Imagine, if necessary, a case you see every hour in the ED – a child with a fever. Wave a magic wand in triage, find the source of the fever, and let the doctor pick up the decision-making process advance from there.
This scenario is, of course, totally farfetched – after all, you still need a certain number of HPI and ROS elements before you wave the magic wand to bill at a higher level of service.
But, the principle – this is a fascinating article regarding the workup of “fever of unknown origin” in adults. These 81 patients had fevers for 3 weeks without a satisfactory explanation, and their cases were retrospectively reviewed following referral to FDG-PET scans. Essentially, any time this FDG-PET scan localized to an area of high uptake, it provided significant helpful localizing information regarding the underlying disease process. Examples of diagnoses it identified were infectious endocarditis, tuberculosis, pyogenic spondylitis, graft infections, Takayasu arteritis, and a host of other fascinatingly difficult diseases to identify.
The main diagnostic drawback is that it is mostly only structurally/anatomically specific, not necessarily disease specific, so there is a lot to do in terms of clinical correlation with imaging findings. And then there is the small issue where it’s a nuclear medicine study requiring 5 hours of fasting and an injection of the FDG tracer 1 hour before the study is performed. But, someday a decade out, the next generations of these devices might be more clinician-friendly….
“FDG-PET for the diagnosis of fever of unknown origin: a Japanese multi-center study.”
www.ncbi.nlm.nih.gov/pubmed/21344168