Children Suspected Of Having Pulmonary Embolism: Multidetector CT Pulmonary Angiography—Thromboembolic Risk Factors and Implications for Appropriate Use

Introduction: While pulmonary embolism(PE) appears to be a major issue in Covid-19, data remain sparse. Hypothesis: We aimed to describe the risk factors and baseline characteristics of patients with PE in a cohort of Covid-19 patients. Methods: In a retrospective multicentric observational study, we included consecutive hospitalised patients for Covid-19. Patients without computed tomography pulmonary angiography (CTPA)-proven PE diagnosis and those who were directly admitted to an intensive care unit(ICU) were excluded. Results: Among 1,240 patients (58.1% men, mean age 64±17 years), 103 (8.3%) patients had PE confirmed by CTPA. The ICU transfer and mechanical ventilation were significantly higher in the PE group (for both p<0.001). In an univariable analysis, traditional venous thromboembolic risk factors were not associated with PE (p>0.05), while patients under therapeutic-dose anticoagulation before hospitalisation or prophylaxis-dose anticoagulation introduced during hospitalisation had lower PE occurrence (OR 0.40, 95%CI(0.14-0.91); p=0.04 and OR 0.11, 95%CI(0.06-0.18); p<0.001, respectively). In a multivariable analysis, the following variables, also statistically significant in univariable analysis, were associated with PE: male gender (OR 1.03, 95%CI(1.003-1.069); p=0.04), anticoagulation with prophylaxis-dose (OR 0.83, 95%CI(0.79-0.85), p<0.001) or therapeutic-dose (OR 0.87, 95%CI(0.82-0.92), p<0.001), C-reactive protein (OR 1.03, 95%CI(1.01-1.04), p=0.001) and time from symptom onset to hospitalisation (OR 1.02, 95%CI(1.006-1.038), p=0.002). Conclusions: Pulmonary embolism risk factors in Covid-19 context do not include traditional thromboembolic risk factors but rather independent clinical and biological findings at admission, including a major contribution to inflammation.

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Pulmonary embolism

Emergencies in Respiratory Medicine ◽

10.1093/med/9780199202447.003.0028 ◽

2007 ◽

pp. 177-188

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Pulmonary Angiography ◽

Hospitalized Patients ◽

Pulmonary Emboli ◽

Ct Pulmonary Angiography ◽

Clinical Probability ◽

Clinical Conditions ◽

Specific Symptoms ◽

Symptoms And Signs

Introduction 178 Risk factors 178 Clinical probability 179 Submassive PE 180 Massive PE 185 Further investigation of patients following PE 187 Prevention of pulmonary emboli 187 Pulmonary embolism (PE) can present with numerous non-specific symptoms and signs and hence mimics several other clinical conditions. The annual incidence of PE is approximately 60–70 cases in 100 000. Half occur in hospitalized patients, with a quarter having clear risk factors and the remainder being idiopathic. Most hospitals will have their own protocol for investigation; some still use ventilation–perfusion scintigraphy if they have on-site facilities, but most now use multi-detector CT pulmonary angiography (CTPA)....

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Intraindividual comparison of gadolinium- and iodine-enhanced 64-slice multidetector CT pulmonary angiography for the detection of pulmonary embolism in a porcine model

Emergency Radiology ◽

10.1007/s10140-010-0926-3 ◽

2010 ◽

Vol 18 (3) ◽

pp. 189-195 ◽

Cited By ~ 2

Author(s):

Frank Oliver Gerhard Henes ◽

Michael Groth ◽

Philipp G. C. Begemann ◽

Gerhard Adam ◽

Marc Regier

Keyword(s):

Pulmonary Embolism ◽

Porcine Model ◽

Multidetector Ct ◽

Pulmonary Angiography ◽

Ct Pulmonary Angiography ◽

Intraindividual Comparison

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A Systematic Review of Double Low-dose CT Pulmonary Angiography in Pulmonary Embolism

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405614666180813120619 ◽

2019 ◽

Vol 15 (5) ◽

pp. 453-460 ◽

Cited By ~ 1

Author(s):

Sultan Aldosari ◽

Zhonghua Sun

Keyword(s):

Systematic Review ◽

Pulmonary Embolism ◽

Image Quality ◽

Radiation Dose ◽

Contrast Medium ◽

Low Dose ◽

Pulmonary Angiography ◽

Ct Pulmonary Angiography ◽

Low Contrast ◽

Low Contrast Medium

Background: The aim of this study is to perform a systematic review of the feasibility and clinical application of double low-dose CT pulmonary angiography (CTPA) in the diagnosis of patients with suspected pulmonary embolism. Discussion: A total of 13 studies were found to meet selection criteria reporting both low radiation dose (70 or 80 kVp versus 100 or 120 kVp) and low contrast medium dose CTPA protocols. Lowdose CTPA resulted in radiation dose reduction from 29.6% to 87.5% in 12 studies (range: 0.4 to 23.5 mSv), while in one study, radiation dose was increased in the dual-energy CT group when compared to the standard 120 kVp group. CTPA with use of low contrast medium volume (range: 20 to 75 ml) was compared to standard CTPA (range: 50 to 101 ml) in 12 studies with reduction between 25 and 67%, while in the remaining study, low iodine concentration was used with 23% dose reduction achieved. Quantitative assessment of image quality (in terms of signal-to-noise ratio and contrast-to-noise ratio) showed that low-dose CTPA was associated with higher, lower and no change in image quality in 3, 3 and 6 studies, respectively when compared to the standard CTPA protocol. The subjective assessment indicated similar image quality in 11 studies between low-dose and standard CTPA groups, and improved image quality in 1 study with low-dose CTPA. Conclusion: This review shows that double low-dose CTPA is feasible in the diagnosis of pulmonary embolism with significant reductions in both radiation and contrast medium doses, without compromising diagnostic image quality.

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COVID-19-induced vascular angiopathy: CTPA signs in critically ill patients other than acute pulmonary embolism and high-lung opacity scores

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00491-4 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Mohamed Hossameldin khalifa ◽

Ahmed Samir ◽

Ayman Ibrahim Baess ◽

Sara Samy Hendawi

Keyword(s):

Artificial Intelligence ◽

Pulmonary Embolism ◽

Lung Volume ◽

Acute Pulmonary Embolism ◽

Pulmonary Angiography ◽

Vascular Tree ◽

Ct Pulmonary Angiography ◽

Artificial Intelligence System ◽

Intelligence System ◽

Severity Scores

Abstract Background Vascular angiopathy is suggested to be the major cause of silent hypoxia among COVID-19 patients without severe parenchymal involvement. However, pulmonologists and clinicians in intensive care units become confused when they encounter acute respiratory deterioration with neither severe parenchymal lung involvement nor acute pulmonary embolism. Other radiological vascular signs might solve this confusion. This study investigated other indirect vascular angiopathy signs on CT pulmonary angiography (CTPA) and involved a novel statistical analysis that was performed to determine the significance of associations between these signs and the CT opacity score of the pathological lung volume, which is calculated by an artificial intelligence system. Results The study was conducted retrospectively, during September and October 2020, on 73 patients with critical COVID-19 who were admitted to the ICU with progressive dyspnea and low O2 saturation on room air (PaO2 < 93%). They included 53 males and 20 females (73%:27%), and their age ranged from 18 to 88 years (mean ± SD=53.3 ± 13.5). CT-pulmonary angiography was performed for all patients, and an artificial intelligence system was utilized to quantitatively assess the diseased lung volume. The radiological data were analyzed by three expert consultant radiologists to reach consensus. A low CT opacity score (≤10) was found in 18 patients (24.7%), while a high CT opacity score (>10) was found in 55 patients (75.3%). Pulmonary embolism was found in 24 patients (32.9%); three of them had low CT opacity scores. Four other indirect vasculopathy CTPA signs were identified: (1) pulmonary vascular enlargement (57 patients—78.1%), (2) pulmonary hypertension (14 patients—19.2%), (3) vascular tree-in-bud pattern (10 patients—13.7%), and (4) pulmonary infarction (three patients—4.1%). There were no significant associations between these signs and the CT opacity score (0.3205–0.7551, all >0.05). Furthermore, both pulmonary vascular enlargement and the vascular tree-in-bud sign were found in patients without pulmonary embolism and low CT-severity scores (13/15–86.7% and 2/15–13.3%, respectively). Conclusion Pulmonary vascular enlargement or, less commonly, vascular tree-in-bud pattern are both indirect vascular angiopathy signs on CTPA that can explain the respiratory deterioration which complicates COVID-19 in the absence of severe parenchymal involvement or acute pulmonary embolism.

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CT pulmonary angiography in COVID-19 pneumonia: relationship between pulmonary embolism and disease severity

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-020-00389-7 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Aya Yassin ◽

Maryam Ali Abdelkader ◽

Rehab M. Mohammed ◽

Ahmed M. Osman

Keyword(s):

Pulmonary Embolism ◽

Disease Severity ◽

Laboratory Data ◽

Pulmonary Angiography ◽

Significant Relation ◽

Ct Pulmonary Angiography ◽

Laboratory Results ◽

Severity Of The Disease ◽

The Relationship ◽

D Dimer

Abstract Background Pulmonary embolism (PE) is one of the known sequels of COVID-19 infection. We aimed to assess the incidence of PE in patients with COVID-19 infection and to evaluate the relationship between the CT severity of the disease and the laboratory indicators. This was a retrospective study conducted on 96 patients with COVID-19 infection proved by positive PCR who underwent CT pulmonary angiography (CTPA) with a calculation of the CT severity of COVID-19 infection. Available patients’ complaint and laboratory data at the time of CTPA were correlated with PE presence and disease severity. Results Forty patients (41.7%) showed positive PE with the median time for the incidence of PE which was 12 days after onset of the disease. No significant correlation was found between the incidence of PE and the patients’ age, sex, laboratory results, and the CT severity of COVID-19. A statistically significant relation was found between the incidence of PE and the patients’ desaturation, hemoptysis, and chest pain. A highly significant correlation was found between the incidence of PE and the rising in the D-dimer level as well as the progressive CT findings when compared to the previous one. Conclusion CT progression and the rising in D-dimer level are considered the most important parameters suggesting underlying PE in patients with positive COVID-19 infection which is commonly seen during the second week of infection and alert the use of CT pulmonary angiography to exclude or confirm PE. This is may help in improving the management of COVID-19 infection.

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