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S. D. Smith, C. Y. Lowder, O. F. Moura Brasil, R. Margolis, P. K. Kaiser; Chest Computerized Tomography in the Evaluation of Chronic Uveitis of Unknown Etiology. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4404.
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To investigate the value of chest computerized tomography (CT) in the evaluation of patients with chronic uveitis of unknown etiology.
Records were reviewed of all patients who had a chest CT as a part of their diagnostic evaluation between June 1997 and May 2006. Patients with iridocyclitis, vitritis, and/or choroiditis of duration >6 weeks with no definitive cause for the inflammation were included in the analysis. A chest CT was considered positive if parenchymal lesions and/or mediastinal or hilar adenopathy typical of sarcoidosis were identified. Non-specific findings such as small pulmonary nodules or calcifications were also considered to be positive. The primary outcome measure was the diagnostic yield of chest CT for sarcoidosis.
A total of 131 patients were included in the study. The mean patient age was 51.8 ± 17.1 years. Chest CT was positive in 55 (42%) of patients. Patients with a positive chest CT were significantly older than other patients (58.5 ± 2.2 vs. 47.0 ± 1.8 years, p<0.0001). There was no association between chest CT results and gender or race. Of the 33 patients who also underwent biopsy as part of their diagnostic evaluation, 25 (75.8%) had histopathologic confirmation of sarcoidosis. Using histopathologic diagnosis as the gold standard for identifying sarcoidosis, the sensitivity and specificity of chest CT were 100% and 62.5%, respectively. In this patient population, the positive predictive value of chest CT for sarcoidosis was 89.3%. Although younger patients were less likely to have a positive chest CT, when present it was equally predictive of sarcoidosis as in older patients (positive predictive value ≤50 years: 90.0%; positive predictive value >50 years: 88.9%).
Chest CT has a high diagnostic yield in the evaluation of patients with chronic uveitis of unknown etiology, and is useful regardless of age, gender or race.
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