scholarly journals Combined CT Pulmonary Angiography & Indirect CT Venography in Evaluation of Clinically Suspected Cases of Pulmonary Embolism- Our Experience in an Oncologic Setup

2013 ◽  
Vol 3 (1) ◽  
pp. 40-52
Author(s):  
Anuj Thankral ◽  
D Thakral ◽  
E Mohamed ◽  
EP Singh ◽  
H Lal
Keyword(s):  
Pulmonary Embolism ◽  
Clinical Symptoms ◽  
Imaging Modality ◽  
Pulmonary Angiography ◽  
Ct Pulmonary Angiography ◽  
Ct Venography ◽  
Vein Thrombosis ◽  
Presenting Symptoms ◽  
Pulmonary Scintigraphy ◽  
Time Required

The study was aimed at evaluating role of CT Pulmonary Angiography (CTPA) and Indirect CT venography (ICTV) in clinically suspected pulmonary embolism (PE) in oncology setup.17/31 (54.9%) patients were diagnosed with PE with or without deep vein thrombosis. DVT was diagnosed in 12(38.7%). 1 patient had DVT in absence of PE while 13/31 (41.9%) patients were diagnosed not to have PE or DVT. Clinical symptoms or pre-test probability determined by Well’s criteria and other laboratory investigations were not found predictive of PE. CTPA diagnosed PE with greater ease, shorter time required with no dependence on clinical pretest probability unlike pulmonary scintigraphy. In cases with CTPA negative for PE, CT described additional findings possibly explaining patient’s presenting symptoms unlike negative pulmonary scintigraphy. In cases where PE was excluded, CTV identified DVT (if present) in the same sitting, obviating separate venous Doppler. A single investigation with ability to deal with complete spectrum of DVT and PE makes CTPA & ICTV ‘one stop shop’ imaging modality for PE and DVT. Nepalese Journal of Radiology / Vol.3 / No.1 / Issue 4 / Jan-June, 2013 / 40-52 DOI: http://dx.doi.org/10.3126/njr.v3i1.8795

scholarly journals Advances in the Diagnosis of Venous Thromboembolism: A Literature Review

Diagnostics ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. 365 ◽  
Author(s):  
Harish Patel ◽  
Haozhe Sun ◽  
Ali N. Hussain ◽  
Trupti Vakde
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Valsalva Maneuver ◽  
Imaging Modality ◽  
Diagnostic Algorithm ◽  
Pulmonary Angiography ◽  
Vein Thrombosis ◽  
Compression Ultrasound ◽  
Test Probability ◽  
D Dimer

The incidence of venous thromboembolism (VTE), including lower extremity deep vein thrombosis (DVT) and pulmonary embolism (PE) is increasing. The increase in suspicion for VTE has lowered the threshold for performing imaging studies to confirm diagnosis of VTE. However, only 20% of suspected cases have a confirmed diagnosis of VTE. Development of pulmonary embolism rule-out criteria (PERC) and update in pre-test probability have changed the paradigm of ruling-out patient with low index of suspicion. The D-dimer test in conjunction to the pre-test probability has been utilized in VTE diagnosis. The age appropriate D-dimer cutoff and inclusion of YEARS algorithm (signs of the DVT, hemoptysis and whether PE is the likely diagnosis) for the D-dimer cutoff have been recent updates in the evaluation of suspected PE. Multi-detector computed tomography pulmonary angiography (CTPA) and compression ultrasound (CUS) are the preferred imaging modality to diagnose PE and DVT respectively. The VTE diagnostic algorithm do differ in pregnant individuals. The prerequisite of avoiding excessive radiation has recruited planar ventilation-perfusion (V/Q) scan as preferred in pregnant patients to evaluate for PE. The modification of CUS protocol with addition of the Valsalva maneuver should be performed while evaluating DVT in pregnant individual.

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.

Management of pulmonary embolism in pregnancy

ESC CardioMed ◽  
2018 ◽  
pp. 2786-2790
Author(s):  
Thijs E. van Mens ◽  
Saskia Middeldorp
Keyword(s):  
Pulmonary Embolism ◽  
Vitamin K Antagonists ◽  
Decision Rules ◽  
Total Duration ◽  
Clinical Decision ◽  
Evidence Base ◽  
Pulmonary Angiography ◽  
Vein Thrombosis ◽  
Pulmonary Scintigraphy ◽  
In Pregnancy

Pulmonary embolism, although rare, is a leading cause of maternal mortality. There is no strong evidence base for the diagnosis and management of pregnancy-related pulmonary embolism, hampering firm recommendations. In women with a suspicion of pulmonary embolism, the diagnosis is confirmed in 1 in 25–30 women only. However, imaging is always necessary to exclude pulmonary embolism, as no clinical decision rules or D-dimer-based strategies have been validated in pregnancy. Computed tomography pulmonary angiography and pulmonary scintigraphy are both suitable modalities, unless deep vein thrombosis is confirmed by compression ultrasonography of lower limb veins. Low-molecular-weight heparin (LMWH) in therapeutic doses is the treatment of choice during pregnancy, and anticoagulation should be continued until 6 weeks after delivery with a minimum total duration of 3 months. Use of LMWH or vitamin K antagonists does not preclude breastfeeding. Whether dosing should be based on weight or anti-Xa levels is unknown, and practices differ between centres. Management of delivery, including the type of anaesthesia if deemed necessary, requires a multidisciplinary approach, and several options are possible, depending on local preferences and patient-specific conditions. Prevention of pulmonary embolism with LMWH is indicated in all postpartum women with a history of venous thromboembolism, and in most women also during pregnancy.

A Systematic Review of Double Low-dose CT Pulmonary Angiography in Pulmonary Embolism

2019 ◽  
Vol 15 (5) ◽  
pp. 453-460 ◽  
Author(s):  
Sultan Aldosari ◽  
Zhonghua Sun
Keyword(s):  
Systematic Review ◽  
Pulmonary Embolism ◽  
Image Quality ◽  
Radiation Dose ◽  
Contrast Medium ◽  
Low Dose ◽  
Pulmonary Angiography ◽  
Ct Pulmonary Angiography ◽  
Low Contrast ◽  
Low Contrast Medium

Background: The aim of this study is to perform a systematic review of the feasibility and clinical application of double low-dose CT pulmonary angiography (CTPA) in the diagnosis of patients with suspected pulmonary embolism. Discussion: A total of 13 studies were found to meet selection criteria reporting both low radiation dose (70 or 80 kVp versus 100 or 120 kVp) and low contrast medium dose CTPA protocols. Lowdose CTPA resulted in radiation dose reduction from 29.6% to 87.5% in 12 studies (range: 0.4 to 23.5 mSv), while in one study, radiation dose was increased in the dual-energy CT group when compared to the standard 120 kVp group. CTPA with use of low contrast medium volume (range: 20 to 75 ml) was compared to standard CTPA (range: 50 to 101 ml) in 12 studies with reduction between 25 and 67%, while in the remaining study, low iodine concentration was used with 23% dose reduction achieved. Quantitative assessment of image quality (in terms of signal-to-noise ratio and contrast-to-noise ratio) showed that low-dose CTPA was associated with higher, lower and no change in image quality in 3, 3 and 6 studies, respectively when compared to the standard CTPA protocol. The subjective assessment indicated similar image quality in 11 studies between low-dose and standard CTPA groups, and improved image quality in 1 study with low-dose CTPA. Conclusion: This review shows that double low-dose CTPA is feasible in the diagnosis of pulmonary embolism with significant reductions in both radiation and contrast medium doses, without compromising diagnostic image quality.

scholarly journals COVID-19-induced vascular angiopathy: CTPA signs in critically ill patients other than acute pulmonary embolism and high-lung opacity scores

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Mohamed Hossameldin khalifa ◽  
Ahmed Samir ◽  
Ayman Ibrahim Baess ◽  
Sara Samy Hendawi
Keyword(s):  
Artificial Intelligence ◽  
Pulmonary Embolism ◽  
Lung Volume ◽  
Acute Pulmonary Embolism ◽  
Pulmonary Angiography ◽  
Vascular Tree ◽  
Ct Pulmonary Angiography ◽  
Artificial Intelligence System ◽  
Intelligence System ◽  
Severity Scores

Abstract Background Vascular angiopathy is suggested to be the major cause of silent hypoxia among COVID-19 patients without severe parenchymal involvement. However, pulmonologists and clinicians in intensive care units become confused when they encounter acute respiratory deterioration with neither severe parenchymal lung involvement nor acute pulmonary embolism. Other radiological vascular signs might solve this confusion. This study investigated other indirect vascular angiopathy signs on CT pulmonary angiography (CTPA) and involved a novel statistical analysis that was performed to determine the significance of associations between these signs and the CT opacity score of the pathological lung volume, which is calculated by an artificial intelligence system. Results The study was conducted retrospectively, during September and October 2020, on 73 patients with critical COVID-19 who were admitted to the ICU with progressive dyspnea and low O2 saturation on room air (PaO2 < 93%). They included 53 males and 20 females (73%:27%), and their age ranged from 18 to 88 years (mean ± SD=53.3 ± 13.5). CT-pulmonary angiography was performed for all patients, and an artificial intelligence system was utilized to quantitatively assess the diseased lung volume. The radiological data were analyzed by three expert consultant radiologists to reach consensus. A low CT opacity score (≤10) was found in 18 patients (24.7%), while a high CT opacity score (>10) was found in 55 patients (75.3%). Pulmonary embolism was found in 24 patients (32.9%); three of them had low CT opacity scores. Four other indirect vasculopathy CTPA signs were identified: (1) pulmonary vascular enlargement (57 patients—78.1%), (2) pulmonary hypertension (14 patients—19.2%), (3) vascular tree-in-bud pattern (10 patients—13.7%), and (4) pulmonary infarction (three patients—4.1%). There were no significant associations between these signs and the CT opacity score (0.3205–0.7551, all >0.05). Furthermore, both pulmonary vascular enlargement and the vascular tree-in-bud sign were found in patients without pulmonary embolism and low CT-severity scores (13/15–86.7% and 2/15–13.3%, respectively). Conclusion Pulmonary vascular enlargement or, less commonly, vascular tree-in-bud pattern are both indirect vascular angiopathy signs on CTPA that can explain the respiratory deterioration which complicates COVID-19 in the absence of severe parenchymal involvement or acute pulmonary embolism.

scholarly journals CT pulmonary angiography in COVID-19 pneumonia: relationship between pulmonary embolism and disease severity

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Aya Yassin ◽  
Maryam Ali Abdelkader ◽  
Rehab M. Mohammed ◽  
Ahmed M. Osman
Keyword(s):  
Pulmonary Embolism ◽  
Disease Severity ◽  
Laboratory Data ◽  
Pulmonary Angiography ◽  
Significant Relation ◽  
Ct Pulmonary Angiography ◽  
Laboratory Results ◽  
Severity Of The Disease ◽  
The Relationship ◽  
D Dimer

Abstract Background Pulmonary embolism (PE) is one of the known sequels of COVID-19 infection. We aimed to assess the incidence of PE in patients with COVID-19 infection and to evaluate the relationship between the CT severity of the disease and the laboratory indicators. This was a retrospective study conducted on 96 patients with COVID-19 infection proved by positive PCR who underwent CT pulmonary angiography (CTPA) with a calculation of the CT severity of COVID-19 infection. Available patients’ complaint and laboratory data at the time of CTPA were correlated with PE presence and disease severity. Results Forty patients (41.7%) showed positive PE with the median time for the incidence of PE which was 12 days after onset of the disease. No significant correlation was found between the incidence of PE and the patients’ age, sex, laboratory results, and the CT severity of COVID-19. A statistically significant relation was found between the incidence of PE and the patients’ desaturation, hemoptysis, and chest pain. A highly significant correlation was found between the incidence of PE and the rising in the D-dimer level as well as the progressive CT findings when compared to the previous one. Conclusion CT progression and the rising in D-dimer level are considered the most important parameters suggesting underlying PE in patients with positive COVID-19 infection which is commonly seen during the second week of infection and alert the use of CT pulmonary angiography to exclude or confirm PE. This is may help in improving the management of COVID-19 infection.

Sign in / Sign up

Export Citation Format

Share Document