Computed tomography for suspected pulmonary embolism results in a large number of non-significant incidental findings and follow-up investigations

2018 ◽  
Vol 26 (1) ◽  
pp. 29-35 ◽  
Author(s):  
Omar Anjum ◽  
Helena Bleeker ◽  
Robert Ohle
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Incidental Findings ◽  
Suspected Pulmonary Embolism

scholarly journals Ruling out Pulmonary Embolism in Patients with (Suspected) COVID-19—A Prospective Cohort Study

TH Open ◽  
2021 ◽  
Vol 05 (03) ◽  
pp. e387-e399
Author(s):  
Milou A.M. Stals ◽  
Fleur H.J. Kaptein ◽  
Remy H.H. Bemelmans ◽  
Thomas van Bemmel ◽  
Inge C. Boukema ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Failure Rate ◽  
Outcome Study ◽  
Suspected Pulmonary Embolism ◽  
Thrombotic Risk ◽  
Diagnostic Strategies ◽  
Opt Out ◽  
Wells Rule

Abstract Background Diagnostic strategies for suspected pulmonary embolism (PE) have not been prospectively evaluated in COVID-19 patients. Methods Prospective, multicenter, outcome study in 707 patients with both (suspected) COVID-19 and suspected PE in 14 hospitals. Patients on chronic anticoagulant therapy were excluded. Informed consent was obtained by opt-out approach. Patients were managed by validated diagnostic strategies for suspected PE. We evaluated the safety (3-month failure rate) and efficiency (number of computed tomography pulmonary angiographies [CTPAs] avoided) of the applied strategies. Results Overall PE prevalence was 28%. YEARS was applied in 36%, Wells rule in 4.2%, and “CTPA only” in 52%; 7.4% was not tested because of hemodynamic or respiratory instability. Within YEARS, PE was considered excluded without CTPA in 29%, of which one patient developed nonfatal PE during follow-up (failure rate 1.4%, 95% CI 0.04–7.8). One-hundred seventeen patients (46%) managed according to YEARS had a negative CTPA, of whom 10 were diagnosed with nonfatal venous thromboembolism (VTE) during follow-up (failure rate 8.8%, 95% CI 4.3–16). In patients managed by CTPA only, 66% had an initial negative CTPA, of whom eight patients were diagnosed with a nonfatal VTE during follow-up (failure rate 3.6%, 95% CI 1.6–7.0). Conclusion Our results underline the applicability of YEARS in (suspected) COVID-19 patients with suspected PE. CTPA could be avoided in 29% of patients managed by YEARS, with a low failure rate. The failure rate after a negative CTPA, used as a sole test or within YEARS, was non-negligible and reflects the high thrombotic risk in these patients, warranting ongoing vigilance.

scholarly journals Systematic review and meta-analysis of outcomes in patients with suspected pulmonary embolism

2021 ◽  
Vol 5 (8) ◽  
pp. 2237-2244
Author(s):  
Parth Patel ◽  
Payal Patel ◽  
Meha Bhatt ◽  
Cody Braun ◽  
Housne Begum ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Ct Scan ◽  
Major Bleeding ◽  
Meta Analysis ◽  
Cochrane Central Register ◽  
Suspected Pulmonary Embolism ◽  
Central Register ◽  
Mortality Incidence ◽  
D Dimer

Abstract Prompt evaluation and therapeutic intervention of suspected pulmonary embolism (PE) are of paramount importance for improvement in outcomes. We systematically reviewed outcomes in patients with suspected PE, including mortality, incidence of recurrent PE, major bleeding, intracranial hemorrhage, and postthrombotic sequelae. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase for eligible studies, reference lists of relevant reviews, registered trials, and relevant conference proceedings. We included 22 studies with 15 865 patients. Among patients who were diagnosed with PE and discharged with anticoagulation, 3-month follow-up revealed that all-cause mortality was 5.69% (91/1599; 95% confidence interval [CI], 4.56-6.83), mortality from PE was 1.19% (19/1597; 95% CI, 0.66-1.72), recurrent venous thromboembolism (VTE) occurred in 1.38% (22/1597; 95% CI: 0.81-1.95), and major bleeding occurred in 0.90% (2/221%; 95% CI, 0-2.15). In patients with a low pretest probability (PTP) and negative D-dimer, 3-month follow-up revealed mortality from PE was 0% (0/808) and incidence of VTE was 0.37% (4/1094; 95% CI: 0.007-0.72). In patients with intermediate PTP and negative D-dimer, 3-month follow-up revealed that mortality from PE was 0% (0/2747) and incidence of VTE was 0.46% (14/3015; 95% CI: 0.22-0.71). In patients with high PTP and negative computed tomography (CT) scan, 3-month follow-up revealed mortality from PE was 0% (0/651) and incidence of VTE was 0.84% (11/1302; 95% CI: 0.35-1.34). We further summarize outcomes evaluated by various diagnostic tests and diagnostic pathways (ie, D-dimer followed by CT scan).

VENOGRAPHY (VG) OF THE LOWER LIMBS IN THE MANAGEMENT OF PATIENTS WITH SUSPECTED PULMONARY EMBOLISM (PE)

1987 ◽  
Author(s):  
W H J Kruit ◽  
A K Sing ◽  
G J H den Ottolander ◽  
A C de Beor ◽  
J J C Jonker
Keyword(s):  
Pulmonary Embolism ◽  
Impedance Plethysmography ◽  
Lower Limbs ◽  
Surgical Patients ◽  
Additional Patient ◽  
Suspected Pulmonary Embolism ◽  
X Ray ◽  
Group A ◽  
Group B

In a prospective cohort study, we evaluated X-ray VG in the management of non-surgical patients with clinically suspected PE. Thusfar follow up is available on 131 consecutive patients with suspected PE. In all patients a perfusion lungscan (PS) was carried out within 24 hours. In case of a normal PS (group A, n=32), no anticoagulant (AC) therapy was given. In case of an abnormal PS, AC therapy was started (heparin) and a bilateral ascending VG was carried out within 72 hours. In 46 patients (group C) venous thrombosis (DVT) was demonstrated by VG, and these patients were treated with AC for 6 months. In 53 patients with suspected PE and an abnormal lungscan, bilateral VG did not show DVT (group B). AC therapy was discontinued in these patients These patients were then screened for 14 days with fibrinogen legscanning and impedance plethysmography (IPG), followed by IPG alone every 2 months for at least 1 year. In group B, 6 patients died in the follow up period. None of the patients had signs of PE at autopsy. One additional patient in group B developed DVT documented by repeat VG, 6 months after entry into the trial. According to these preliminary data, it seems safe to base the decision whether or not to treat a patient with suspected PE with AC, on the presence or absence of DVT in the lower limbs as demonstrated by VG

scholarly journals Clinically significant incidental findings during preoperative computed tomography of patients undergoing cardiac surgery

2020 ◽  
Vol 31 (5) ◽  
pp. 629-631
Author(s):  
Davorin Sef ◽  
Inderpaul Birdi
Keyword(s):  
Computed Tomography ◽  
Cardiac Surgery ◽  
Incidental Findings ◽  
Preoperative Assessment ◽  
Female Gender ◽  
Ct Scans ◽  
Abdominal Ct ◽  
Clinically Significant ◽  
Work Up

Abstract With the development of minimally invasive cardiac surgery, chest and abdominal computed tomography (CT) scans are becoming an integral part of preoperative assessment and planning. Therefore, the number of incidental findings (IFs) detected with CT is rising. We aimed to investigate the frequency of clinically significant IFs on chest and abdominal CT scans performed during the preoperative assessment of patients undergoing adult cardiac surgery in a 2-year period. In a cohort of 401 patients (mean age 67.4 ± 12.3, female gender 28.9%, median logistic EuroSCORE 5.8 [0.9, 90.5]) who underwent chest or abdominal CT imaging during the study period, we identified 75 patients (18.7%) with clinically significant IFs who needed a further treatment or work-up to confirm the diagnosis or postoperative follow-up. Our data indicate that clinically significant IFs in patients referred for cardiac surgery are frequent. It is important to identify clinically significant Ifs, as a clear postoperative follow-up plan should be made.

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