Advances in the Diagnosis and Treatment of Pulmonary Embolism

Kroegel, Claus

doi:10.1159/000068418

Cited by 6 publications

(6 citation statements)

References 20 publications

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“…As a result, patients with V/Q scan findings judged ‘intermediate’ or ‘low’ probability for PE require further investigation. In addition, although V/Q scanning is highly sensitive for PE, it lacks anatomic resolution and sufficient specificity, making it an imperfect tool in the diagnosis of PE [6]. …”

Section: Introductionmentioning

confidence: 99%

Massive Pulmonary Emboli and CT Pulmonary Angiography

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Erkan²,

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et al. 2008

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Background: Massive pulmonary embolism (PE) is a devastating form of PE which usually results in acute right ventricular failure and death within 1–2 h. Objectives: To retrospectively assess pulmonary vascular, cardiac, pleural, and parenchymal findings on CT pulmonary angiography (CTPA) in patients with a diagnosis of massive PE (systolic blood pressure <90 mm Hg, syncope and/or shock). Methods: In 33 consecutive patients with proven massive PE, hemodynamic severity was assessed by the extent of right ventricular dysfunction (RVD); diameter of the main pulmonary artery; the shape of the interventricular septum; and the extent of obstruction to the pulmonary arterial circulation (CT obstruction index). Results: Central pulmonary arteries were embolized in all patients. RVD was detected in all patients (94% of them had severe RVD); the diameter of the main pulmonary artery was wider than normal in 76% of the patients; the shape of the interventricular septum was abnormal in all patients, and the CT obstruction index was higher than or equal to 50% in 85% of the patients. Wedge-shaped pleural-based consolidation was the most common parenchymal abnormality (36%). Pleural effusions were seen in 26 patients (79%). Twenty-eight patients were alive, and only the use of thrombolytic therapy was found to be statistically significant. Conclusions: In patients with acute massive PE, embolization of the central pulmonary arteries, RVD and displacement of the interventricular septum are commonly seen with CTPA. A CT obstruction index of >50% is commonly observed in massive PE. There was no association between CTPA findings and survival.

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Section: Introductionmentioning

confidence: 99%

Massive Pulmonary Emboli and CT Pulmonary Angiography

Fındık

Erkan²,

Light³

et al. 2008

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“…Spiral CT is widely available, and preliminary studies have shown that the test has a sensitivity and specificity of at least 90% for central emboli [4,5,6,7,10,11,12,13]. However, its place in diagnostic algorithms remains uncertain [14,15,16]. There is concern spiral CT may lack the necessary sensitivity to replace conventional angiography while others have recommended utilizing it in place of ventilation-perfusion scanning [17].…”

Section: Introductionmentioning

confidence: 99%

Impact of Spiral Computed Tomography on the Diagnosis of Pulmonary Embolism in a Community Hospital Setting

et al. 2004

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Background: While the optimal role of spiral CT angiography (CTA) in the diagnosis of pulmonary embolism (PE) remains controversial, this technology is already being widely utilized in the community setting. Objectives: To assess the impact CTA has had on angiography utilization rates and the overall diagnostic rate of PE. Methods: All patients evaluated for PE during a 4-year period were studied. PE was defined as either a high-probability V/Q scan, a positive conventional angiogram, or a CTA with emboli in the segmental or larger pulmonary vessels. Diagnostic rates of PE per 1,000 hospital admissions were determined and analyzed for time periods before and after the introduction of CTA. CT reports were compared with their concurrent chest radiograph (CXR) reports and additional findings that were not apparent on CXR were abstracted. Results: The diagnostic rate of PE per 1,000 hospital admissions was 1.8 prior to the introduction of CTA and increased to 2.8 per 1,000 admissions after the introduction of CTA (p < 0.0001). Total costs for diagnostic testing per PE diagnosis made went from $2,518 to $2,572. While the number of PE diagnosed by V/Q scan remained constant, the number of PE diagnosed by conventional angiography decreased while the number diagnosed by CTA increased. In patients with intermediate probability V/Q scan results, the percentage of patients receiving subsequent angiography (conventional or CTA) increased from 17 to 26% (p = 0.043). When conventional angiography was performed, CT imaging of the chest still had to be ordered for other reasons 38% of the time. Additional information was obtained in 78% of cases when CTA was performed. Conclusions: Increased utilization of CTA was associated with an increase in angiography utilization rates and diagnostic rates of PE, was cost effective, and often provided additional, useful, and unanticipated diagnostic information.

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“…Thus, PE continues to represent a challenging diagnostic problem in clinical practice. The reasons for this disquieting situation probably relate to the notoriously variable clinical manifestation, the highly dynamic nature of the condition, the lack of a specific diagnostic marker or objective diagnostic technique, and the interdisciplinary character of the condition [7]. …”

Section: Introductionmentioning

confidence: 99%

“…Although mortality from pulmonary embolism has not significantly changed in the past decades [7, 8, 9, 10], there is evidence to suggest that we are currently witnessing a shift regarding certain aspects relating to PE. These include an increasing awareness of the condition by the general public regarding its potentially life-threatening character [11], rising hospital admission rates for thromboembolic diseases [12]at least in some countries, therapeutic advances in anticoagulant therapy [13], and the introduction of new diagnostic techniques such as D-dimer [14, 15], transthoracic sonography [16, 17], and contrast material-enhanced magnetic resonance angiography [18].…”

Section: Introductionmentioning

confidence: 99%