Role of perfusion defects at follow-up lung scan in predicting recurrences after a first episode of symptomatic pulmonary embolism

2018 ◽  
Vol 29 (1) ◽  
pp. 75-80 ◽  
Author(s):  
Liliana Villari ◽  
Roberta Pancani ◽  
Ferruccio Aquilini ◽  
Letizia Marconi ◽  
Laura Carrozzi ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
First Episode ◽  
Symptomatic Pulmonary Embolism ◽  
Lung Scan ◽  
Perfusion Defects

Presence of Residual Thromboemboli at Least Six Months after a First Episode of Symptomatic Pulmonary Embolism: DO Perfusion Scintigraphy and CT-Angiography Agree?

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3030-3030
Author(s):  
Francesco Dentali ◽  
Marco Donadini ◽  
Benilde Cosmi ◽  
Alessandro Squizzato ◽  
Silvia Bozzato ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Complete Resolution ◽  
First Episode ◽  
Kappa Statistics ◽  
Perfusion Scintigraphy ◽  
Partial Resolution ◽  
Expert Radiologist ◽  
Symptomatic Pulmonary Embolism ◽  
Angio Ct

Abstract Introduction. The natural history of residual thromboembolic obstructions after pulmonary embolism (PE) and the clinical utility of imaging techniques at follow up are not completely known; in particular, to our knowledge, there are no clinical studies that compared the accuracy of angio-computed tomography (angio-CT) and perfusion scintigraphy (Q scan) in detecting residual thromboemboli after at least 6 months from a first episode of symptomatic PE. Methods. Consecutive patients on anticoagulant treatment for a first episode of symptomatic PE diagnosed by angio-CT scan and/or Q scan underwent angio-CT and Q scan after 6 to 12 months from the index event. Exclusion criteria were previous PE, recurrent symptomatic PE or deep vein thrombosis (DVT) during the follow-up period. All diagnostic tests were independently assessed by one expert radiologist unaware of the clinical status of the patients. The results of the tests were classified as no signs of recanalization or reperfusion, partial resolution or complete resolution. The agreement beyond chance between tests was assessed by kappa statistics. Results. Twenty-five patients (14 males, 56%, mean age 59.8) were included after a mean of 7.2 months (217 days, standard deviation 58 days) after acute PE. PE was diagnosed by CT alone in 13 cases, by high probability Q scan alone in 2 cases and by both CT and Q scan in 10 patients. Eleven episodes (44%) were considered idiopathic, 11 (44%) were secondary to transient risk factors, 3 (12%) patients had cancer; concomitant DVT was detected in 17 (68%) patients. At follow-up, Q scan showed no signs of reperfusion in 1 patient (4%), partial resolution in 13 patients (52%) and complete resolution in 11 (44%). Angio-CT showed no signs of recanalization in 0 patient, partial resolution in 17 patients (68%) and complete resolution in 8 (32%). Complete resolution was present in both tests in 1 patient (4%), partial resolution was present in both tests in 6 (24%) patients, with a k agreement between tests < 0.2 (slight). Conclusions. Partial resolution of thromboemboli after a mean period of 7.2 months from a first episode of PE is present at Q scan or at angio-CT in more than 50% of patients, confirming the results of previous studies. However, the results of our study show for the first time that the agreement between these two tests is low. Thus, caution should be used when interpreting the results of either of these tests to monitor patients with previous PE.

Risk of recurrence in patients with pulmonary embolism: Predictive role of D-dimer and of residual perfusion defects on lung scintigraphy

2013 ◽  
Vol 109 (02) ◽  
pp. 181-186 ◽  
Author(s):  
Caterina Cenci ◽  
Emilia Antonucci ◽  
Elisa Grifoni ◽  
Chiara Arcangeli ◽  
Domenico Prisco ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Recurrence Risk ◽  
First Episode ◽  
Lung Scintigraphy ◽  
Oral Anticoagulant Treatment ◽  
Vein Thrombosis ◽  
Lung Scan ◽  
Perfusion Defects ◽  
Deep Vein ◽  
D Dimer

SummaryThe stratification of recurrence risk after a first episode of venous thromboembolism (VTE) is an important topic of research, especially in patients with pulmonary embolism (PE). Elevated D-dimer levels and residual vein obstruction (RVO) at compression ultrasonography have been studied as predictors of recurrence after withdrawing oral anticoagulant treatment (OAT). It is still unknown if residual perfusion defects (PD) on lung scintigraphy are related to recurrent PE. In the present study, we evaluated the association of PD with PE recurrence. The relationship between PD, elevated D-dimer levels, and RVO was also investigated. We prospectively followed 236 consecutive patients who survived a first episode of objectively confirmed PE, with or without deep-vein thrombosis. After at least three months of OAT, treatment was withdrawn in 139 patients. D-dimer levels were evaluated at one month of OAT withdrawal, RVO was measured, and perfusion lung scan (P-scan) was performed to evaluate PD. During follow-up, 20 patients experienced a recurrent episode of VTE. Elevated D-dimer levels were significantly associated with VTE recurrence, (p=0.003). RVO was present in 22% of the patients with recurrence and in 7.5% of those without (p=0.07). No significant association was found between PD >10% and VTE recurrence, D-dimer, or RVO. In conclusion, we confirmed the positive predictive value of elevated D-dimer levels for recurrent VTE. Residual PD on lung scintigraphy are neither predictive of recurrence nor related to D-dimer levels or RVO.

Family involvement in first-episode psychosis

2019 ◽  
pp. 117-130
Author(s):  
Greeshma Mohan ◽  
R. Padmavati ◽  
R. Thara
Keyword(s):  
Treatment Adherence ◽  
Family Involvement ◽  
First Episode Psychosis ◽  
First Episode ◽  
Rapid Urbanization ◽  
Episode Psychosis ◽  
The Family ◽  
Expanding Population

In the Indian secular, pluralistic, and collectivist society, the family is the oldest and the most important institution that has survived through the ages. With rapid urbanization and an ever-expanding population, there is a scarcity of financial and human resources in the area of mental health. Though progressively decreasing in size, families continue to provide a valuable support system, which can be helpful in the management of various stressful situations. Yet, very often this resource is not adequately and appropriately utilized. This chapter describes the role of family involvement in first-episode psychosis, drawing from various research projects carried out by the Schizophrenia Research Foundation (SCARF) and from other Indian centres. It deals with the identification of prodromes, access to care, treatment adherence and follow-up, and stigma.

scholarly journals Pulmonary embolism in patients with COVID-19: characteristics and outcomes in the Cardio-COVID Italy multicenter study

2020 ◽  
Author(s):  
Pietro Ameri ◽  
Riccardo M. Inciardi ◽  
Mattia Di Pasquale ◽  
Piergiuseppe Agostoni ◽  
Antonio Bellasi ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Involvement ◽  
Hospital Death ◽  
Bleeding Events ◽  
Younger Age ◽  
Sizable Proportion ◽  
Bleeding Episodes ◽  
Restricted Cubic Splines

Abstract Background Pulmonary embolism (PE) has been described in coronavirus disease 2019 (COVID-19) critically ill patients, but the evidence from more heterogeneous cohorts is limited. Methods Data were retrospectively obtained from consecutive COVID-19 patients admitted to 13 Cardiology Units in Italy, from March 1st to April 9th, 2020, and followed until in-hospital death, discharge, or April 23rd, 2020. The association of baseline variables with computed tomography-confirmed PE was investigated by Cox hazards regression analysis. The relationship between d-dimer levels and PE incidence was evaluated using restricted cubic splines models. Results The study included 689 patients (67.3 ± 13.2 year-old, 69.4% males), of whom 43.6% were non-invasively ventilated and 15.8% invasively. 52 (7.5%) had PE over 15 (9–24) days of follow-up. Compared with those without PE, these subjects had younger age, higher BMI, less often heart failure and chronic kidney disease, more severe cardio-pulmonary involvement, and higher admission d-dimer [4344 (1099–15,118) vs. 818.5 (417–1460) ng/mL, p < 0.001]. They also received more frequently darunavir/ritonavir, tocilizumab and ventilation support. Furthermore, they faced more bleeding episodes requiring transfusion (15.6% vs. 5.1%, p < 0.001) and non-significantly higher in-hospital mortality (34.6% vs. 22.9%, p = 0.06). In multivariate regression, only d-dimer was associated with PE (HR 1.72, 95% CI 1.13–2.62; p = 0.01). The relation between d-dimer concentrations and PE incidence was linear, without inflection point. Only two subjects had a baseline d-dimer < 500 ng/mL. Conclusions PE occurs in a sizable proportion of hospitalized COVID-19 patients. The implications of bleeding events and the role of d-dimer in this population need to be clarified. Graphic abstract

Pulmonary leukostasis: Role of perfusion lung scan in diagnosis and follow up

2001 ◽  
Vol 67 (2) ◽  
pp. 136-138 ◽  
Author(s):  
M. Szyper-Kravitz ◽  
J. Strahilevitz ◽  
V. Oren ◽  
M. Lahav
Keyword(s):  
Lung Scan

Longterm Follow-Up of Patients with Suspected Pulmonary Embolism and a Normal Lung Scan

CHEST Journal ◽  
1982 ◽  
Vol 82 (4) ◽  
pp. 411-415 ◽  
Author(s):  
Michael S. Kipper ◽  
Kenneth M. Moser ◽  
Keith E. Kortman ◽  
William L. Ashburn
Keyword(s):  
Pulmonary Embolism ◽  
Normal Lung ◽  
Suspected Pulmonary Embolism ◽  
Lung Scan

Unresolved major pulmonary embolism: Importance of follow-up lung scan in diagnosis

1986 ◽  
Vol 12 (5-6) ◽  
pp. 252-253 ◽  
Author(s):  
Hyung S. Yoo ◽  
Charles M. Intenzo ◽  
Chan H. Park
Keyword(s):  
Pulmonary Embolism ◽  
Lung Scan

The value of 64-detector row computed tomography for the exclusion of pulmonary embolism

2011 ◽  
Vol 105 (05) ◽  
pp. 901-907 ◽  
Author(s):  
Giorgio de Conti ◽  
Isabella Minotto ◽  
Lucia Filippi ◽  
Marta Mongiat ◽  
Daniele de Faveri ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Clinical Decision ◽  
First Episode ◽  
Diagnostic Strategy ◽  
Clinical Disorder ◽  
Vein Thrombosis ◽  
Test Probability ◽  
D Dimer

SummaryRecently, a diagnostic strategy using a clinical decision rule, D-dimer testing and spiral computed tomography (CT) was found to be effective in the evaluation of patients with clinically suspected pulmonary embolism (PE). However, the rate of venous thromboembolic complications in the three-month follow-up of patients with negative CT was still substantial and included fatal events. It was the objective to evaluate the safety of withholding anticoagulants after a normal 64-detector row CT (64-DCT) scan from a cohort of patients with suspected PE. A total of 545 consecutive patients with clinically suspected first episode of PE and either likely pre-test probability of PE (using the simplified Wells score) or unlikely pre-test probability in combination with a positive D-dimer underwent a 64-DCT. 64-DCT scanning was inconclusive in nine patients (1.6%), confirmed the presence of PE in 169 (31%), and ruled out the diagnosis in the remaining 367. During the three-month follow-up of the 367 patients one developed symptomatic distal deep-vein thrombosis (0.27%; 95%CI, 0.0 to 1.51%) and none developed PE (0 %; 95%CI, 0 to 1.0%). We conclude that 64-DCT scanning has the potential to safely exclude the presence of PE virtually in all patients presenting with clinical suspicion of this clinical disorder.

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