scholarly journals Clinical and Demographic Predictors of Acute Pulmonary Embolism in Central Africa Using 64-Rows Multi-Detector Computed Tomography Angiography

2017 ◽  
Vol 2 (2) ◽  
pp. 185
Author(s):  
Florent Wetshokonda Lomamba ◽  
Jean Mukaya Tshibola ◽  
Michel Lelo Tshikwela
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Computed Tomography Angiography ◽  
Acute Pulmonary Embolism ◽  
Central Africa ◽  
Clinical Suspicion ◽  
Logistic Regression Models ◽  
Demographic Predictors ◽  
Life Threatening ◽  
Multi Detector Computed Tomography

<p><em>Background: Acute pulmonary embolism is a life-threatening entity. Its diagnosis remains a challenge for clinicians and it is important to be aware of factors that increase risks of the disease. In this study, we access the clinical and demographic predictors of pulmonary embolism using 64-rows multi-detector Computed Tomography Angiography in central Africa.</em></p><p><em>Methods: From 01 January to 30 July 2016, the data record of patients who underwent chest 64-rows multi-detector Computed Tomography Angiography indicated for clinical suspicion of acute pulmonary embolism at Biamba Marie Mutombo Dikembe Hospital were retrospectively </em><em>were revisited and analyzed using logistic regression models.</em><em></em></p><p><em>Results: Sixty-five consecutive patients (age range, 24 to 84 years and mean age 56.8 ± 14.9 years) were included with a female predominance. Pulmonary embolism was formerly detected in 17 patients (26.2% of cases). Age ≥ 65 years (OR = 9.5 CI 95%:14.74, 60.79, p = 0.018) and obesity (OR = 40.8 CI 95%:2.85, 58.44, p = 0.006) were the predictors of pulmonary embolism. Heart disease and pneumonia were the main pathologies associated and the main alternative diagnoses.</em></p><p><em>Conclusion: This study shows that age and obesity were independent predictors of PE. In central Africa</em><em> where Computed Tomography machine is not widely available,</em><em> aged and obese patients</em><em> with a clinical suspicion of pulmonary embolism</em><em> </em><em>should be dealt with as a higher suspicion of true </em><em>pulmonary embolis</em><em>m.</em><em> </em></p>

scholarly journals Loss of Pulmonary Vascular Volume as a Predictor of Right Ventricular Dysfunction and Mortality in Acute Pulmonary Embolism

2021 ◽  
Vol 14 (9) ◽  
Author(s):  
Jasleen Minhas ◽  
Pietro Nardelli ◽  
Syed Moin Hassan ◽  
Nadine Al-Naamani ◽  
Eileen Harder ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Relative Risk ◽  
Computed Tomography Angiography ◽  
Acute Pulmonary Embolism ◽  
Hazard Ratio ◽  
Cardiac Biomarkers ◽  
Clinical Biomarkers ◽  
Increased Risk ◽  
Venous Volume

Background: In acute pulmonary embolism, chest computed tomography angiography derived metrics, such as the right ventricle (RV): left ventricle ratio are routinely used for risk stratification. Paucity of intraparenchymal blood vessels has previously been described, but their association with clinical biomarkers and outcomes has not been studied. We sought to determine if small vascular volumes measured on computed tomography scans were associated with an abnormal RV on echocardiography and mortality. We hypothesized that decreased small venous volume would be associated with greater RV dysfunction and increased mortality. Methods: A retrospective cohort of patients with intermediate risk pulmonary embolism admitted to Brigham and Women’s Hospital between 2009 and 2017 was assembled, and clinical and radiographic data were obtained. We performed 3-dimensional reconstructions of vasculature to assess intraparenchymal vascular volumes. Statistical analyses were performed using multivariable regression and cox proportional hazards models, adjusting for age, sex, lung volume, and small arterial volume. Results: Seven hundred twenty-two subjects were identified of whom 573 had documented echocardiography. A 50% reduction in small venous volume was associated with an increased risk of RV dilation (relative risk: 1.38 [95% CI, 1.18–1.63], P <0.001), RV dysfunction (relative risk: 1.62 [95% CI, 1.36–1.95], P <0.001), and RV strain (relative risk: 1.67 [95% CI, 1.37–2.04], P <0.001); increased cardiac biomarkers, and higher 30-day and 90-day mortality (hazard ratio: 2.50 [95% CI, 1.33–4.67], P =0.004 and hazard ratio: 1.84 [95% CI, 1.11–3.04], P =0.019, respectively). Conclusions: Loss of small venous volume quantified from computed tomography angiography is associated with increased risk of abnormal RV on echocardiography, abnormal cardiac biomarkers, and higher risk of 30- and 90-day mortality. Small venous volume may be a useful marker for assessing disease severity in acute pulmonary embolism.

Echopulmonography as a surrogate modality in disclosure of occult pulmonary consequences of pulmonary vascular occlusion

2021 ◽  
Vol 17 ◽  
Author(s):  
Ahmed Mohammed Abumossalam ◽  
Marwa Mohammed Nashat El Mekkawy ◽  
Raed Elmetwally Ali Eid ◽  
Mohamed Salah ◽  
Ahmed Ehab
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Computed Tomography Angiography ◽  
Diagnostic Yield ◽  
False Negative ◽  
Screening Method ◽  
Vascular Occlusion ◽  
Clinical Suspicion ◽  
University Hospital ◽  
Quasi Experimental

Objective: The aim in our work was to assess the diagnostic yield of echopulmonography in patients with PE regarding pleural, parenchymal and vascular features of acute events and consequences. Methods: This is a prospective quasi experimental study in which transthoracic echopulmonography was adopted as a screening method for patients with clinical suspicion of PE in comparison to Multi Detector Computed Tomography Angiography of chest which is the best standard. This study was conducted on 32 patients attended at chest department in Mansoura university Hospital and specialized internal medicine hospital. Results: Echopulmonography was positive for pulmonary embolism in 68.75 % but was of negative value in 31.25%. On the other hand, CTPA was positive for pulmonary embolism in (71.78%) but was of negative value in 28.12%. EPG confirm PE in 87% of patients diagnosed with PE by CTPA with false negative result of 13%. EPG could exclude PE in 77.7% of patients who were negative for PE by CTPA with false-positive result of 22.2%. Conclusion: Echopulmonography might show promising features to be a substitute for computed tomography angiography in the diagnosis of pulmonary embolism.

scholarly journals Incidence and morphological characteristics of the reversed halo sign in patients with acute pulmonary embolism and pulmonary infarction undergoing computed tomography angiography of the pulmonary arteries

2019 ◽  
Vol 45 (1) ◽  
Author(s):  
Alexandre Dias Mançano ◽  
Rosana Souza Rodrigues ◽  
Miriam Menna Barreto ◽  
Gláucia Zanetti ◽  
Thiago Cândido de Moraes ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Computed Tomography Angiography ◽  
Acute Pulmonary Embolism ◽  
Pulmonary Arteries ◽  
Lower Lobe ◽  
Pulmonary Infarction ◽  
Halo Sign ◽  
Reversed Halo Sign ◽  
The Right

ABSTRACT Objective: To determine the incidence of the reversed halo sign (RHS) in patients with pulmonary infarction (PI) due to acute pulmonary embolism (PE), detected by computed tomography angiography (CTA) of the pulmonary arteries, and to describe the main morphological features of the RHS. Methods: We evaluated 993 CTA scans, stratified by the risk of PE, performed between January of 2010 and December of 2014. Although PE was detected in 164 scans (16.5%), three of those scans were excluded because of respiratory motion artifacts. Of the remaining 161 scans, 75 (46.6%) showed lesions consistent with PI, totaling 86 lesions. Among those lesions, the RHS was seen in 33 (38.4%, in 29 patients). Results: Among the 29 patients with scans showing lesions characteristic of PI with the RHS, 25 (86.2%) had a single lesion and 4 (13.8%) had two, totaling 33 lesions. In all cases, the RHS was in a subpleural location. To standardize the analysis, all images were interpreted in the axial plane. Among those 33 lesions, the RHS was in the right lower lobe in 17 (51.5%), in the left lower lobe in 10 (30.3%), in the lingula in 5 (15.2%), and in the right upper lobe in 1 (3.0%). Among those same 33 lesions, areas of low attenuation were seen in 29 (87.9%). The RHS was oval in 24 (72.7%) of the cases and round in 9 (27.3%). Pleural effusion was seen in 21 (72.4%) of the 29 patients with PI and the RHS. Conclusions: A diagnosis of PE should be considered when there are findings such as those described here, even in patients with nonspecific clinical symptoms.

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.

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