scholarly journals Analysis of Parenchymal and Pleural Findings of Acute Pulmonary Embolism Detected with Thorax Computerized Tomography Angiography

2019 ◽  
Author(s):  
Kadihan Yalçın
Keyword(s):  
Pulmonary Embolism ◽  
Computerized Tomography ◽  
Acute Pulmonary Embolism ◽  
Computerized Tomography Angiography

Computerized tomography: coronary angiography and cardiac imaging

2021 ◽  
pp. 224-245
Author(s):  
Jeff M Smit ◽  
Mohammed El Mahdiui ◽  
Michiel A de Graaf ◽  
Arthur JHA Scholte ◽  
Lucia Kroft ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Pulmonary Embolism ◽  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Computerized Tomography ◽  
Acute Chest Pain ◽  
Non Invasive ◽  
Computerized Tomography Angiography ◽  
Artery Disease

Patients presenting with chronic and acute chest pain constitute a common and important diagnostic challenge. This has increased interest in using computerized tomography for non-invasive visualization of coronary artery disease in patients presenting with acute chest pain to the emergency department, particularly the subset of patients who are suspected of having an acute coronary syndrome, but without typical electrocardiographic changes and with normal troponin levels at presentation. As a result of rapid developments in coronary computerized tomography angiography technology, high diagnostic accuracies for excluding coronary artery disease can be obtained. It has been shown that these patients can be discharged safely. The accuracy for detecting a significant coronary artery stenosis is also high, but the presence of coronary artery atherosclerosis or stenosis does not imply necessarily that the cause of the chest pain is related to coronary artery disease. Moreover, non-invasive detection of coronary artery disease by computerized tomography has been shown to be related with an increased use of subsequent invasive coronary angiography and revascularization, and further studies are needed to define which patients benefit from invasive evaluation following coronary computerized tomography angiography. Conversely, implementation of coronary computerized tomography angiography can significantly reduce the length of hospital stay, with a significant cost reduction. Additionally, computerized tomography is an excellent modality in patients whose symptoms suggest other causes of acute chest pain such as aortic aneurysm, aortic dissection, or pulmonary embolism. Furthermore, acquisition of the coronary arteries, thoracic aorta, and pulmonary arteries in a single computerized tomography examination is feasible, allowing ‘triple rule-out’ (exclusion of aortic dissection, pulmonary embolism, and coronary artery disease). Finally, other applications, such as evaluation of coronary artery plaque composition, myocardial function and perfusion, and non-invasive assessment of fractional flow reserve from coronary computerized tomography angiography, are currently being developed and may also become valuable in the setting of chronic and acute chest pain in the future.

Tissue plasminogen activator as a novel diagnostic aid in acute pulmonary embolism

VASA ◽  
2014 ◽  
Vol 43 (6) ◽  
pp. 450-458 ◽  
Author(s):  
Julio Flores ◽  
Ángel García-Avello ◽  
Esther Alonso ◽  
Antonio Ruíz ◽  
Olga Navarrete ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Negative Predictive Value ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Predictive Value ◽  
Acute Pulmonary Embolism ◽  
Enzyme Linked Immunosorbent Assay ◽  
Diagnostic Utility ◽  
Tissue Plasminogen ◽  
D Dimer

Background: We evaluated the diagnostic efficacy of tissue plasminogen activator (tPA), using an enzyme-linked immunosorbent assay (ELISA) and compared it with an ELISA D-dimer (VIDAS D-dimer) in acute pulmonary embolism (PE). Patients and methods: We studied 127 consecutive outpatients with clinically suspected PE. The diagnosis of PE was based on a clinical probability pretest for PE and a strict protocol of imaging studies. A plasma sample to measure the levels of tPA and D-dimer was obtained at enrollment. Diagnostic accuracy for tPA and D-dimer was determined by the area under the receiver operating characteristic (ROC) curve. Sensitivity, specificity, predictive values, and the diagnostic utility of tPA with a cutoff of 8.5 ng/mL and D-dimer with a cutoff of 500 ng/mL, were calculated for PE diagnosis. Results: PE was confirmed in 41 patients (32 %). Areas under ROC curves were 0.86 for D-dimer and 0.71 for tPA. The sensitivity/negative predictive value for D-dimer using a cutoff of 500 ng/mL, and tPA using a cutoff of 8.5 ng/mL, were 95 % (95 % CI, 88–100 %)/95 % (95 % CI, 88–100 %) and 95 % (95 % CI, 88–100 %)/94 %), respectively. The diagnostic utility to exclude PE was 28.3 % (95 % CI, 21–37 %) for D-dimer and 24.4 % (95 % CI, 17–33 %) for tPA. Conclusions: The tPA with a cutoff of 8.5 ng/mL has a high sensitivity and negative predictive value for exclusion of PE, similar to those observed for the VIDAS D-dimer with a cutoff of 500 ng/mL, although the diagnostic utility was slightly higher for the D-dimer.

Pulmonary emboli due to venous aneurysm of extremities

VASA ◽  
2011 ◽  
Vol 40 (4) ◽  
pp. 327-332 ◽  
Author(s):  
Gabrielli ◽  
Rosati ◽  
Vitale ◽  
Millarelli ◽  
Siani ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Surgical Resection ◽  
Potential Risk ◽  
Acute Pulmonary Embolism ◽  
Prophylactic Surgery ◽  
Venous Aneurysm ◽  
Pulmonary Emboli ◽  
Thromboembolic Events ◽  
Thromboembolic Complications ◽  
Risk Patients

Venous aneurysms are uncommon but they can have devastating consequences, including pulmonary embolism, other thromboembolic events and death. We report six cases of venous aneurysm of the extremities, in which the first sign of presence was acute pulmonary embolism. Surgical resection is recommended whenever possible. Our experience suggests that prophylactic surgery is cautiously recommended for low-risk patients with venous aneurysms of the abdomen and strongly recommended for extremity deep and superficial venous aneurysms for their potential risk of developing thromboembolic complications despite adequate anticoagulation. Other venous aneurysms should be excised only if they are symptomatic or enlarging.

Diagnostic accuracy of magnetic resonance angiography for acute pulmonary embolism - a systematic review and meta-analysis

VASA ◽  
2016 ◽  
Vol 45 (2) ◽  
pp. 149-154 ◽  
Author(s):  
Jie Li ◽  
Lei Feng ◽  
Jiangbo Li ◽  
Jian Tang
Keyword(s):  
Pulmonary Embolism ◽  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Diagnostic Accuracy ◽  
Acute Pulmonary Embolism ◽  
Meta Analysis ◽  
Likelihood Ratios ◽  
Summary Receiver Operating Characteristic ◽  
Acute Pe ◽  
Limited Sensitivity

Abstract. Background: The aim of this meta-analysis was to evaluate the diagnostic accuracy of magnetic resonance angiography (MRA) for acute pulmonary embolism (PE). Methods: A systematic literature search was conducted that included studies from January 2000 to August 2015 using the electronic databases PubMed, Embase and Springer link. The summary receiver operating characteristic (SROC) curve, sensitivity, specificity, positive likelihood ratios (PLR), negative likelihood ratios (NLR), and diagnostic odds ratio (DOR) as well as the 95 % confidence intervals (CIs) were calculated to evaluate the diagnostic accuracy of MRA for acute PE. Meta-disc software version 1.4 was used to analyze the data. Results: Five studies were included in this meta-analysis. The pooled sensitivity (86 %, 95 % CI: 81 % to 90 %) and specificity (99 %, 95 % CI: 98 % to 100 %) demonstrated that MRA diagnosis had limited sensitivity and high specificity in the detection of acute PE. The pooled estimate of PLR (41.64, 95 % CI: 17.97 to 96.48) and NLR (0.17, 95 % CI: 0.11 to 0.27) provided evidence for the low missed diagnosis and misdiagnosis rates of MRA for acute PE. The high diagnostic accuracy of MRA for acute PE was demonstrated by the overall DOR (456.51, 95 % CI: 178.38 - 1168.31) and SROC curves (AUC = 0.9902 ± 0.0061). Conclusions: MRA can be used for the diagnosis of acute PE. However, due to limited sensitivity, MRA cannot be used as a stand-alone test to exclude acute PE.

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