scholarly journals Rate of Nondiagnostic Computerized Tomography Pulmonary Angiograms (CTPAs) Performed for the Diagnosis of Pulmonary Embolism in Pregnant and Immediately Postpartum Patients

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Sarah Hogan ◽  
Jillian Greene ◽  
Jeffery Flemming
Keyword(s):  
Pulmonary Embolism ◽  
Breast Tissue ◽  
Main Pulmonary Artery ◽  
Pulmonary Angiography ◽  
Eastern Health ◽  
X Rays ◽  
Diagnostic Quality ◽  
Normal Chest ◽  
Line Imaging

Objective. To evaluate the nondiagnostic rate of computed tomography pulmonary angiography (CTPA) in pregnant and postpartum patients with suspected pulmonary embolism (PE) to determine whether CTPA or ventilation-perfusion (VQ) scan should be considered first line imaging in this patient population considering their equivalent accuracy and the greater radiation exposure to proliferating breast tissue of CTPA. Methods. All pregnant/postpartum female patients between 18 and 50 years of age who had CTPA within the Eastern Health Authority between November 2012 and November 2016 were included. Each scan was evaluated for nondiagnosis based on two criteria: contrast density in the main pulmonary artery, and respiratory motion artefact. If either of these criteria were not met, the scan was labelled as nondiagnostic. Results. The nondiagnostic rate overall was 43% (n=83). This is similar to current literature values for rates of CTPA nondiagnosis, and comparable to the reported diagnostic quality of the reporting radiologist. This is much greater compared to rates of ventilation/perfusion nondiagnosis in comparable populations. Even in patients with normal chest radiographs, which represents the main patient group where VQ may be considered as an alternative, the nondiagnostic rate of CT is much higher. Conclusion. This is the first study to attempt to identify an objective method of determining nondiagnosis in pregnant and postpartum patients undergoing a CTPA. Our results strengthen the argument that alternative imaging should be considered when investigating for PE in this population in order to protect the proliferating breast tissue, and VQ scan should be considered especially in patients with normal chest X-rays.

CT Pulmonary Angiography is the First-Line Imaging Test for Acute Pulmonary Embolism: A Survey of US Clinicians

2006 ◽  
Vol 13 (4) ◽  
pp. 434-446 ◽  
Author(s):  
Clifford R. Weiss ◽  
John C. Scatarige ◽  
Gregory B. Diette ◽  
Edward F. Haponik ◽  
Barry Merriman ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Pulmonary Angiography ◽  
First Line ◽  
Ct Pulmonary Angiography ◽  
Imaging Test ◽  
Line Imaging

Negative spiral CT in acute pulmonary embolism

2002 ◽  
Vol 43 (5) ◽  
pp. 486-491 ◽  
Author(s):  
T. Nilsson ◽  
A. Olausson ◽  
H. Johnsson ◽  
U. Nyman ◽  
P. Aspelin
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Pulmonary Arteries ◽  
Negative Contrast ◽  
Spiral Ct ◽  
Pulmonary Angiography ◽  
Diagnostic Quality ◽  
Anticoagulation Treatment ◽  
Acute Pe

Purpose: To retrospectively evaluate the clinical outcome of non-anticoagulated patients with clinically suspected acute pulmonary embolism (PE) and no symptoms or signs of deep venous thrombosis (DVT) following a negative contrast medium-enhanced spiral CT of the pulmonary arteries (s-CTPA). Material and Methods: During a 24-month period, 739 of 751 patients underwent s-CTPA with acceptable diagnostic quality for clinically suspected acute PE. All patients who had a CT study not positive for PE were followed up with a questionnaire, a telephone interview and review of all medical reports, including autopsies and death certificates for any episodes of venous thromboembolism (VTE) during a 3-month period. Results: PE was diagnosed in 158 patients. Of the remaining 581 patients with a negative s-CTPA, 45 patients were lost to follow-up. 88 patients were excluded because of anticoagulation treatment (cardiac disorder n=32, chronic VTE or acute symptomatic DVT n=31, PE diagnosed at pulmonary angiography n=1, thrombus prophylaxis during diagnostic work-up or other reasons than VTE n=24) and 7 patients undergoing lower extremity venous studies because of symptoms of DVT (all negative). Thus, 441 patients with a negative s-CTPA and no DVT symptoms, venous studies or anticoagulant treatment constituted the follow-up cohort. Four of these patients had proven VTE (all PE) during the 3-month follow-up period. Two of the PE episodes contributed to the patient's death. Conclusion: Patients with clinically suspected acute PE, no symptoms or signs of DVT and a negative single slice s-CTPA using 3–5 mm collimation, may safely be left without anticoagulation treatment unless they are critically ill, have a limited cardiopulmonary reserve and/or if a high clinical suspicion remains.

scholarly journals Evaluation of the Therapeutic Effect of Pulmonary Embolism by CT Pulmonary Angiography Combined With Clinical Indexes

2021 ◽  
Author(s):  
Meng Yuan ◽  
XinYuan Cui ◽  
ChunXue Yang ◽  
XinYang Zhang ◽  
DeLi Zhao ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Heart Function ◽  
Main Pulmonary Artery ◽  
Pulmonary Angiography ◽  
Trunk Diameter ◽  
Right Heart Function ◽  
Before And After ◽  
Pulmonary Artery Obstruction ◽  
D Dimer

Abstract Background To evaluate the value of CT pulmonary angiography (CTPA) in evaluating the therapeutic efficacy of pulmonary embolism (PE) through the study of CT pulmonary artery obstruction index (PAOI),right ventricular function parameters and some clinical indexes related to coagulation function and cardiac function injury.Materials and methods Select 30 patients with pulmonary embolism who underwent CTPA examination before and after treatment in our hospital, sort out their CTPA images before and after treatment, and obtain PAOI and right heart function parameters, including ascending aorta diameter (AAd), main pulmonary artery diameter (MPAd), ratio of main pulmonary artery diameter to ascending aorta diameter (MPAd/AAd), right pulmonary artery trunk diameter (RPAd), left pulmonary artery trunk diameter (LPAd), the ratio of the maximum short axis diameter of the right ventricle to the maximum short axis diameter of the left ventricle (RVd/LVd), and calculate the pulmonary artery obstruction index (PAOI).At the same time obtain the required clinical indicators, including serum D-dimer, N-terminal B-type natriuretic peptide precursor (NT-proBNP), cardiac troponin I (cTnI), myocardial enzyme profile (aspartate aminotransferase (AST), lactate dehydrogenase (LDH), creatine kinase (CK)).Results MPAd, RPAd, LPAd, RVd / LVd, PAOI, D-dimer, cTnI, CK, LDH, AST had significant changes after treatment (P < 0.05), while the other parameters and indexes had no significant differences before and after treatment (P > 0.05). PAOI is positively correlated with RVd/LVd, MPAd, D-dimer. The correlation coefficient ranges from 0.281 to 0.423, among which, the correlation with D-dimer is the closest, with a correlation coefficient of 0.423. There was no significant correlation between other parameters and PAOI (P < 0.05).Conclusion CTPA is of great significance in evaluating the severity of pulmonary embolism, right heart function and therapeutic efficacy.

CT pulmonary angiography and suspected acute pulmonary embolism

2003 ◽  
Vol 44 (3) ◽  
pp. 310-315 ◽  
Author(s):  
T. Enden ◽  
N.-E. Kløw
Keyword(s):  
Pulmonary Embolism ◽  
Contrast Material ◽  
Pulmonary Arteries ◽  
Blood Gases ◽  
Clinical Parameter ◽  
Pulmonary Angiography ◽  
Clinical Parameters ◽  
Ct Pulmonary Angiography ◽  
Vein Thrombosis

Purpose: To evaluate the use and quality of CT pulmonary angiography in our department, and to relate the findings to clinical parameters and diagnoses. Material and Methods: A retrospective study of 324 consecutive patients referred to CT pulmonary angiography with clinically suspected pulmonary embolism (PE). From the medical records we registered clinical parameters, blood gases, d-dimer, risk factors and the results of other relevant imaging studies. Results: 55 patients (17%) had PE detected on CT. 39 had bilateral PE, and 8 patients had isolated peripheral PE. 87% of the examinations showing PE had satisfactory filling of contrast material including the segmental pulmonary arteries, and 60% of the subsegmental arteries.D-dimer test was performed in 209 patients, 85% were positive. A negativeD-dimer ruled out PE detected at CT. Dyspnea and concurrent symptoms or detection of deep vein thrombosis (DVT), contraceptive pills and former venous thromboembolism (VTE) were associated with PE. The presence of only one clinical parameter indicated a negative PE diagnosis ( p < 0.017), whereas two or more suggested a positive PE diagnosis ( p < 0.002). CT also detected various ancillary findings such as consolidation, pleural effusion, nodule or tumor in nearly half of the patients; however, there was no association with the PE diagnosis. Conclusion: The quality of CT pulmonary angiography was satisfactory as a first-line imaging of PE. CT also showed additional pathology of importance in the chest. Our study confirmed that a negativeD-dimer ruled out clinically suspected VTE.

How I diagnose acute pulmonary embolism

Blood ◽  
2013 ◽  
Vol 121 (22) ◽  
pp. 4443-4448 ◽  
Author(s):  
Menno V. Huisman ◽  
Frederikus A. Klok
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Standard Of Care ◽  
Clinical Decision ◽  
Pulmonary Angiography ◽  
Management Approach ◽  
Computed Tomographic ◽  
Diagnostic Management ◽  
Computed Tomographic Pulmonary Angiography ◽  
Line Imaging

Abstract The clinical diagnosis of acute pulmonary embolism (PE) is frequently considered in patients presenting to the emergency department or when hospitalized. Since symptoms are a-specific and the consequences of anticoagulant treatment are considerable, objective tests to either establish or refute the diagnosis have become a standard of care. Computed tomographic pulmonary angiography (CTPA), which has replaced pulmonary angiography as first-line imaging test, is associated with radiation exposure, several complications resulting from contrast dye administration, and over diagnosis. Importantly, CTPA can be avoided in 20% to 30% of patients who present with a first or recurrent episode of clinically suspected acute PE by using a standardized algorithm. This algorithm should always include a clinical decision rule to assess the likelihood that PE is present, followed by a D-dimer blood test and/or CTPA. The aim of this review is to provide clinicians this practical diagnostic management approach using evidence from the literature.

scholarly journals Clinical significance of peculiarities of the lesions of the vascular bed associated with pulmonary thromboembolism

2017 ◽  
Vol 95 (5) ◽  
pp. 394-397
Author(s):  
M. A. Bachurina ◽  
V. V. Mazur ◽  
E. S. Mazur
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Pulmonary Artery ◽  
Main Pulmonary Artery ◽  
Clinical Manifestations ◽  
Pulmonary Angiography ◽  
Community Acquired Pneumonia ◽  
Low Risk ◽  
Risk Patients ◽  
Vascular Obstruction

Aim. To study effect of the level of vascular obstruction on the clinical manifestations of pulmonary embolism (PE). Material and methods. 63 patients with PE were included in this study. PE was verified by multidetector computed tomography (MSCT) with pulmonary angiography. 43 patients with high-risk PE survived the first week of the disease. In the remaining 20 patients with community-acquired pneumonia PE was diagnosed using MSCT pulmonary angiography in the first week of illness. Results. Obstruction of the trunk of the pulmonary artery or its lobar branches was detected in 34 (79.1%) patients with a high risk of PE and in only 2 (10%) ones with low-risk PE (p <0,001). The development of pneumonia complicated the course of the disease in 14 (32.6%) patients with a high risk of pulmonary embolism. The clots in the segmental branches of the pulmonary artery were identified in 9 (64.3%) patients with pneumonia. In high-risk patients with PE without pneumonia the lesion of segmental branches was detected only in 1 (3.4%) case (p <0,001). In patients with pneumonia at low risk of PE, the obstruction segmental branches was detected in 17 (85%) cases. Conclusion. The development of obstructive shock in PE is associated with a trunk embolism and/or the main pulmonary artery branches embolism. Infarction pneumonia is associated with the lesions of segmental branches of the pulmonary artery.

scholarly journals Visibility and image quality of peripheral pulmonary arteries in pulmonary embolism patients using free-breathing combined with a high-threshold bolus-triggering technique in CT pulmonary angiography

2020 ◽  
Vol 48 (8) ◽  
pp. 030006052093932
Author(s):  
Daliang Liu ◽  
Xiansheng Cai ◽  
Xiaoshuang Che ◽  
Yong Ma ◽  
Yucun Fu ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Image Quality ◽  
Pulmonary Artery ◽  
Main Pulmonary Artery ◽  
Pulmonary Arteries ◽  
Free Breathing ◽  
Pulmonary Angiography ◽  
Motion Artifacts ◽  
Breath Holding ◽  
High Threshold

Objective To investigate the visibility of peripheral pulmonary arteries by computed tomography pulmonary angiography (CTPA) and image quality using a free-breathing combined with a high-threshold bolus triggering technique and to explore the feasibility of this technique in pulmonary embolism (PE) patients who cannot hold their breath. Methods Patients with suspected PE who underwent CTPA (n=240) were randomly assigned to two groups: free-breathing (n=120) or breath-holding (n=120). Results The mean scanning time or visible pulmonary artery distal branches were not different between the groups. Mean CT main pulmonary artery (MPA) values, apical segment (S1), and posterior basal segment (S10) in the free-breathing group were higher compared with the breath-holding group. The subjective image quality score in the free-breathing group was higher compared with the breath-holding group. In the free-breathing group, no respiratory artifact was observed. In the breath-holding group, obvious respiratory artifacts were caused by severe chronic obstructive pulmonary disease (COPD), dyspnea, or other diseases that preclude patients from holding their breath. Conclusion The free-breathing mode CTPA combined with a high-threshold bolus triggering technique can provide high quality images with a lower incidence of respiratory and cardiac motion artifacts, which is especially valuable for patients who cannot hold their breath.

Diagnostic quality of digitized versus traditional chest X-rays: an observer performance study

1988 ◽  
Vol 13 (4) ◽  
pp. 373-374
Author(s):  
L. H. L. Winter ◽  
F. P. Ottes ◽  
F. H. Barneveld-Binkhuysen ◽  
J. P. J. de Valk ◽  
B. M. Ter Haar Romeny ◽  
...  
Keyword(s):  
Observer Performance ◽  
X Rays ◽  
Performance Study ◽  
Diagnostic Quality

scholarly journals Role of multidetector CT in predicting patient outcome in cases of pulmonary embolism: correlation between imaging findings, ICU admissions and mortality rate

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Heba Ibrahim ◽  
Samar M. El-Maadawy
Keyword(s):  
Pulmonary Embolism ◽  
Multidetector Ct ◽  
Medical Condition ◽  
Imaging Modality ◽  
Main Pulmonary Artery ◽  
Pulmonary Angiography ◽  
Septal Deviation ◽  
Hepatic Veins ◽  
Icu Admission ◽  
Contrast Reflux

Abstract Background Pulmonary embolism (PE) is a critical medical condition that requires prompt diagnosis and treatment to avoid serious morbidity and mortality risk. Multidetector CT pulmonary angiography (CTPA) is considered the first-line imaging modality for suspected acute PE. The presence of right heart strain, which supports the diagnosis, requires special attention. The aim of our retrospective study is to assess the reliability of CTPA hemodynamic indices in predicting patients’ outcome in cases of PE. Results Sixty patients were included in our study. CTPA parameters including main pulmonary artery (MPA) diameter, left ventricle (LV) diameter, right ventricle (RV)/LV ratio, and septal deviation had a clinical prognostic value for short-term 30-day mortality and ICU admission. Statistically significant relationship between MPA diameter > 29 mm, LV diameter, RV/LV ratio > 1, left-sided septal deviation and contrast reflux into the IVC/distal hepatic veins with ICU admission was observed with p values 0.031, 0.000, 0.000, 0.005 and 0.028 respectively. There was a statistically significant correlation between MPA diameter > 29 mm, LV diameter, RV/LV > 1 ratio and septal deviation with 30-day mortality with p values of < 0.001, 0.001, < 0.001 and 0.015 respectively. No significant correlation was found between 30-day mortality and contrast reflux to IVC with p value of 0.070. Conclusions CTPA measurements including MPA diameter, RV/LV ratio and septal deviation were found to be significantly correlated to ICU admission and 30-day mortality as predictors for PE severity. CT contrast reflux was found to be correlated to ICU admission; however, it was not significantly correlated to 30-day mortality.

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