scholarly journals The diagnostic yield of CTPA: pulmonary embolism, alternative diagnoses and incidental findings

2016 ◽  
Vol 15 (3) ◽  
pp. 130-133
Author(s):  
Shoaib Faruqi ◽  
◽  
Nalla Kishore ◽  
Richard Bodington ◽  
Salim Meghjee ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Incidental Findings ◽  
Clinical Presentation ◽  
Diagnostic Yield ◽  
Patient Anxiety ◽  
Presenting Symptoms ◽  
Pulmonary Angiogram ◽  
Unexpected Findings ◽  
Made In

Aims: In this retrospective study we assess the diagnostic yield of computed tomography pulmonary angiogram (CTPA) and the incidence of alterative and incidental diagnoses. Methods: The results of all CTPA scans performed in our trust over a period of 18 months were reviewed and all diagnoses noted. Data collected was descriptively analysed. Results: A total of 1138 scans were performed (56.5% men, mean age 59 years). A diagnosis of pulmonary embolism (PE) was made in 20.2%, an alternative aetiology for presenting symptoms in 26.4% and incidental findings in 19.5%. The commonest alternative diagnosis was pneumonia (9.5%). Conclusions: Significant numbers of CTPA yield unexpected findings, which may provide an explanation for the clinical presentation. Furthermore substantial numbers of incidental pathologies are also diagnosed which may lead to inappropriate resource utilization and increased patient anxiety.

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.

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.

Pulmonary Embolism

2019 ◽  
Author(s):  
Nadav Granat ◽  
Evan Avraham Alpert
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Blood Clot ◽  
Pretest Probability ◽  
Treatment Modalities ◽  
Pulmonary Vasculature ◽  
Pulmonary Angiogram ◽  
Catheter Directed Thrombolysis ◽  
D Dimer ◽  
Rule Out

Pulmonary embolism is caused by a blood clot that travels from the deep veins through the heart and then lodges in the pulmonary vasculature. Common symptoms include pleuritic chest pain, dyspnea, or palpitations. Clinical scores such as the Wells score and Revised Geneva score can be used to assess the pretest probability of pulmonary embolism (PE) and guide work-up such as deciding to order D-dimer testing or imaging. However, clinical gestalt can also accurately assess the pretest probability of PE. The Pulmonary Embolism Rule-out Criteria is a decision rule that can be used to rule out PE without further testing. Imaging modalities include computed tomography pulmonary angiogram or ventilation/perfusion scanning. Novel or new oral anticoagulants are becoming the mainstay of treatment for the hemodynamically stable patient with pulmonary embolism. For the patient who is hemodynamically unstable, treatment modalities include intravenous alteplase, catheter-directed thrombolysis, surgical embolectomy, and catheter-directed embolectomy. A subset of patients with PE can be treated as outpatients. This review contains 1 figure, 4 tables, and 55 references. Key Words: anticoagulants, antithrombins, D-dimer, low-molecular-weight heparin, mechanical thrombolysis, multidetector computed tomography, radionuclide imaging, unfractionated heparin, pulmonary embolism, tissue plasminogen activator, warfarin

scholarly journals Focus Assessed Transthoracic Echocardiography (FATE) to facilitate the diagnosis of low risk Pulmonary Embolism in Emergency Department

2013 ◽  
Vol 12 (4) ◽  
pp. 459-461 ◽  
Author(s):  
RS Sazwan ◽  
YU Devi ◽  
FM Hashairi ◽  
WAR Wan Faizia
Keyword(s):  
Emergency Department ◽  
Pulmonary Embolism ◽  
Transthoracic Echocardiography ◽  
Gold Standard ◽  
Clinical Presentation ◽  
Medical Science ◽  
Low Risk ◽  
Pulmonary Angiogram ◽  
Ct Pulmonary Angiogram ◽  
Standard Investigation

A diagnosis of Pulmonary Embolism (PE) is difficult that may be missed because of non specific clinical presentation. However, early diagnosis is fundamental, since immediate treatment is highly effective. Thus, with the availability of ultrasound machine in Emergency Department (ED) can help Emergency Physician to diagnose PE by using Focus Assessed Transthoracic Echocardiography (FATE) to facilitate the diagnosis of PE in low risk patient before proceed with the gold standard investigation which is CT Pulmonary Angiogram (CTPA). We believed this case was likely to be repeated on some readers' clinical practice and this procedure is an appropriate option to consider in such cases. DOI: http://dx.doi.org/10.3329/bjms.v12i4.16101 Bangladesh Journal of Medical Science Vol. 12 No. 04 October ’13 Page 459-461

scholarly journals Pulmonary thromboembolism as presenting feature of COVID-19: Report of four cases

2021 ◽  
Vol 2 (5) ◽  
Author(s):  
Negar Omidi ◽  
◽  
Seyyed Mojtaba Ghorashi ◽  
Masoumeh Lotfi-Tokaldany ◽  
Shaghayegh Ghasemi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ct Angiography ◽  
Clinical Presentation ◽  
Pulmonary Thromboembolism ◽  
Incidental Finding ◽  
Chest Ct ◽  
Presenting Symptoms ◽  
First Impression ◽  
D Dimer ◽  
Pulmonary Ct

Coronavirus disease 2019 (COVID-19) infection is associated with a hypercoagulable state. The similarity in clinical presentation between Pulmonary Thromboembolism (PTE) and COVID-19 render the triage of these patients challenging. We present four cases of COVID-19 who were admitted with first impression of pulmonary thromboembolism in emergency department. The patients were male with age ranged between 46 and 60 years old. None of the patients had criteria of severe COVID-19. Pulmonary Computed Tomography (CT) angiography at admission was consistent with PTE. Incidental finding in pulmonary CT angiography was lung lesions in favor of COVID-19. Pulmonary thromboembolism might be a first presentation feature in COVID-19 patients. Overlaps between presenting symptoms and paraclinical findings such as chest CT and elevations in D-dimer levels in PTE and COVID-19 should be kept in mind.

IMPROVING COMPUTED TOMOGRAPHY PULMONARY ANGIOGRAM (CTPA) UTILIZATION IN SUSPECTED PULMONARY EMBOLISM

CHEST Journal ◽  
2009 ◽  
Vol 136 (4) ◽  
pp. 13S
Author(s):  
Guy W. Soo Hoo ◽  
Carol C. Wu ◽  
Sondra Vazirani ◽  
Zhaoping Li ◽  
Bruce M. Barack
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Suspected Pulmonary Embolism ◽  
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.

scholarly journals Pulmonary Embolism Detection in COVID-19 Patients

2021 ◽  
Author(s):  
Priyancaa Jeyabaladevan ◽  
Sharenja Jeyabaladevan
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Biochemical Marker ◽  
Study Patient ◽  
Single Centre ◽  
Patient Cohort ◽  
Pulmonary Angiogram ◽  
Cutoff Levels ◽  
D Dimer ◽  
Rule Out

Background: A clinically important impact of Coronavirus Disease 2019 (COVID-19) is the increased likelihood of thromboembolism, mainly pulmonary embolism (PE). To screen for these complications a biochemical marker, D-dimer, is usually done. There is a plethora of research validating the use of D-dimer cutoff levels in non-COVID-19 patients, however less so in the COVID-19 population. Aim: To determine the number of suspected COVID patients with D-dimer ≥ 0.5 and PE reported on CTPA. Methods: Non-interventional single-centre retrospective clinical correlational study. Patient cohort was patients admitted with suspected COVID-19 over a 5-week period. N=690. Results: 76.5% of suspected COVID-19 patients were PCR positive. 40% of these patients had a CTPA completed with 19% reported to have a PE. 52% of patients had a D-dimer value ≥ 0.5 10.6% patients had a PE with a D-dimer ≥ 0.5. Conclusion: Nationally, hospitals are adopting existing D-dimer cut off levels to rule out PEs, however this leads to a large proportion of admitted COVID-19 patients having possibly unnecessary computed tomography pulmonary angiogram. This study highlights that majority of patients with D-dimers above the cut off level have negative PEs and contributes to the notion that standard D-dimer cutoffs are insufficiently accurate to be used as a standalone test in diagnosis in the context of an underlying SARS-CoV-2 infection.

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