scholarly journals Multimodal indirect imaging signs of pulmonary embolism

2020 ◽  
Vol 93 (1108) ◽  
pp. 20190635 ◽  
Author(s):  
Pedro Paulo Teixeira e Silva Torres ◽  
Alexandre Dias Mançano ◽  
Gláucia Zanetti ◽  
Bruno Hochhegger ◽  
Ana Caroline Vieira Aurione ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Chest Pain ◽  
Nephrogenic Systemic Fibrosis ◽  
Venous Access ◽  
X Ray ◽  
Unenhanced Ct ◽  
Chest X Ray ◽  
Anaphylactoid Reactions ◽  
Imaging Signs ◽  
Ct And Mri

The clinical diagnosis of pulmonary embolism is often difficult, as symptoms range from syncope and chest pain to shock and sudden death. Adding complexity to this picture, some patients with non-diagnosed pulmonary embolism may undergo unenhanced imaging examinations for a number of reasons, including the prevention of contrast medium-related nephrotoxicity, anaphylactic/anaphylactoid reactions and nephrogenic systemic fibrosis, as well as due to patients’ refusal or lack of venous access. In this context, radiologists’ awareness and recognition of indirect signs are cornerstones in the diagnosis of pulmonary embolism. This article describes the indirect signs of pulmonary embolism on chest X-ray, unenhanced CT, and MRI.

scholarly journals Pleuritic chest pain: infection, infarction or musculoskeletal?

2002 ◽  
Vol 1 (2) ◽  
pp. 64-66
Author(s):  
S Gill ◽  
◽  
A Pope ◽  
Keyword(s):  
Pulmonary Embolism ◽  
Chest Pain ◽  
Initial Presentation ◽  
Pulmonary Emboli ◽  
Pleuritic Chest Pain ◽  
X Ray ◽  
Blood Tests ◽  
Chest X Ray ◽  
Initial Blood ◽  
D Dimer

A 52 year old patient, originally thought to have musculoskeletal chest pain was found to have features consistent with infective pleurisy on initial blood tests and chest x-ray, with a negative d-dimer indicating a low likelihood of pulmonary embolism. Two weeks later he represented with continued symptoms and investigations revealed extensive pulmonary emboli, which were thought to have developed after his initial presentation.

Portable Ventilation/Perfusion Scanning is Useful for Evaluating Clinically Significant Pulmonary Embolism in the ICU Despite Abnormal Chest Radiography

2018 ◽  
Vol 35 (10) ◽  
pp. 1032-1038 ◽  
Author(s):  
Aaron S. Weinberg ◽  
William Chang ◽  
Grace Ih ◽  
Alan Waxman ◽  
Victor F. Tapson
Keyword(s):  
Pulmonary Embolism ◽  
Chest Radiograph ◽  
High Probability ◽  
Hemodynamic Instability ◽  
X Rays ◽  
X Ray ◽  
Abnormal Chest ◽  
Chest X Ray ◽  
Low Probability ◽  
Clinically Significant

Objective: Computed tomography angiography is limited in the intensive care unit (ICU) due to renal insufficiency, hemodynamic instability, and difficulty transporting unstable patients. A portable ventilation/perfusion (V/Q) scan can be used. However, it is commonly believed that an abnormal chest radiograph can result in a nondiagnostic scan. In this retrospective study, we demonstrate that portable V/Q scans can be helpful in ruling in or out clinically significant pulmonary embolism (PE) despite an abnormal chest x-ray in the ICU. Design: Two physicians conducted chart reviews and original V/Q reports. A staff radiologist, with 40 years of experience, rated chest x-ray abnormalities using predetermined criteria. Setting: The study was conducted in the ICU. Patients: The first 100 consecutive patients with suspected PE who underwent a portable V/Q scan. Interventions: Those with a portable V/Q scan. Results: A normal baseline chest radiograph was found in only 6% of patients. Fifty-three percent had moderate, 24% had severe, and 10% had very-severe radiographic abnormalities. Despite the abnormal x-rays, 88% of the V/Q scans were low probability for a PE despite an average abnormal radiograph rating of moderate. A high-probability V/Q for PE was diagnosed in 3% of the population despite chest x-ray ratings of moderate to severe. Six patients had their empiric anticoagulation discontinued after obtaining the results of the V/Q scan, and no anticoagulation was started for PE after a low-probability V/Q scan. Conclusion: Despite the large percentage of moderate-to-severe x-ray abnormalities, PE can still be diagnosed (high-probability scan) in the ICU with a portable V/Q scan. Although low-probability scans do not rule out acute PE, it appeared less likely that any patient with a low-probability V/Q scan had severe hypoxemia or hemodynamic instability due to a significant PE, which was useful to clinicians and allowed them to either stop or not start anticoagulation.

scholarly journals Is Routine Chest X-ray After Ultrasound and Intracavitary Electrocardiogram Guided Peripherally Inserted Central Catheter Insertion Choosing Wisely? A Population-based Retrospective Study of 2857 Patients With Cancer

2021 ◽  
Author(s):  
Yan-Fen Shen ◽  
Jing Dong ◽  
Xin-Peng Wang ◽  
Xiao-Zheng Wang ◽  
Yuan-Yuan Zheng ◽  
...  
Keyword(s):  
Venous Access ◽  
Population Based ◽  
X Ray ◽  
Patients With Cancer ◽  
Potential Risk Factors ◽  
Catheter Tip ◽  
Chest X Ray ◽  
Clinical Records ◽  
The Cost ◽  
Routine Chest

Abstract Background: In China, routine chest X-ray (CXR) is generally required for peripherally inserted central venous catheters (PICC) to determine the position of the catheter tip. The aim of this study is to assess the value of a routine post-procedural CXR in the era of ultrasound and intracavitary electrocardiography(IC-ECG) -guided PICC insertion. Methods: A retrospective population-based cohort study was conducted to review the clinical records of all patients who had PICCs in the Venous Access Center of Beijing Cancer Hospital between January 1, 2019 and June 30, 2020. The incidence of catheter misplacement after insertion was measured. A logistic regression analysis was performed to examine potential risk factors associated with PICC-related complications and a cost analysis to assess the economic impact of the use of CXR.Results: There were 2,857 samples from 2,647 patients included. The overall incidence of intraoperative and postoperative catheter misplacement was 7.4% (n=210) and 0.67% (n=19), respectively. There was a high risk of postoperative catheter misplacement when the left-arm was chosen for placement (OR: 10.478; 95% CI: 3.467-31.670; p<0.001). The cost of performing CXR for screening of PICC-related complications was $23,808 per year, and that of using CXR to diagnose one case of catheter misplacement was $1253.Conclusion: This study confirms that misplacement of PICCs guided by ultrasound and IC-ECG is rare and that postoperative CXR is very costly. In our setting, routine postoperative CXR is unnecessary and not a wise option.

Suggests More Tests for Chest Pain Diagnosis

PEDIATRICS ◽  
1978 ◽  
Vol 61 (1) ◽  
pp. 143-144
Author(s):  
Michael F. Elmore ◽  
Glen A. Lehman
Keyword(s):  
Chest Pain ◽  
Physical Examination ◽  
Pediatric Patients ◽  
Laboratory Studies ◽  
Psychiatric Interview ◽  
X Ray ◽  
Pain Diagnosis ◽  
Chest X Ray ◽  
Pain Characteristics ◽  
Diagnostic Work

Driscoll et al. (Pediatrics 57:648, May 1976) reported a series of 43 patients with chest pain evaluated by history and physical examination, psychiatric interview, screening laboratory studies, ECG, and chest x-ray film. No organic cause was identified in 45% of patients, and various psychiatric aspects of the pain were discussed. The history obtained from pediatric patients is often suboptimal, and specific pain characteristics and associations cannot be defined. We therefore propose that more vigorous diagnostic work-ups are necessary before chest pain can be classed as "idiopathic."

scholarly journals Aurea diagnosis of pneumomediastinum. A case report

2020 ◽  
Vol 14 (3) ◽  
pp. 179-183
Author(s):  
Lucio Brugioni ◽  
Francesca De Niederhausern ◽  
Chiara Gozzi ◽  
Pietro Martella ◽  
Elisa Romagnoli ◽  
...  
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Chest Pain ◽  
Correct Diagnosis ◽  
Young Male ◽  
Differential Diagnoses ◽  
Diagnostic Process ◽  
Acute Aortic Syndrome ◽  
X Ray ◽  
Chest X Ray

Pericarditis and spontaneous pneumomediastinum are among the pathologies that are in differential diagnoses when a patient describes dorsal irradiated chest pain: if the patient is young, male, and long-limbed, it is necessary to exclude an acute aortic syndrome firstly. We present the case of a young man who arrived at the Emergency Department for chest pain: an echocardiogram performed an immediate diagnosis of pericarditis. However, if the patient had performed a chest X-ray, this would have enabled the observation of pneumomediastinum, allowing a correct diagnosis of pneumomediastinum and treatment. The purpose of this report is to highlight the importance of the diagnostic process.

scholarly journals Pneumomediastinum and pneumopericardium in an adolescent with asthma attacks. Case report

Case reports ◽  
2020 ◽  
Vol 6 (1) ◽  
pp. 63-69
Author(s):  
María Fernanda Ochoa-Ariza ◽  
Jorge Luis Trejos-Caballero ◽  
Cristian Mauricio Parra-Gelves ◽  
Marly Esperanza Camargo-Lozada ◽  
Marlon Adrián Laguado-Nieto
Keyword(s):  
Case Report ◽  
Chest Pain ◽  
Subcutaneous Emphysema ◽  
Respiratory Symptoms ◽  
Laboratory Tests ◽  
Young Patients ◽  
Clinical Suspicion ◽  
X Ray ◽  
Chest X Ray ◽  
The Right

Introduction: Pneumomediastinum is defined as the presence of air in the mediastinal cavity. This is a rare disease caused by surgical procedures, trauma or spontaneous scape of air from the lungs; asthma is a frequently associated factor. It has extensive differential diagnoses due to its symptoms and clinical signs.Case presentation: A 17-year-old female patient presented with respiratory symptoms for 2 days, dyspnea, chest pain radiated to the neck and shoulders, right supraclavicular subcutaneous emphysema, wheezing in both lung fields, tachycardia and tachypnea. On admission, laboratory tests revealed leukocytosis and neutrophilia, and chest X-ray showed subcutaneous emphysema in the right supraclavicular region. Diagnosis of pneumomediastinum was confirmed through a CT scan of the chest. The patient was admitted for treatment with satisfactory evolution.Discussion: Pneumomediastinum occurs mainly in young patients with asthma, and is associated with its exacerbation. This condition can cause other complications such as pneumopericardium, as in this case. The course of the disease is usually benign and has a good prognosis.Conclusion: Because of its presentation, pneumomediastinum requires clinical suspicion to guide the diagnosis and treatment. In this context, imaging is fundamental.

Chest X-ray in acute pulmonary embolism: forgiven but not forgotten

2019 ◽  
Vol 45 (12) ◽  
pp. 1822-1823 ◽  
Author(s):  
Marco Zuin ◽  
Gianluca Rigatelli ◽  
Pietro Zonzin ◽  
Loris Roncon
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
X Ray ◽  
Chest X Ray

Man in his 50s with chest pain and dyspnoea

Heart ◽  
2018 ◽  
Vol 104 (10) ◽  
pp. 868-868 ◽  
Author(s):  
Yuki Obayashi ◽  
Chisato Izumi ◽  
Yoshihisa Nakagawa
Keyword(s):  
Chest Pain ◽  
Emergency Room ◽  
Prosthetic Valve ◽  
Cardiopulmonary Arrest ◽  
Supplementary File ◽  
List Type ◽  
Main Trunk ◽  
X Ray ◽  
Doppler Image ◽  
Chest X Ray

Clinical introductionA man in his 50s with sudden-onset chest pain and dyspnoea was transferred to the emergency room. He had a history of aortic valve replacement due to aortic regurgitation with a mechanical valve 6 years previously. Heart rate was 90 bpm, and blood pressure was too low to measure. In the emergency room, he presented with severe dyspnoea and a chest X-ray showed severe lung congestion (figure 1A). ECG showed complete left bundle branch block. His respiratory status rapidly worsened, and he went into cardiopulmonary arrest. After cardiopulmonary resuscitation, transthoracic echocardiography was performed (figure 1B, online supplementary video 1).Supplementary file 1Figure 1(A) Chest X-ray. (B) Colour Doppler image from apical five-chamber view.QuestionWhat is the most likely cause of the patient’s cardiopulmonary arrest?Myocardial infarction in left main trunkAortic dissectionProsthetic valve thrombosisProsthetic valve embolisationPulmonary embolism

scholarly journals A patient with fever, chest pain and a rapidly changing chest X-ray

2010 ◽  
Vol 3 (4) ◽  
pp. 525-526
Author(s):  
Bas de Groot ◽  
Daan Brand ◽  
Tessel N. E. Vossenberg ◽  
Andrea Warnemunde
Keyword(s):  
Chest Pain ◽  
X Ray ◽  
Chest X Ray
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