The value of chest computed tomography for identifying the source of infection in febrile patients without abnormal findings on chest radiography

¹Department of Emergency Medicine, Daejin Medical Center, Bundang Jesaeng Hospital, Seongnam, Korea
²Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Korea

Correspondence

Rubi Jeong ,Tel: 031-412-5381, Fax: 031-412-5659, Email: rubioov@naver.com,

Received: December 31, 2023; Revised: May 9, 2024 Accepted: August 25, 2025. Published online: October 30, 2025.

ABSTRACT

Objective:
This study assessed the significance of chest computed tomography (CT) in febrile patients with normal chest X-rays, identifying the predictors for infection factors on CT.
Methods:
Retrospective data from Seongnam, Korea’s Secondary Medical Institution (Jan 1, 2020-Dec 31, 2021) on adult patients with ≥37.5℃ in the emergency department were analyzed. Gender, age, visit date, vital signs, consciousness levels, and blood test results were examined. Statistical data analysis was performed to compare the two groups, which were divided into a positive and negative group with and without abnormalities in the chest, respectively, after performing CT of the chest and abdomen.
Results:
Of the 7,680 investigated patients, 318 were enrolled and 7,362 were excluded. A higher temperature and lower Glasgow Coma Scale score indicated a higher likelihood that a chest CT scan should be considered, while a lower C-reactive protein level indicated a higher likelihood that a chest CT scan would reveal abnormalities. Nineteen patients had pneumonia, and CT of the chest can be considered for the differential diagnosis of pneumonia if the patient is female, has rapid breathing, high body temperature, and a high erythrocyte sedimentation rate.
Conclusion:
Among febrile patients presenting to the emergency department, the severity was often low when the simple chest X-ray was normal, even in the presence of infection factors such as pneumonia. Therefore, abdominal CT alone is sufficient in the emergency department, and the need for chest CT is relatively low.

Key words: Fever; Radiography; X-ray computed tomography; Pneumonia; Infections