scholarly journals Chest X-Ray Not Routinely Indicated Prior to the YEARS Algorithm in the Diagnostic Management of Suspected Pulmonary Embolism

TH Open ◽  
2019 ◽  
Vol 03 (01) ◽  
pp. e22-e27 ◽  
Author(s):  
Liselotte van der Pol ◽  
Cecile Tromeur ◽  
Laura Faber ◽  
Tom van der Hulle ◽  
Lucia Kroft ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Final Diagnosis ◽  
Diagnostic Value ◽  
Routine Care ◽  
Diagnostic Process ◽  
Unexpected Finding ◽  
Suspected Pulmonary Embolism ◽  
Likelihood Ratios ◽  
X Ray ◽  
Chest X Ray

Background The YEARS algorithm was designed to simplify the diagnostic process of suspected pulmonary embolism (PE) and to reduce the number of required computed tomography pulmonary angiography (CTPA) scans. Chest X-ray (CXR) is often used as initial imaging test in patients suspected for PE. Aim To determine if CXR results differ between patients with confirmed PE and with PE ruled out, and to investigate whether CXR provides incremental diagnostic value to the YEARS criteria that is used for selecting patients with CTPA indication. Methods This post-hoc analysis concerned 1,473 consecutive patients with suspected PE who were managed according to YEARS and were subjected to CXR as part of routine care. The prevalence and likelihood ratios of seven main CXR findings for a final diagnosis of PE were calculated. Results A total of 214 patients were diagnosed with PE at baseline (15%). Abnormal CXR occurred more often in patients with confirmed PE (36%, 77/214) than in patients without PE (26%; 327/1,259), for an odds ratio of 1.60 (95% confidence interval: 1.18–2.18). Only the unexpected finding of a (rib)fracture or pneumothorax, present in as few as six patients (0.4%), significantly lowered the post-test probability of PE to an extent that CTPA could have been avoided. Conclusion The incremental diagnostic value of CXR to the YEARS algorithm to rule out PE was limited. CXR was more frequently abnormal in patients with PE than in those in whom PE was ruled out. These data do not support to perform CXR routinely in all patients with suspected PE, prior to CTPA imaging.

Interest of chest X-ray in tailoring the diagnostic strategy in patients with suspected pulmonary embolism

2015 ◽  
Vol 26 (6) ◽  
pp. 643-648
Author(s):  
Philippe Robin ◽  
Pierre-Yves Le Roux ◽  
Valentin Tissot ◽  
Aurélien Delluc ◽  
Alexandra Le Duc-Pennec ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Diagnostic Strategy ◽  
Suspected Pulmonary Embolism ◽  
X Ray ◽  
Chest X Ray

The Use of Scinti-Scanning in the Diagnosis of Pulmonary Embolism

1971 ◽  
Vol 57 (3) ◽  
pp. 131-135
Author(s):  
Murdoch A. Macleod
Keyword(s):  
Pulmonary Embolism ◽  
Sensitive Indicator ◽  
Suspected Pulmonary Embolism ◽  
Normal Appearance ◽  
X Ray ◽  
First Choice ◽  
Highly Sensitive ◽  
Chest X Ray ◽  
Pulmonary Embolism Diagnosis ◽  
Lung Scanning

AbstractIt is becoming increasingly evident that in many patients with pulmonary embolism, diagnosis is made difficult by minimal or absent symptoms and normal appearance of the chest X-ray, especially in the earlier stages. In this paper 30 cases of suspected pulmonary embolism are presented, 23 of whom were radiologically normal and whose symptoms ranged from that of severe to minor. It is concluded that lung scanning is a highly sensitive indicator for, and the investigation of first choice in, the diagnosis of pulmonary embolism.

Accuracy of X-ray with perfusion scan in young patients with suspected pulmonary embolism

2015 ◽  
Vol 136 (2) ◽  
pp. 221-224 ◽  
Author(s):  
J. van Es ◽  
R.A. Douma ◽  
R.E.L. Hezemans ◽  
A. Penaloza ◽  
S. Motte ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Young Patients ◽  
Suspected Pulmonary Embolism ◽  
X Ray ◽  
Perfusion Scan

Portable Ventilation/Perfusion Scanning is Useful for Evaluating Clinically Significant Pulmonary Embolism in the ICU Despite Abnormal Chest Radiography

2018 ◽  
Vol 35 (10) ◽  
pp. 1032-1038 ◽  
Author(s):  
Aaron S. Weinberg ◽  
William Chang ◽  
Grace Ih ◽  
Alan Waxman ◽  
Victor F. Tapson
Keyword(s):  
Pulmonary Embolism ◽  
Chest Radiograph ◽  
High Probability ◽  
Hemodynamic Instability ◽  
X Rays ◽  
X Ray ◽  
Abnormal Chest ◽  
Chest X Ray ◽  
Low Probability ◽  
Clinically Significant

Objective: Computed tomography angiography is limited in the intensive care unit (ICU) due to renal insufficiency, hemodynamic instability, and difficulty transporting unstable patients. A portable ventilation/perfusion (V/Q) scan can be used. However, it is commonly believed that an abnormal chest radiograph can result in a nondiagnostic scan. In this retrospective study, we demonstrate that portable V/Q scans can be helpful in ruling in or out clinically significant pulmonary embolism (PE) despite an abnormal chest x-ray in the ICU. Design: Two physicians conducted chart reviews and original V/Q reports. A staff radiologist, with 40 years of experience, rated chest x-ray abnormalities using predetermined criteria. Setting: The study was conducted in the ICU. Patients: The first 100 consecutive patients with suspected PE who underwent a portable V/Q scan. Interventions: Those with a portable V/Q scan. Results: A normal baseline chest radiograph was found in only 6% of patients. Fifty-three percent had moderate, 24% had severe, and 10% had very-severe radiographic abnormalities. Despite the abnormal x-rays, 88% of the V/Q scans were low probability for a PE despite an average abnormal radiograph rating of moderate. A high-probability V/Q for PE was diagnosed in 3% of the population despite chest x-ray ratings of moderate to severe. Six patients had their empiric anticoagulation discontinued after obtaining the results of the V/Q scan, and no anticoagulation was started for PE after a low-probability V/Q scan. Conclusion: Despite the large percentage of moderate-to-severe x-ray abnormalities, PE can still be diagnosed (high-probability scan) in the ICU with a portable V/Q scan. Although low-probability scans do not rule out acute PE, it appeared less likely that any patient with a low-probability V/Q scan had severe hypoxemia or hemodynamic instability due to a significant PE, which was useful to clinicians and allowed them to either stop or not start anticoagulation.

scholarly journals The diagnostic value of chest X-ray in coronavirus disease 2019: A comparative study of X-ray and CT

2021 ◽  
Vol 104 (3) ◽  
pp. 003685042110162
Author(s):  
Fengxia Zeng ◽  
Yong Cai ◽  
Yi Guo ◽  
Weiguo Chen ◽  
Min Lin ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Diagnostic Value ◽  
Rapid Identification ◽  
Chest Ct ◽  
Ct Scans ◽  
Ground Glass ◽  
X Ray ◽  
Chest X Ray ◽  
Laboratory Examinations ◽  
Sensitivity Specificity

As the coronavirus disease 2019 (COVID-19) epidemic spreads around the world, the demand for imaging examinations increases accordingly. The value of conventional chest radiography (CCR) remains unclear. In this study, we aimed to investigate the diagnostic value of CCR in the detection of COVID-19 through a comparative analysis of CCR and CT. This study included 49 patients with 52 CT images and chest radiographs of pathogen-confirmed COVID-19 cases and COVID-19-suspected cases that were found to be negative (non-COVID-19). The performance of CCR in detecting COVID-19 was compared to CT imaging. The major signatures that allowed for differentiation between COVID-19 and non-COVID-19 cases were also evaluated. Approximately 75% (39/52) of images had positive findings on the chest x-ray examinations, while 80.7% (42/52) had positive chest CT scans. The COVID-19 group accounted for 88.4% (23/26) of positive chest X-ray examinations and 96.1% (25/26) of positive chest CT scans. The sensitivity, specificity, and accuracy of CCR for abnormal shadows were 88%, 80%, and 87%, respectively, for all patients. For the COVID-19 group, the accuracy of CCR was 92%. The primary signature on CCR was flocculent shadows in both groups. The shadows were primarily in the bi-pulmonary, which was significantly different from non-COVID-19 patients ( p = 0.008). The major CT finding of COVID-19 patients was ground-glass opacities in both lungs, while in non-COVID-19 patients, consolidations combined with ground-glass opacities were more common in one lung than both lungs ( p = 0.0001). CCR showed excellent performance in detecting abnormal shadows in patients with confirmed COVID-19. However, it has limited value in differentiating COVID-19 patients from non-COVID-19 patients. Through the typical epidemiological history, laboratory examinations, and clinical symptoms, combined with the distributive characteristics of shadows, CCR may be useful to identify patients with possible COVID-19. This will allow for the rapid identification and quarantine of patients.

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

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