Computed Tomographic Pulmonary Angiography to Diagnose Acute Pulmonary Embolism: The Good, the Bad, and the Ugly

2009 ◽  
Vol 169 (21) ◽  
pp. 1966 ◽  
Author(s):  
Ami Schattner
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Pulmonary Angiography ◽  
Computed Tomographic ◽  
Computed Tomographic Pulmonary Angiography

scholarly journals Right-to-left Ventricular Diameter Ratio At Computed Tomographic Pulmonary Angiography in Patients with Acute Pulmonary Embolism and Obstructive Sleep Apnea

2020 ◽  
Vol 14 ◽  
pp. 117954842097643
Author(s):  
Thomas M Berghaus ◽  
Fabian Geissenberger ◽  
Dinah Konnerth ◽  
Michael Probst ◽  
Thomas Kröncke ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Obstructive Sleep Apnea ◽  
Acute Pulmonary Embolism ◽  
Pulmonary Angiography ◽  
Left Ventricular ◽  
Diameter Ratio ◽  
Computed Tomographic ◽  
Obstructive Sleep ◽  
Computed Tomographic Pulmonary Angiography ◽  
Acute Pe

Purpose: Right ventricular (RV) dysfunction in acute pulmonary embolism (PE) is a critical determinant of outcome. Obstructive sleep apnea (OSA) is a common comorbidity of PE and might also affect RV function. Therefore, we sought to investigate RV dysfunction in PE patients in proportion to the severity of OSA by evaluating the right-to-left ventricular (RV/LV) diameter ratio on computed tomographic pulmonary angiography (CTPA). Materials and Methods: 197 PE patients were evaluated for sleep-disordered breathing by portable monitoring and nocturnal polysomnography. RV dilatation was defined as an RV/LV diameter ratio of ⩾ 1.0. Results: RV dilatation was significantly more frequent in OSA patients compared to study participants without OSA (66.4% vs 49.1%, P = .036). Elevated troponin I values, indicating myocardial injury due to acute, PE-related RV strain, were significantly more frequent in OSA patients with an apnea-hypopnea index (AHI) ⩾ 15/h compared to those with an AHI < 15/h (62.1% vs 45.8%, P = .035). However, RV dysfunction documented by the RV/LV diameter ratio on CTPA was not significantly associated with the severity of OSA in multivariable regression analysis. Conclusion: Patients with moderate or severe OSA might compensate acute, PE-related RV strain better, as they are adapted to repetitive right heart pressure overloads during sleep.

scholarly journals Time efficiency and reliability of established computed tomographic obstruction scores in patients with acute pulmonary embolism

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0260802
Author(s):  
Hans-Jonas Meyer ◽  
Nikolaos Bailis ◽  
Alexey Surov
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Inverse Correlation ◽  
Pulmonary Angiography ◽  
Strong Correlations ◽  
Time Duration ◽  
Time Efficiency ◽  
Computed Tomographic ◽  
Life Threatening ◽  
Computed Tomographic Pulmonary Angiography

Objective Acute pulmonary embolism (PE) is a life-threatening disease with a high mortality. Computed tomographic pulmonary angiography (CTPA) is used in clinical routine for diagnosis of PE. Many pulmonary obstruction scores were proposed to aid in stratifying clinical course of PE. The purpose of the present study was to compare common pulmonary obstruction scores in PE in regard of time efficiency and interreader agreement based upon a representative patient sample. Methods Overall, 50 patients with acute PE were included in this single center, retrospective analysis. Two readers scored the CT images blinded to each other and assessed the scores proposed by Mastora et al., Qanadli et al., Ghanima et al. and Kirchner et al. The required time was assessed of each reading for scoring. Results For reader 1, Mastora score took the longest time duration, followed by Kirchner score, Qanadli score and finally Ghanima score (every test, p<0.0001). The interreader variability was excellent for all scores with no significant differences between them. In the Spearman’s correlation analysis strong correlations were identified between the scores of Mastora, Qanadli and Kirchner, whereas Ghanima score was only moderately correlated with the other scores. There was a weak correlation between time duration and Mastora score (r = 0.35, p = 0.014). For the Ghanima score, a significant inverse correlation was found (r = -0.67, p<0.0001). Conclusion For the investigated obstruction scores, there are significant differences in regard of time consumption with no relevant differences in regard of interreader variability in patients with acute pulmonary embolism. Mastora score requires the most time effort, whereas the score by Ghanima the least time.

How I diagnose acute pulmonary embolism

Blood ◽  
2013 ◽  
Vol 121 (22) ◽  
pp. 4443-4448 ◽  
Author(s):  
Menno V. Huisman ◽  
Frederikus A. Klok
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Standard Of Care ◽  
Clinical Decision ◽  
Pulmonary Angiography ◽  
Management Approach ◽  
Computed Tomographic ◽  
Diagnostic Management ◽  
Computed Tomographic Pulmonary Angiography ◽  
Line Imaging

Abstract The clinical diagnosis of acute pulmonary embolism (PE) is frequently considered in patients presenting to the emergency department or when hospitalized. Since symptoms are a-specific and the consequences of anticoagulant treatment are considerable, objective tests to either establish or refute the diagnosis have become a standard of care. Computed tomographic pulmonary angiography (CTPA), which has replaced pulmonary angiography as first-line imaging test, is associated with radiation exposure, several complications resulting from contrast dye administration, and over diagnosis. Importantly, CTPA can be avoided in 20% to 30% of patients who present with a first or recurrent episode of clinically suspected acute PE by using a standardized algorithm. This algorithm should always include a clinical decision rule to assess the likelihood that PE is present, followed by a D-dimer blood test and/or CTPA. The aim of this review is to provide clinicians this practical diagnostic management approach using evidence from the literature.

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