scholarly journals Acute Pulmonary Embolism during Puerperium in an HIV Positive Patient Confirmed by Computed Tomography Pulmonary Angiogram

2017 ◽  
Vol 02 (01) ◽  
Author(s):  
Alexei Ortiz Milan ◽  
Carlos Medina Merino ◽  
Aurelio Rodriguez ◽  
Fernandez ◽  
Megan Cox
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Positive Patient ◽  
Hiv Positive ◽  
Pulmonary Angiogram

scholarly journals Canadian Society of Thoracic Radiology/Canadian Association of Radiologists Best Practice Guidance for Investigation of Acute Pulmonary Embolism, Part 2: Technical Issues and Interpretation Pitfalls

2021 ◽  
pp. 084653712110007
Author(s):  
Elsie T. Nguyen ◽  
Cameron Hague ◽  
Daria Manos ◽  
Brett Memauri ◽  
Carolina Souza ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Image Quality ◽  
Best Practice ◽  
Acute Pulmonary Embolism ◽  
Reporting Quality ◽  
Diagnostic Quality ◽  
Pulmonary Angiogram ◽  
Canadian Association ◽  
Clinical Scenarios

The investigation of acute pulmonary embolism is a common task for radiologists in Canada. Technical image quality and reporting quality must be excellent; pulmonary embolism is a life-threatening disease that should not be missed but overdiagnosis and unnecessary treatment should be avoided. The most frequently performed imaging investigation, computed tomography pulmonary angiogram (CTPA), can be limited by poor pulmonary arterial opacification, technical artifacts and interpretative errors. Image quality can be affected by patient factors (such as body habitus, motion artifact and cardiac output), intravenous (IV) contrast protocols (including the timing, rate and volume of IV contrast administration) and common physics artifacts (including beam hardening). Mimics of acute pulmonary embolism can be seen in normal anatomic structures, disease in non-vascular structures and pulmonary artery filling defects not related to acute pulmonary emboli. Understanding these pitfalls can help mitigate error, improve diagnostic quality and optimize patient outcomes. Dual energy computed tomography holds promise to improve imaging diagnosis, particularly in clinical scenarios where routine CTPA may be problematic, including patients with impaired renal function and patients with altered cardiac anatomy.

Is a normal computed tomography pulmonary angiography safe to rule out acute pulmonary embolism in patients with a likely clinical probability?

2017 ◽  
Vol 117 (08) ◽  
pp. 1622-1629 ◽  
Author(s):  
Tom van der Hulle ◽  
Nick van Es ◽  
Paul den Exter ◽  
Josien van Es ◽  
Inge Mos ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Meta Analysis ◽  
Pulmonary Angiography ◽  
Computed Tomography Pulmonary Angiography ◽  
Clinical Probability ◽  
Pulmonary Angiogram ◽  
Wells Rule ◽  
Rule Out

SummaryA normal computed tomography pulmonary angiography (CTPA) remains a controversial criterion for ruling out acute pulmonary embolism (PE) in patients with a likely clinical probability. We set out to determine the risk of VTE and fatal PE after a normal CTPA in this patient category and compare these risk to those after a normal pulmonary angiogram of 1.7% (95%CI 1.0–2.7%) and 0.3% (95%CI 0.02–0.7%). A patient-level meta-analysis from 4 prospective diagnostic management studies that sequentially applied the Wells rule, D-dimer tests and CTPA to consecutive patients with clinically suspected acute PE. The primary outcome was the 3-month VTE incidence after a normal CTPA. A total of 6,148 patients were included with an overall PE prevalence of 24%. The 3-month VTE incidence in all 4,421 patients in whom PE was excluded at baseline was 1.2% (95%CI 0.48–2.6) and the risk of fatal PE was 0.11% (95%CI 0.02–0.70). In patients with a likely clinical probability the 3-month incidences of VTE and fatal PE were 2.0% (95%CI 1.0–4.1%) and 0.48% (95%CI 0.20–1.1%) after a normal CTPA. The 3-month incidence of VTE was 6.3% (95%CI 3.0–12) in patients with a Wells rule >6 points. In conclusion, this study suggests that a normal CTPA may be considered as a valid diagnostic criterion to rule out PE in the majority of patients with a likely clinical probability, although the risk of VTE is higher in subgroups such as patients with a Wells rule >6 points for which a closer follow-up should be considered.Supplementary Material to this article is available online at www.thrombosis-online.com.

scholarly journals Computed Tomography Pulmonary Perfusion for Prediction of Short-Term Clinical Outcome in Acute Pulmonary Embolism

TH Open ◽  
2021 ◽  
Vol 05 (01) ◽  
pp. e66-e72
Author(s):  
Lisette F. van Dam ◽  
Lucia J. M. Kroft ◽  
Menno V. Huisman ◽  
Maarten K. Ninaber ◽  
Frederikus A. Klok
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Predictive Value ◽  
Acute Pulmonary Embolism ◽  
Clinical Presentation ◽  
Reperfusion Therapy ◽  
Pulmonary Perfusion ◽  
Short Term ◽  
Acute Pe ◽  
Related Mortality

Abstract Background Computed tomography pulmonary angiography (CTPA) is the imaging modality of choice for the diagnosis of acute pulmonary embolism (PE). With computed tomography pulmonary perfusion (CTPP) additional information on lung perfusion can be assessed, but its value in PE risk stratification is unknown. We aimed to evaluate the correlation between CTPP-assessed perfusion defect score (PDS) and clinical presentation and its predictive value for adverse short-term outcome of acute PE. Patients and Methods This was an exploratory, observational study in 100 hemodynamically stable patients with CTPA-confirmed acute PE in whom CTPP was performed as part of routine clinical practice. We calculated the difference between the mean PDS in patients with versus without chest pain, dyspnea, and hemoptysis and 7-day adverse outcome. Multivariable logistic regression analysis and likelihood-ratio test were used to assess the added predictive value of PDS to CTPA parameters of right ventricle dysfunction and total thrombus load, for intensive care unit admission, reperfusion therapy and PE-related death. Results We found no correlation between PDS and clinical symptoms. PDS was correlated to reperfusion therapy (n = 4 with 16% higher PDS, 95% confidence interval [CI]: 3.5–28%) and PE-related mortality (n = 2 with 22% higher PDS, 95% CI: 4.9–38). Moreover, PDS had an added predictive value to CTPA assessment for PE-related mortality (from Chi-square 14 to 19, p = 0.02). Conclusion CTPP-assessed PDS was not correlated to clinical presentation of acute PE. However, PDS was correlated to reperfusion therapy and PE-related mortality and had an added predictive value to CTPA-reading for PE-related mortality; this added value needs to be demonstrated in larger studies.

Clinical Usefulness of Computed Tomography Study Without Contrast Injection in the Evaluation of Acute Pulmonary Embolism

2005 ◽  
Vol 29 (1) ◽  
pp. 6-12 ◽  
Author(s):  
Rocco Cobelli ◽  
Maurizio Zompatori ◽  
Giovanni De Luca ◽  
Gianfranco Chiari ◽  
Paolo Bresciani ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Clinical Usefulness ◽  
Contrast Injection

McConnell’s Sign As An indicator of Right Ventricular Infarction: A Case Report

2021 ◽  
Author(s):  
Judah Nijas Arul ◽  
Preetam Krishnamurthy ◽  
Balakrishnan Vinod Kumar ◽  
Thoddi Ramamurthy Muralidharan ◽  
Senguttuvan Nagendra Boopathy ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Right Ventricular ◽  
Medical Management ◽  
Acute Pulmonary Embolism ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Right Ventricular Infarction ◽  
Coronary Syndrome ◽  
Pulmonary Angiogram ◽  
Ventricular Infarction

Abstract BackgroundMcConnell’s sign is a specific echocardiographic finding that was first described in patient with acute pulmonary embolism signifying right ventricular dysfunction. It remains an under-recognized sign in patients with right ventricular infarction.Case PresentationAn 80-year-old woman presented with sudden onset chest pain and breathlessness. The electrocardiogram showed features suggestive of inferior, posterior, and right ventricular infarction with complete heart block and McConnell’s sign was seen on the echocardiography. CT pulmonary angiogram ruled out the present of pulmonary thromboembolism. Coronary angiogram revealed an occluded right coronary artery with collateral supply from the left circulation. Medical management was planned after patient-physician discussion. Patient symptomatically improved with medical management.ConclusionAlthough McConnell’s sign is suggestive of acute pulmonary embolism, it may also be present in patients with right ventricular dysfunction due to infarction. The presence of McConnell’s sign in a patient presenting with acute coronary syndrome should prompt evaluation for right ventricular infarction in the absence of acute pulmonary embolism.

scholarly journals Factors Affecting Radiation Dose in Computed Tomography Angiograms for Pulmonary Embolism: A Retrospective Cohort Study

2020 ◽  
Vol 10 ◽  
pp. 74
Author(s):  
Prashant Nagpal ◽  
Sarv Priya ◽  
Ali Eskandari ◽  
Aidan Mullan ◽  
Tanya Aggarwal ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Radiation Dose ◽  
Care Center ◽  
Tertiary Care ◽  
Multivariate Logistic Regression Analysis ◽  
Factors Affecting ◽  
Model Based ◽  
Pulmonary Angiogram ◽  
The Mean

Objectives: Computed tomography pulmonary angiogram (CTPA) is one of the most commonly ordered and frequently overused tests. The purpose of this study was to evaluate the mean radiation dose to patients getting CTPA and to identify factors that are associated with higher dose. Material and Methods: This institutionally approved retrospective study included all patients who had a CTPA to rule out acute pulmonary embolism between 2016 and 2018 in a tertiary care center. Patient data (age, sex, body mass index [BMI], and patient location), CT scanner type, image reconstruction methodology, and radiation dose parameters (dose-length product [DLP]) were recorded. Effective dose estimates were obtained by multiplying DLP by conversion coefficient (0.014 mSv•mGy−1•cm−1). Multivariate logistic regression analysis was performed to determine the factors affecting the radiation dose. Results: There were 2342 patients (1099 men and 1243 women) with a mean age of 58.1 years (range 0.2–104.4 years) and BMI of 31.3 kg/m2 (range 12–91.5 kg/m2). The mean effective radiation dose was 5.512 mSv (median – 4.27 mSv; range 0.1–43.0 mSv). Patient factors, including BMI >25 kg/m2, male sex, age >18 years, and intensive care unit (ICU) location, were associated with significantly higher dose (P < 0.05). CT scanning using third generation dual-source scanner with model-based iterative reconstruction (IR) had significantly lower dose (mean: 4.90 mSv) versus single-source (64-slice) scanner with filtered back projection (mean: 9.29 mSv, P < 0.001). Conclusion: Patients with high BMI and ICU referrals are associated with high CT radiation dose. They are most likely to benefit by scanning on newer generation scanner using advance model-based IR techniques.

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