Helical CT for the evaluation of acute pulmonary embolism.
ABSTRACT OBJECTIVE: In this article, we review the current role of CT pulmonary angiography and indirect CT venography for the evaluation of pulmonary thromboembolic disease. CONCLUSION: With advances in MDCT technology, evaluation of pulmonary thromboembolic disease can now be performed with combined CT pulmonary angiography and CT venography as a "one-stop-shopping" test. CT pulmonary angiography is cost-effective, is accurate, has high interobserver agreement, and has an added advantage of detecting other life-threatening diseases in the chest that mimic pulmonary embolism.
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ABSTRACT: Pulmonary embolism is a major cause of worldwide morbidity and mortality. It is a common cause of cardiovascular care, second only to ischemic heart disease and cerebrovascular events, with a prevalence of 3 to 15%, and its diagnosis remains crucial in the early hours of symptom onset. Given its clinical variability, it has become a diagnostic challenge in the emergency rooms, thus a fast and accurate paraclinical evaluation is needed. The aim of the present manuscript is to review the current role of imaging methods, in particular multidetector computed tomography, their advantages and limitations and the imaging findings of acute or chronic pulmonary thromboembolism. Finally, diagnostic algorithms based on the Thoracic Fleischner Society and the group of PIOPED II study investigators, are shown.Archivos de cardiología de México 06/2011; 81(2):137-150.
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ABSTRACT: Purpose: Our purpose was to review the utility of multi-detector Computed Tomography pulmonary angiography in positive diagnosis of acute pulmonary embolism and prove the importance of negative CT findings for excluding the clinically suspected pulmonary embolism. Patients and methods: our study included 72 patients clinically suspected to have acute pulmonary embolism (clinical suspicious was based on physical examination, ECG findings and high plasma D – dimmer concentration). All patients underwent MDCT pulmonary angiography within the 1st 48 hours of the attack. Results: CT diagnosis of PE was positive in 36% of clinically suspected cases, indeterminate for PE in 6.9% and negative for PE in 56.9% of our cases. Conclusion: MDCT is an accurate non invasive imaging modality for the diagnosis of pulmonary emboli. The negative predictive values of normal CT study is high and appear to be reliable for excluding clinical suspected PE, so CT provide an important information for the final diagnosis and exclusion of PE in clinical suspected patient who has no pulmonary emboli.
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ABSTRACT: Increasing use of computed tomography pulmonary angiography together with higher-resolution scanners has increased the detection of peripheral filling defects. Physicians face the dilemma of whether to treat patients with these findings, especially single defects. The aims of this study were to compare the outcomes of treated and untreated patients with single peripheral filling defects (SPFD) and identify factors associated with treatment. All cases with SPFDs over 66 months in a single institution were identified. Patient and treatment information were abstracted and data on 90-day mortality and postdischarge venous thromboembolism (VTE) were collected. A total of 4906 computed tomography pulmonary angiograms were reviewed. A SPFD was identified in 3.1% (n = 153). Of the 153 patients, 134 met criteria for study inclusion. In 99 of 134 (73.9%) studies, the defect was called a pulmonary embolus (PE) by the initial radiologist. Treatment was administered to 61 of 134 (45.5%) patients; 5 patients died in each group. Postdischarge VTE occurred in 3 treated and 2 untreated patients. In 52 of 153 cases, an additional study was performed. None of the patients with normal ventilation perfusion scan and compression ultrasound received treatment. Immobility (odds ratio [OR]: 3.90, 95% confidence interval [CI]: 1.45-10.60), previous VTE (OR: 3.72, 95% CI: 1.18-11.70), and determination of PE by the radiologist (OR: 24.68, 95% CI: 5.40-112.90) were associated with treatment. There was no difference in 90-day mortality or recurrence between treated and untreated patients. The most influential factor associated with treatment was the radiologist's interpretation. When secondary lung imaging studies were negative, no patient received treatment. Journal of Hospital Medicine 2013. © 2013 Society of Hospital Medicine.Journal of Hospital Medicine 01/2014; 9(1). DOI:10.1002/jhm.2128 · 2.08 Impact Factor