Pulmonary Angiography
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2021 ◽  
Vol 2021 ◽  
pp. 1-8
Zhongxing Zhang ◽  
Yan Zhang ◽  
Xiaohui Wang ◽  
Xiaoli Han ◽  
Xin Zhang ◽  

This paper aimed to study the clinical characteristics of patients with pulmonary embolism (PE) with syncope (PE + S) based on the three-dimensional (3D) reconstruction algorithm in computed tomography (CT) pulmonary angiography (CTPA). In this study, 857 patients with acute PE (APE) who were treated in hospital were selected as the research objects and divided into syncope group (group S) and nonsyncope group (group NS). The 3D reconstruction marching cubes (3DR-MC) algorithm was compared with the traditional MC (T-MC) algorithm and the mesh simplification MC (MMS-MC) algorithm, and the results proved that the running time of the 3DR-MC algorithm on the platform was shorter than that of the other two algorithms. The incidence of syncope in group S in women was higher than that in group NS (51.7% vs. 38.2%). The incidence of syncope classified as high risk in group S was higher than that in group NS, and the mortality rate of pulmonary embolism patients with syncope was higher, and the difference was statistically significant (χ2 = 113.332, P < 0.05 ). The incidence of syncope in group S was higher than that in group NS (χ2 = 4.074, P < 0.05 ). In short, hypertension was an independent risk factor for syncope. PE + S patients could be diagnosed and treated as early as possible based on the clinical characteristics, so as to reduce the adverse consequences of misdiagnosis.

Gudula J. A. M. Boon ◽  
Yvonne M. Ende-Verhaar ◽  
Ludo F. M. Beenen ◽  
Johan Coolen ◽  
Marion Delcroix ◽  

Abstract Objectives Closer reading of computed tomography pulmonary angiography (CTPA) scans of patients presenting with acute pulmonary embolism (PE) may identify those at high risk of developing chronic thromboembolic pulmonary hypertension (CTEPH). We aimed to validate the predictive value of six radiological predictors that were previously proposed. Methods Three hundred forty-one patients with acute PE were prospectively followed for development of CTEPH in six European hospitals. Index CTPAs were analysed post hoc by expert chest radiologists blinded to the final diagnosis. The accuracy of the predictors using a predefined threshold for ‘high risk’ (≥ 3 predictors) and the expert overall judgment on the presence of CTEPH were assessed. Results CTEPH was confirmed in nine patients (2.6%) during 2-year follow-up. Any sign of chronic thrombi was already present in 74/341 patients (22%) on the index CTPA, which was associated with CTEPH (OR 7.8, 95%CI 1.9–32); 37 patients (11%) had ≥ 3 of 6 radiological predictors, of whom 4 (11%) were diagnosed with CTEPH (sensitivity 44%, 95%CI 14–79; specificity 90%, 95%CI 86–93). Expert judgment raised suspicion of CTEPH in 27 patients, which was confirmed in 8 (30%; sensitivity 89%, 95%CI 52–100; specificity 94%, 95%CI 91–97). Conclusions The presence of ≥ 3 of 6 predefined radiological predictors was highly specific for a future CTEPH diagnosis, comparable to overall expert judgment, while the latter was associated with higher sensitivity. Dedicated CTPA reading for signs of CTEPH may therefore help in early detection of CTEPH after PE, although in our cohort this strategy would not have detected all cases. Key Points • Three expert chest radiologists re-assessed CTPA scans performed at the moment of acute pulmonary embolism diagnosis and observed a high prevalence of chronic thrombi and signs of pulmonary hypertension. • On these index scans, the presence of ≥ 3 of 6 predefined radiological predictors was highly specific for a future diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH), comparable to overall expert judgment. • Dedicated CTPA reading for signs of CTEPH may help in early detection of CTEPH after acute pulmonary embolism.

Diagnostics ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 2179
Amayar Zaw ◽  
Rebecca Nguyen ◽  
Leon Lam ◽  
Anthony Kaplan ◽  
Claudia C. Dobler

(1) Background: Computed tomography pulmonary angiography (CTPA) is the standard imaging test for the evaluation of acute pulmonary embolism (PE), but it is associated with patients’ exposure to radiation. Studies have suggested that radiation exposure can be reduced without compromising PE detection by limiting the scan range (the z-axis, going from up to down); (2) Methods: A literature search was conducted in MEDLINE and EMBASE on 17 July 2021. Studies were included if they enrolled patients who had undergone a CTPA and described the yield of PE diagnoses, number of missed filling defects and/or other diagnoses using a reduced z-axis in comparison to a full-length scan. To assess risk of bias, we modified an existing risk of bias tools for observational studies, the Newcastle-Ottawa Scale. Results were synthesized in a narrative review. Primary outcomes were the number of missed PE diagnoses (based on at least one filling defect) and filling defects; the secondary outcome was the number of other missed findings; (3) Results: Eleven cohort studies and one case-control study were included reporting on a total of 3955 scans including 1025 scans with a diagnosis of PE. Six different reduced scan ranges were assessed; the most studied was from the top of the aortic arch to below the heart, in which no PEs were missed (seven studies). One sub-segmental PE was missed when the scan coverage was 10 cm starting from the bottom of the aortic arch and 14.7 cm starting from the top of the arch. Five studies that reported on other findings all found that other diagnoses were missed with a reduced z-axis. Most of the included studies had a high risk of bias; (4) Conclusions: CTPA scan coverage reduction from the top of aortic arch to below the heart reduced radiation exposure without affecting PE diagnoses, but studies were generally at high risk of bias.

2021 ◽  
Ghufran Aref Saeed ◽  
Waqar Haider Gaba ◽  
Abd Al Kareem Mohd Adi ◽  
Reima Obaid Al Marshoodi ◽  
Safaa Saeed Al Mazrouei ◽  

Purpose. Our aim is to identify the prevalence and distribution of pulmonary thromboembolism in COVID-19 infected patients in our hospital. Materials and Methods. Data of all patients with COVID-19 infection either on RT-PCR testing or non-contrast high resolution CT(HRCT) who had CT pulmonary angiography (CTPA) from April to June 2020 were included. 133 patients were initially included in the study, 7 were excluded according to exclusion criteria, leaving a total number of 126 patients. Results. Twenty (15.8%) patients had evidence of pulmonary embolism (PE) on CTPA with mean age of 50 years (range 31-85) of which 95% were males. The mean D-dimer was 5.61mcg/mL among the PE-negative and 14.49 mcg/mL in the PE-positive groups respectively. Among the patients with evidence of pulmonary embolism on CTP, almost half required admission to intensive care unit in comparison to only one-fifth with negative CTPA. One-fourth died among the PE positive group with only 5% died among the PE negative group. There was a 33% reduction in the development of PE in the COVID-19 patients who had received low molecular weight heparin (LMWH) prior to their CTPA study versus those who had not. Conclusion. D-dimer correlates well with the incidence of pulmonary embolism among COVID-19 patients. Our data suggest that majority of our patients, developed pulmonary embolisms within 5 days into their hospital stay, accounting to almost two thirds of all positive cases diagnosed by CTPA. Those with PE among COVID-19 patients have high chances of ICU admission and mortality. Use of thromboprophylaxis early on might reduce the incidence of PE.

2021 ◽  
Vol 10 (41) ◽  
pp. 3604-3606
Sanyukta Hepat ◽  
Ruchita Kabra ◽  
Abhijit Wadekar ◽  
Sourya Acharya ◽  
Samarth Shukla ◽  

Pulmonary arteriovenous malformation (PAVM) is one of the rare pulmonary vascular anomalies. Pulmonary arteriovenous malformation results in right to left shunt due to the abnormal communications between the pulmonary arteries and the pulmonary veins bypassing the normal capillary bed.1 This condition being rare could be easily missed, hence, it is essential for clinicians to suspect it based on the classical clinical features. This helps in early diagnosis and deciding further appropriate treatment option. Here we report the case of a patient affected by a large idiopathic pulmonary arteriovenous malformation in the right lung. Most patients with pulmonary arteriovenous malformation are asymptomatic. This is due to the chronic compensation and secondary erythrocytic response. Dyspnoea due to PAVMs are a result of right-to-left shunt. Initial diagnostic tools include chest radiography and contrast enhanced computed tomography but the gold standard is pulmonary angiography.2 Because AVM has substantial morbidity rates associated with it, all patients with PAVMs who can undergo embolization should be treated with transcatheter embolization. In rest of the patients, surgical excision should be considered. The main objective of this study was to highlight the early suspicion and diagnosis of pulmonary arteriovenous malformation as this is easily missed and leads to undue delay of treatment.

2021 ◽  
Vol 9 (09) ◽  
pp. 345-349
Saleh Alkhubaizi ◽  
Ahmad Al. ALalwi ◽  
Mamdoh Mahboob ◽  
Mohammed Al. Thubity ◽  

Background: The risk of developing pulmonary embolism (PE) is high in patients infected with COVID-19, and its diagnosis is a severe challenge for healthcare professionals duringthe COVID-19 pandemic. Physicians are frequently usingcomputed tomography pulmonary angiography(CTPA), d-dimer, and well score for the diagnosis of PE. Methods: A retrospective study was used in which we investigated the reliability of clinical well scores by collecting data, such as medical records in registered form (serum D-dimer level and Wells scores) of every patient for whom physicians have requested whose CTPA with suspicion of PE at King Faisal Medical Center (KFMC) from the period from 1st of April to the 1st of October. Results: The study results showed significantly higher values of d-dimer in patients with positive PEcompared to those with negative values. In addition wells score is not a reliable preclinical score in diagnosis PE in COVID 19 patient. Conclusions: As per the results of the well score, there is no significant difference between vulnerable people with PE +ve and -ve.

2021 ◽  
Vol 5 (1) ◽  
Tuomas Vainio ◽  
Teemu Mäkelä ◽  
Sauli Savolainen ◽  
Marko Kangasniemi

Abstract Background Chronic pulmonary embolism (CPE) is a life-threatening disease easily misdiagnosed on computed tomography. We investigated a three-dimensional convolutional neural network (CNN) algorithm for detecting hypoperfusion in CPE from computed tomography pulmonary angiography (CTPA). Methods Preoperative CTPA of 25 patients with CPE and 25 without pulmonary embolism were selected. We applied a 48%–12%–40% training-validation-testing split (12 positive and 12 negative CTPA volumes for training, 3 positives and 3 negatives for validation, 10 positives and 10 negatives for testing). The median number of axial images per CTPA was 335 (min–max, 111–570). Expert manual segmentations were used as training and testing targets. The CNN output was compared to a method in which a Hounsfield unit (HU) threshold was used to detect hypoperfusion. Receiver operating characteristic area under the curve (AUC) and Matthew correlation coefficient (MCC) were calculated with their 95% confidence interval (CI). Results The predicted segmentations of CNN showed AUC 0.87 (95% CI 0.82–0.91), those of HU-threshold method 0.79 (95% CI 0.74–0.84). The optimal global threshold values were CNN output probability ≥ 0.37 and ≤ -850 HU. Using these values, MCC was 0.46 (95% CI 0.29–0.59) for CNN and 0.35 (95% CI 0.18–0.48) for HU-threshold method (average difference in MCC in the bootstrap samples 0.11 (95% CI 0.05–0.16). A high CNN prediction probability was a strong predictor of CPE. Conclusions We proposed a deep learning method for detecting hypoperfusion in CPE from CTPA. This model may help evaluating disease extent and supporting treatment planning.

Muhammad Farid Bin Mohd Fauad ◽  
Hazlyna Baharuddin ◽  
Mohd Arif Mohd Zim ◽  
Bushra Johari

Pulmonary embolism (PE) was reported in about 9% patients with antiphospholipid syndrome (APS). Seronegative APS is an entity which demonstrates clinical manifestations highly suggestive of APS but persistently negative APS antibodies. A 31-year-old lady presented with a two-month history of exertional dyspnoea. She had two consecutive miscarriages at 12 and 14 weeks, previously. Physical examination revealed a thin lady who was tachycardic, tachypneic, hypoxic but normotensive. There was a loud P2 without signs of heart failure. Investigations revealed a type 1 respiratory failure, sinus tachycardia with right ventricular strain pattern, cardiomegaly with normal lung fields, and dilated right atrium and right ventricle with increased in pulmonary arterial pressure of 70mmHg from echocardiography. CT pulmonary angiography (CTPA) confirmed the presence of PE over bilateral pulmonary arteries. She continued to have exertional dyspnoea and was readmitted 9 months later with worsening dyspnoea. APS antibodies performed during both admissions were negative. Seronegative APS was diagnosed. Interestingly, two CTPAs performed at 6 months and 9 months after initial presentation revealed persistent bilateral pulmonary embolism. The provoking factors for PE should be sought because ‘unprovoked’ PE especially in young individuals need further attention. APS, including seronegative APS, should be considered. Persistence of symptoms of PE also warrants further attention as chronic thromboembolic pulmonary hypertension (CTEPH) may be the cause. Currently, there are available medical and surgical treatment of CTEPH, therefore establishing its diagnosis is important and it is best performed in pulmonary hypertension expert centre.International Journal of Human and Health Sciences Supplementary Issue-2: 2021 Page: S25

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