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E. S. Ahn, C. Y. Lowder, D. A. Culver; The Use of Chest Computerized Tomography in the Evaluation of Uveitis. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3778.
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Title: The use of chest computerized tomography (CT) in the evaluation of uveitis
To describe the relationship between chest CT findings and non-infectious uveitis
Retrospective chart review of 126 patients who had chest CTs during laboratory evaluation of uveitis between 1995 and 2008. Patient age ranged from 7 to 92 years (mean: 55 ±17 years). There were 93/126 females, 80/126 Caucasian, 30/126 African Americans. One of the authors (CYL) classified all patients based on SUN classification as having anterior, intermediate, posterior, or panuveitis. A chest CT was ordered as part of the evaluation of patients presenting with unremitting/recurrent disease, bilateral involvement, or other systemic findings. CT results were interpreted as unremarkable, consistent with sarcoidosis (CS), abnormal but not consistent with sarcoidosis (NCS), or old granulomatous disease (OG). Interpretation as CS included mediastinal and/or hilar adenopathy, fibrosis or irregularities in a bronchovascular distribution, and multiple pulmonary or subpleural nodules. 20 patients with lung biopsies in this group were included to assess CT accuracy. Fisher’s exact test was performed to determine whether a statistical difference existed between different anatomic classes of uveitis.
Chest CTs showed 20/126 patients CS, 29/126 NCS, 22/126 with OG, and 55/126 unremarkable or no findings. By anatomic site, 23/47 CTs were considered positive (excluding only those deemed unremarkable) in anterior uveitis, 0/2 in intermediate, 11/17 in posterior, and 37/60 in panuveitis, with no one location achieving significance. Analysis of those with CT findings CS or NCS also showed no significant difference by location. 7/9 of the biopsy positive patients also had a CT read as CS, but 5/11 patients with biopsies without granulomas had CTs read as CS. The sensitivity of CT to detect sarcoidosis was 58.3% with a specificity of 75.0%.
The use of chest CT in the evaluation of non-infectious uveitis is a useful tool in screening for concurrent pulmonary disease. Although panuveitis might be suspected to have a higher association with such systemic findings, this study showed no such difference. Nevertheless, 38.9% of patients demonstrated a detectable abnormality (CS and NCS), a result that may decrease morbidity and/or mortality from earlier detection of non-ocular disease.
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