VENTILATION/PERFUSION LUNG IMAGING IN PULMONARY EMBOLISM: ANALYSIS WITH CONSIDERATIONS OF SIZE, NUMBER OF SEGMENTS AND CHEST X-RAY.

1983 ◽  
Vol 8 ◽  
pp. P32
Author(s):  
Lalitha Ramanna ◽  
Alan D. Waxman ◽  
Michael B. Brachman ◽  
Dhana Kaushik ◽  
Peter Julien ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Lung Imaging ◽  
X Ray ◽  
Size Number ◽  
Chest X Ray ◽  
Number Of Segments

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.

Chest X-ray in acute pulmonary embolism: forgiven but not forgotten

2019 ◽  
Vol 45 (12) ◽  
pp. 1822-1823 ◽  
Author(s):  
Marco Zuin ◽  
Gianluca Rigatelli ◽  
Pietro Zonzin ◽  
Loris Roncon
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
X Ray ◽  
Chest X Ray

scholarly journals The Role of Imaging In The Diagnosis of Pulmonary Embolism

2019 ◽  
Vol 2 (1) ◽  
pp. 57
Author(s):  
Alfian Nur Rosyid ◽  
M. Yamin ◽  
Arina Dery Puspitasari
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Gold Standard ◽  
Common Condition ◽  
X Ray ◽  
Life Threatening ◽  
Chest X Ray ◽  
Proper Diagnosis ◽  
D Dimer

Pulmonary embolism is a common condition and sometimes can be life-threatening. A proper diagnosis can reduce mortality. Some examinations are needed to diagnose pulmonary embolism, including assessing the risk factors, clinical examination, D-dimer tests, and imaging. Imaging is necessary when the previous assessment requires further investigation. There are more imaging that can be used to diagnose and assess the severity of pulmonary embolism. However, it is still controversial regarding imaging modalities for optimizing pulmonary embolism diagnose. Chest X-Ray cannot exclude pulmonary embolism, but it is needed to guide the next examinations and to find alternative diagnoses. Pulmonary Multi-Detector CT Angiography is the gold standard to diagnose pulmonary embolism.

Value of Chest X-ray Combined with Perfusion Scan versus Ventilation/Perfusion Scan in Acute Pulmonary Embolism

2000 ◽  
Vol 83 (03) ◽  
pp. 412-415 ◽  
Author(s):  
Franktien Turkstra ◽  
Marinus van Marwijk Kooy ◽  
Ad H. Oostdijk ◽  
Edwin J. van Beek ◽  
Harry Büller ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Diagnostic Category ◽  
Great Majority ◽  
Chronic Obstructive ◽  
Perfusion Scintigraphy ◽  
X Ray ◽  
Perfusion Defects ◽  
Chest X Ray ◽  
Perfusion Scan

Summary BackgroundThe main purpose of ventilation scanning, as adjunct to perfusion lung scintigraphy, in acute pulmonary embolism is to allow for the classification of segmental perfusion defects as mismatched, which is generally accepted as proof for the presence of pulmonary embolism. We examined whether this function of the ventilation scan could be replaced by the chest X-ray.MethodsIn 389 consecutive patients with suspected pulmonary embolism and at least one segmental perfusion defect we classified the ventilation/perfusion (V/Q) scan and chest X-ray/perfusion (X/Q) scan as either mismatched or matched. Furthermore we analyzed whether this comparison was different in subgroups of patients with concomitant congestive heart failure or chronic obstructive pulmonary disease.Results Overall agreement between the X/Q and V/Q scan diagnostic category was found in 341 of 389 patients (88%; 95% CI 84-92%). The positive predictive value for obtaining a mismatched V/Q scan result in case of a mismatched X/Q scan result was 86% (95% CI 81-90%). If the X/Q scan yielded only matched defects the V/Q scan resulted in the same classification in 90% (95% CI 85-95%). Analysis of the small subgroup of patients with chronic obstructive pulmonary disease showed that a mismatched X/Q scan was confirmed by V/Q scanning in 21 of 34 cases (62%; 95% CI 45-78%).ConclusionThis study shows that in the great majority of patients with clinically suspected acute pulmonary embolism combination of chest X-ray with perfusion scintigraphy reliably replaced ventilation/perfusion scintigraphy in defining (mis)-matching of segmental perfusion defects. These results need confirmation before the chest X-ray can fully obviate the use of ventilation scintigraphy.

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

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.

Isolated unilateral absence of pulmonary artery mimicking chronic pulmonary embolism at chest X-ray: multidetector-row CT angiographic findings

2012 ◽  
Vol 36 (6) ◽  
pp. 845-849 ◽  
Author(s):  
Luigi Camera ◽  
Mario Fusari ◽  
Milena Calabrese ◽  
Cesare Sirignano ◽  
Lucio Catalano ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Multidetector Row Ct ◽  
X Ray ◽  
Multidetector Row ◽  
Chest X Ray ◽  
Chronic Pulmonary Embolism ◽  
Angiographic Findings

scholarly journals Pleuritic chest pain: infection, infarction or musculoskeletal?

2002 ◽  
Vol 1 (2) ◽  
pp. 64-66
Author(s):  
S Gill ◽  
◽  
A Pope ◽  
Keyword(s):  
Pulmonary Embolism ◽  
Chest Pain ◽  
Initial Presentation ◽  
Pulmonary Emboli ◽  
Pleuritic Chest Pain ◽  
X Ray ◽  
Blood Tests ◽  
Chest X Ray ◽  
Initial Blood ◽  
D Dimer

A 52 year old patient, originally thought to have musculoskeletal chest pain was found to have features consistent with infective pleurisy on initial blood tests and chest x-ray, with a negative d-dimer indicating a low likelihood of pulmonary embolism. Two weeks later he represented with continued symptoms and investigations revealed extensive pulmonary emboli, which were thought to have developed after his initial presentation.

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