegh's standard. SPM cases due to mechanical ventilation, trauma, inhaled foreign body or as a result of the underlying disease were not included. Also cases of secondary pneumothorax pneumomediastinum and neonatal mediastinal emphysema were excluded.

RESULTFifteen of 18 cases were boys and 3 were girls, the range of age was from 9 to 17 years. Predisposing factors included sport activities, severe cough or without a known cause. Clinical manifestations included chest pain, chest tightness, dyspnea, neck pain, back pain, foreign body sensation or pain on swallowing, throat pain of swelling. Chest CT of 18 cases showed pneumomediastinum, 8 cases displayed varied degrees of air in neck, chest; 18 cases of SPM responded well to bed rest, oxygen, antitussive and anti-infection treatment. Fifteen cases received chest CT or X-ray inspection after therapy, showing that the pneumomediastinum disappeared or significantly absorbed, 3 cases improved in clinical symptom. Among 18 patients, telephone follow-up of 14 were successful and 4 cases were lost. An average follow-up time was (24 ± 17) months. None of the cases had any serious consequences, and recurrence happened in one case.

CONCLUSIONChildren's spontaneous pneumomediastinum is a benign disease. When a child has chest pain or chest tightness, SPM should be considered after excluding the common diseases. SPM can be diagnosed in association with clinical feature and chest CT examination. Patients respond well to conservative therapy and most of them had no severe sequelae.

Adolescent ; Chest Pain ; diagnosis ; etiology ; Child ; Dyspnea ; diagnosis ; etiology ; Female ; Follow-Up Studies ; Humans ; Male ; Mediastinal Emphysema ; complications ; diagnosis ; therapy ; Oxygen Inhalation Therapy ; Prognosis ; Radiography, Thoracic ; Recurrence ; Subcutaneous Emphysema ; diagnosis ; etiology ; Tomography, X-Ray Computed

To evaluate the safety and efficacy of the computed tomography coronary angiography (CTCA) for evaluation of acute chest pain in real world population, we prospectively enrolled 296 patients with acute chest pain at emergency department (ED) from November 2005 to February 2007. The patients were grouped based on the clinical information and CTCA result. The patients with a low risk profile and no significant coronary stenosis (>50%) in CTCA were discharged immediately (Group 1, n=103). On the other hand, the patients with an intermediate risk profile without significant stenosis were observed in ED for 24 hr (Group 2, n=104). The patients with significant stenosis underwent further coronary evaluation and management accordingly (Group 3, n=89). While no false negative case was found in Group 1, seven cases (6.73%) were found in Group 2, mostly during the observation period. In Group 3, there were 54 (60.67%) cases of acute coronary syndrome including 10 myocardial infarctions. The overall accuracy of CTCA for acute coronary syndrome was 88.5% (sensitivity), 85.1% (specificity), 60.7% (positive predictive value) and 96.6% (negative predictive value). In conclusion, clinical decision based on CTCA is safe and effective for low risk patients. Further validation is needed in patients with intermediate risk profile.
Adult ; Aged ; *Chest Pain/diagnosis/etiology/radiography ; Coronary Angiography/*methods ; Coronary Stenosis/radiography ; Decision Making ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Prospective Studies ; Risk Factors ; Sensitivity and Specificity ; Tomography, X-Ray Computed/*methods

Community-acquired pneumonia (CAP) is defined as an acute infection of pulmonary parenchyma in a patient who has contracted the infection in the community. Diagnostic process includes history taking, physical examination, chest radiograph, blood tests, and microbiologic tests. Common clinical features are cough, sputum, fever, pleuritic chest pain, and dyspnea. There are systemic symptoms such as nausea, vomiting, diarrhea, and changes of mental status. The presence of an infiltrate on chest X-ray is the mainstay for the diagnosis of CAP, although exceptions are early CAP, dehydration, and neutropenia. Prevalent radiographic findings are lobar pneumonia, interstitial infiltrates, and cavitation. Performing diagnostic testing for the microbiologic etiology remains controversial particularly in outpatient settings. The tests are recommended only when pathogens that would not respond to usual empirical antibiotic regimens are suspected. However, for hospitalized patients, routine pursuit of etiologic agents should be done for all occasions. Apart from Gram stain and culture of sputum, blood culture, serologic tests, urine antigen tests, and polymerase chain reactions are being performed in hospitalized patients. Among these, the combination of a good sputum specimen for Gram stain and culture plus urinary antigen testing is most useful for the rapid diagnosis of CAP. The positivity rate of blood culture is relatively low, which makes the test less dependable. We should always consider Mycobacterium as an unpredicted cause of pulmonary infiltrates in Korea. We should also bear in mind unusual pathogens that have an epidemiologic significance or need different regimens from empirical antibiotics. These include Influenza, Legionella, communityacquired methicillin-resistant Staphylococcus aureus, and agents of bioterrorism. In conclusion, any diagnostic tests should not delay the administration of proper antibiotics. Comprehensive knowledge regarding the relevant diagnostic tests is required for the appropriate implementation of diagnostic procedures and empirical antibiotics.
Anti-Bacterial Agents ; Bioterrorism ; Chest Pain ; Cough ; Dehydration ; Diagnosis* ; Diagnostic Tests, Routine ; Diarrhea ; Dyspnea ; Fever ; Hematologic Tests ; Humans ; Influenza, Human ; Korea ; Legionella ; Methicillin-Resistant Staphylococcus aureus ; Mycobacterium ; Nausea ; Neutropenia ; Outpatients ; Physical Examination ; Pneumonia* ; Polymerase Chain Reaction ; Radiography, Thoracic ; Serologic Tests ; Sputum ; Thorax ; Vomiting

BACKGROUND: Although patients may present with typical chest pain and exhibit ischemic changes on the cardiac stress test, they are frequently found to have a normal coronary angiogram. Thus, we wanted to determine which procedures should be performed in order to make an adequate diagnosis of the cause of chest pain. METHODS: 121 patients (males: 42, 34.7%) who had a normal coronary angiogram with typical chest pain were included in this study. All the patients underwent upper endoscopy, Bernstein's test and esophageal manometry. RESULTS: Among the 121 patients, clinically stable angina was noted in 107 (88.4%). Stress testing was done in 82 (67.8%); it was positive in 52 (63.4%). Endoscopic findings were erosive gastritis in 18 (14.8%), gastric ulcer in 4 (3.3%), duodenal ulcer in 5 (4.1%), and reflux esophagitis in 16 (13.2%). Positive results were observed on Berstein's test for 68 patients (56.2%); 59 (86.8%) of them had non-erosive reflux disease. On the esophageal manometry, 35 (28.9%) of these patients had motility disorders. Nutcracker esophagus was observed in 27 patients (22.3%), nonspecific esophageal motility disorder was observed in 5 (4.1%), and hypertensive lower esophageal sphincter was observed in 3 (2.5%). Among the 52 patients with positive cardiac stress testing and a negative coronary angiogram (this clinically corresponded to microvascular angina), 46 patients (85.1%) showed abnormal findings on the gastro-esophageal studies. CONCLUSIONS: In our study, 85.1% of the patients with microvascular angina revealed positive results of gastric or esophageal disease. In spite of any existing evidence of microvascular angina or cardiac syndrome X, it would be more advisable to perform gastro-esophageal studies to adequately manage chest pain.
Stomach Diseases/*complications/epidemiology ; Retrospective Studies ; Middle Aged ; Male ; Incidence ; Humans ; Female ; Esophageal Diseases/*complications/epidemiology ; Coronary Angiography ; Chest Pain/diagnosis/*etiology/radiography ; Aged ; Adult

Mediastinal tumors are uncommon in the pediatric age group and teratoma comprises 5 percent of mediastinal lesions developing in the anterior mediastinum. It is characterized by staying asymptomatically till adulthood and the most common symptoms of mediastinal teratoma are chest pains, dyspnea, and coughs due to the compression of adjacent airways. Untreated benign teratoma can cause complications such as atelectasis of the lung, adjacent tissue compression, infection and rupture of mass. The diagnosis can be made by chest radiography and chest CT, and the treatment of choice is surgical. We report a 2 year, 10 months male patient who presented with coughs, respiratory difficulty caused by pleural effusion due to rupture, and perforation of the mass. The diagnosis was made by chest radiography and chest CT and he underwent surgical resection successfully.
Chest Pain ; Cough ; Diagnosis ; Dyspnea ; Humans ; Lung ; Male ; Mediastinal Neoplasms ; Mediastinum ; Pleural Effusion* ; Pulmonary Atelectasis ; Radiography ; Rupture ; Teratoma* ; Thorax ; Tomography, X-Ray Computed