scholarly journals Acute Pulmonary Embolism in Coronavirus Disease 2019

2020 ◽  
Author(s):  
Yanan Guo ◽  
Wenwu Sun ◽  
Yanli Liu ◽  
Yanling Lv ◽  
Su Zhao ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Pulmonary Angiography ◽  
Severe Condition ◽  
Computed Tomographic ◽  
Number Of Patients ◽  
Wells Score ◽  
Computed Tomographic Pulmonary Angiography ◽  
D Dimer

Abstract Background Pulmonary embolism is a severe condition prone to misdiagnosis given its nonspecific signs and symptoms. Previous studies on the pneumonia outbreak caused by coronavirus disease 2019 (COVID-19) showed a number of patients with elevated d-dimer, whether those patients combined with pulmonary embolism got our attention. Methods Data on clinical manifestations, laboratory and radiological findings, treatment, and disease progression of 19 patients with laboratory-confirmed COVID-19 pneumonia,who completed computed tomographic pulmonary angiography (CTPA) during hospitalization in the Central Hospital of Wuhan from January 2 to March 26, 2020, were reviewed. Results Of the 19 suspected pulmonary embolism and subjected to CTPA patients, six were diagnosed with pulmonary embolism. The Wells’ score of the six patients with pulmonary embolism was 0–1, which suggested a low risk of pulmonary embolism. The median level of d-dimers collected at the day before or on the day of CTPA completion in the patients with pulmonary embolism was 18.36 (interquartile range [IQR]: 6.69–61.46) µg/mL, which was much higher than that in the patients without pulmonary embolism (median 9.47 [IQR: 4.22–28.02] µg/mL). Of the 6 patients diagnosed with pulmonary embolism, all patients received anticoagulant therapy, 5 of which survived and were discharged and 1 died. Conclusion A potential causal relationship exists between COVID-19 infection and pulmonary embolism, but whether this phenomenon is common remains uncertain. The clinical manifestations of COVID-19 patients who developed pulmonary embolism are similar to those of patients with increased d-dimer alone, prompting a significant challenge on differential diagnoses.

scholarly journals Is computed tomographic pulmonary angiography justified in all patients with suspected pulmonary embolism – tertiary multidisciplinary hospital perspective

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Morawiec ◽  
O Brycht ◽  
M Nadel ◽  
J Drozdz
Keyword(s):  
Heart Failure ◽  
Pulmonary Embolism ◽  
Creatinine Level ◽  
Pulmonary Angiography ◽  
Hospital Death ◽  
Contrast Induced Nephropathy ◽  
Computed Tomographic ◽  
Level Increase ◽  
Computed Tomographic Pulmonary Angiography ◽  
Egfr Decline

Abstract Background According to 2019 ESC guidelines for management in patients with the pulmonary embolism (PE), the computed tomographic pulmonary angiography (CTPA) is the diagnostic method of choice in suspected high-risk PE defined as patients with hemodynamic instability. In stable cases, it is recommended to assess the pre-test probability of the PE. However, CTPA with its great accuracy and wide availability in most medical centers is used as often to confirm as to exclude the diagnosis in PE suspected patients, despite the fact that it is linked with the risk of radiation and iodine-containing contrast exposure. Purpose The aim of the study was to assess the validity of CTPA use in patients with suspected PE form the perspective of multidisciplinary clinical center. Methods We retrospectively analyzed the data of from 52,474 hospitalized patients between 01.2018 and 12.2019. A total of 261 (0.5%) consecutive patients with suspected PE (in the emergency department or during hospitalization) were included into the study. Due to suspicion of PE all patients underwent the CTPA. In this group, we analyzed all available clinical data, results of laboratory and diagnostic tests (before and after CTPA) including estimated glomerular filtration rate (eGFR), creatinine level, transthoracic echocardiography (TTE) and planar ventilation/perfusion (lung scintigraphy) scan (V/Q SPECT) if performed. Results The CTPA confirmed PE in 28.9% of patients. The most common final diagnoses, established in the group with negative CTPA result, include heart failure (33.9%), pneumonia (14.4%) exacerbation of chronic obstructive pulmonary disease or asthma (9.3%) and acute coronary syndrome (5.9%). Acute PE was the cause of in-hospital death in 2.4% of patients and the rate of all cause in-hospital death was 11.4%. In 54.2% of patients we observed the eGFR decline and creatinine level increase, meeting the criteria of the acute contrast-induced nephropathy in 33 of them of them (19.8%). In the group with excluded PE, mean eGFR before CTPA was 70.9ml/min/1.73m2 with the decline to mean 60.4ml/min/1.73m2 during the hospitalization (p<0.01). In patients with negative CTPA result and the worsening of the renal function mean eGFR decline was 17.8ml/min/1.73m2 (p<0.01) and mean creatinine level increase was 38.6μmol/l (p<0.01). CONSLUSIONS The initial data collected show the overuse of CTPA in suspected PE, as the diagnosis was confirmed in less than one-third of them. Although CTPA allows to exclude or confirm PE unambiguously, its use is associated with risk of acute contrast-induced nephropathy. Additionally, in patients with exacerbation of heart failure established as final diagnosis after excluding PE, intensive diuretic treatment is crucial and may cause further accompanying renal function worsening. Therefore, optimizing the diagnostic pathway in patients with suspected PE into less aggravating procedures such as TTE or V/Q SPECT is justifiable. Funding Acknowledgement Type of funding source: None

scholarly journals Investigation of Suspected Pulmonary Embolism at Hutt Valley Hospital with CT Pulmonary Angiography: Current Practice and Opportunities for Improvement

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Nick Kennedy ◽  
Sisira Jayathissa ◽  
Paul Healy
Keyword(s):  
Pulmonary Embolism ◽  
Current Practice ◽  
Pulmonary Angiography ◽  
Pretest Probability ◽  
British Thoracic Society ◽  
Suspected Pulmonary Embolism ◽  
Ct Pulmonary Angiography ◽  
Wells Score ◽  
Positive Rate ◽  
D Dimer

Aims. To study the use of CT pulmonary angiography (CTPA) at Hutt Hospital and investigate the use of pretest probability scoring in the assessment of patients with suspected pulmonary embolism (PE).Methods. We studied patients with suspected PE that underwent CTPA between January and May 2012 and collected data on demographics, use of pretest probability scoring, and use of D Dimer and compared our practice with the British Thoracic Society (BTS) guideline.Results. 105 patients underwent CTPA and 15% of patients had PE. 13% of patients had a Wells score prior to their scan. Wells score calculated by researchers revealed 54%, 36%, and 8% patients had low, medium, and high risk pretest probabilities and 8%, 20%, and 50% of these patients had positive scans. D Dimer was performed in 58% of patients and no patients with a negative D Dimer had a PE.Conclusion. The CTPA positive rate was similar to other contemporary studies but lower than previous New Zealand studies and some international guidelines. Risk stratification of suspected PE using Wells score and D Dimer was underutilised. A number of scans could have been safely avoided by using accepted guidelines reducing resources use and improving patient safety.

Diagnosis of acute pulmonary embolism and evolving imaging modalities

ESC CardioMed ◽  
2018 ◽  
pp. 2761-2766
Author(s):  
Helia Robert-Ebadi ◽  
Grégoire Le Gal ◽  
Marc Righini
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Angiography ◽  
Thoracic Imaging ◽  
Diagnostic Strategies ◽  
Computed Tomographic ◽  
Vein Thrombosis ◽  
Clinical Probability ◽  
Venous Compression ◽  
Computed Tomographic Pulmonary Angiography ◽  
Deep Vein

Modern non-invasive diagnostic strategies for pulmonary embolism rely on the sequential use of clinical probability assessment, D-dimer measurement, and thoracic imaging tests. Planar ventilation/perfusion scintigraphy was the cornerstone test for the diagnosis of pulmonary embolism for more than two decades and has now been replaced by computed tomographic pulmonary angiography (CTPA). Diagnostic strategies using CTPA are very safe to rule out pulmonary embolism and have been well validated in large prospective management outcome studies. Venous compression ultrasonography is the cornerstone test to diagnose deep vein thrombosis but is not mandatory for the diagnosis of pulmonary embolism when using multidetector CTPA.

Overutilisation of imaging studies for diagnosis of pulmonary embolism: are we following the guidelines?

2019 ◽  
Vol 95 (1126) ◽  
pp. 420-424 ◽  
Author(s):  
Prajwal Dhakal ◽  
Mian Harris Iftikhar ◽  
Ling Wang ◽  
Varunsiri Atti ◽  
Sagar Panthi ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Imaging Study ◽  
Pulmonary Angiography ◽  
Imaging Studies ◽  
Hospital Emergency ◽  
Wells Score ◽  
Observational Cohort ◽  
Current Guidelines ◽  
Retrospective Observational Cohort Study ◽  
D Dimer

ObjectiveTo evaluate if imaging studies such as CT pulmonary angiography (CTPA) or ventilation–perfusion (V/Q) scan are ordered according to the current guidelines for the diagnosis of pulmonary embolism (PE).MethodsWe performed a retrospective observational cohort study in all adult patients who presented to the Sparrow Hospital Emergency Department from January 2014 to December 2016 and underwent CTPA or V/Q scan. We calculated the Wells’ score retrospectively, and d-dimer values were used to determine if the imaging study was justified.ResultsA total of 8449 patients underwent CTPA (93%) or V/Q scan (7%), among which 142 (1.7%) patients were diagnosed with PE. The Wells’ criteria showed low probabilities for PE in 96 % and intermediate or high probabilities in 4 % of total patients. Modified Wells’ criteria demonstrated PE unlikely in 99.6 % and PE likely in 0.4 % of total patients. D-dimer was obtained in only 37 % of patients who were unlikely to have a PE or had a low score on Wells’ criteria. Despite a low or unlikely Wells’ criteria score and normal d-dimer levels, 260 patients underwent imaging studies, and none were diagnosed with PE.ConclusionMore than 99 % of CTPA or V/Q scans were negative in our study. This suggests extraordinary overutilisation of the imaging methods. D-dimer, recommended in patients with low to moderate risk, was ordered in only one-third of patients. Much greater emphasis of current guidelines is needed to avoid inappropriate utilisation of resources without missing diagnosis of PE.

scholarly journals Symptomatic subsegmental pulmonary embolism: to treat or not to treat?

Hematology ◽  
2017 ◽  
Vol 2017 (1) ◽  
pp. 237-241 ◽  
Author(s):  
Marc Carrier ◽  
Fredrikus A. Klok
Keyword(s):  
Pulmonary Embolism ◽  
Anticoagulation Therapy ◽  
Pulmonary Arteries ◽  
Clinical Importance ◽  
Case Fatality ◽  
Pulmonary Angiography ◽  
Significant Rise ◽  
Computed Tomographic ◽  
Individualized Approach ◽  
Computed Tomographic Pulmonary Angiography

Abstract The introduction of computed tomographic pulmonary angiography and its recent increasing availability has led to a significant rise in its use to help clinicians diagnose acute pulmonary embolism (PE). This has led to a significant increase in the incidence of PE diagnoses. Simultaneously, the case fatality rate of acute PE has been decreasing and no significant change in its mortality has been noted, suggesting that the additional PE diagnoses are less severe and these patients might not benefit from anticoagulation therapy. This also seems to be correlated with an increase in the diagnosis of PE localized in the subsegmental pulmonary arteries (subsegmental pulmonary embolism [SSPE]). The clinical importance of SSPE is unclear. Whereas some studies have shown that it might be reasonable to manage patients with SSPE without anticoagulation, others have not. Although the current medical literature is limited, it suggests that a subgroup of patients with SSPE might be safely managed without the use of anticoagulant therapy. Current clinical practice guidelines suggest that clinicians take an individualized approach after carefully assessing the risk/benefit ratio for patients with SSPE and negative leg limb ultrasonography results. Prospective studies are ongoing and results are eagerly awaited to help tailor the management of this patient population.

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