Correlation of diagnostic imaging and subsequent autopsy findings in patients with pulmonary embolism.

Abstract

who underwent lung scintigraphy for suspected pulmonary embolism and for whom the pul monary embolism was proven at autopsy. MATERIALS AND METHODS. Weperformed a longitudinal follow-upstudyof 1210consecutive patients who underwent scintigraphic imaging for suspected pulmonary embo lism. Patients for whom pulmonary embolism was proven at autopsy within 30 days of lung scintigraphy were studied. Diagnostic testing and risk factors were compared in patients with and without an antemortem diagnosis of pulmonary embolism. RESULTS. The antemortem diagnosis wasmadein fourof eightpatients with autopsyproven pulmonary embolism, yielding a sensitivity of 0.5 (95% confidence interval, 0.16-0.84). The diagnosis was made by high-probability lung scintigraphy in two patients, by pulmonary arteriography in one patient, and by lower extremity venous sonography in another patient. The imaging investigation for suspected pulmonary embolism included only lung scintigra phy in four patients in whom the antemortem diagnosis was incorrect: two with low-probabil ity scintigraphy and two with intermediate-probability scintigraphy. Risk factors were similar for patients with and without pulmonary embolism. CONCLUSION. In thiscohortstudyof patients suspected of havingpulmonary embolism, the antemortem diagnosis was not made in 50% of patients in whom pulmonary embo lism was later proven at autopsy. Underuse of diagnostic testing may have been to blame. We therefore believe that further study is needed to help identify patients with suspected pulmo nary embolism who may benefit from additional diagnostic testing after low-or intermediate probability lung scintigraphy.Lara Patriquin' has been to identify pulmonary embolism pa tients who were autopsied and then to deter mine the clinical characteristics relating to the diagnosis of thromboembolic disease.The diagnostic approaches for suspected pulmonary embolism have broadened to in dude diagnostic testing of the lower extremity veins in addition to pulmonary arteriography [5,6]. Although pulmonary angiography re mains the gold standard for diagnosing pul Autopsy studies have looked at the out come, death from pulmonary embolism, and then determined possible clinical indicators that might have been useful in making the an temortem diagnosis [2,3]. To our knowledge, no studies have looked at autopsy-proven pul monary embolism as the outcome for patients who had been examined for suspected pulmo nary embolism. We therefore longitudinally followed up a cohort of consecutive patients who had been examined for suspected pul monary embolism with ventilationâ€"perfusion scintigraphy. Materials and MethodsWe studied 1210consecutivepatientsseen at the Brigham and Women's Hospital in a 22-month in tervalwho underwentventilationâ€"perfusion scintig

Incidence of diagnosis of subsegmental pulmonary emboli using multidetector row and single-detector row computed tomography

“…Using multidetector row systems, we have shown that 18% of patients have emboli in their subsegmental arteries as the most proximal location of PE. These findings compare well with the range of 6-36% of subsegmental PE reported in the literature [4][5][6]. Importantly, despite the expected superior imaging quality of MDCT, we did not detect a difference between the ability of MDCT and SDCT to localize PE.…”

“…However, among a number of laboratory methods, the platelet function analyzer-100 (PFA-100) has been used in several studies, some of which have shown that ASA resistance defined by results from the PFA-100 predict an increased risk of recurrent thrombosis [1][2][3][4]. In some papers, single determinations on the PFA-100 have been used because the coefficient of variance (CV) has been reported to be about 10% [5,6]. However, in a study establishing reference intervals in healthy men, we found a CV of about 13%, which increased considerably during ASA therapy (unpublished data).…”

Ethnic Differences in Out-of-Hospital Fatal Pulmonary Embolism

“…This is in contrast to fatal, in-hospital PE deaths for which not all clinical diagnoses of fatal PE are confirmed by autopsy. 10 Conversely, the percentage of clinically unsuspected PE causing sudden death has been reported to be as high as 50% 11 to 80%. 12 Here, we report the first autopsy-based study involving a large number (578) of consecutive out-of-hospital fatal PE cases in NYC.…”

Spiral Computed Tomography for Acute Pulmonary Embolism

“…48,49 It is assumed that the presence of such emboli may indicate current DVT that potentially heralds more severe embolic events. 37,46,50 A burden of small peripheral emboli is also thought to have prognostic relevance in individuals with cardiopulmonary disease 46 and for the de- velopment of chronic pulmonary hypertension in patients with thromboembolic disease. 46 Although the accuracy of conventional single-slice spiral CT for the detection of isolated peripheral emboli may be limited, encouraging data are accumulating on the high negative predictive value of a normal spiral CT study 29,[51][52][53][54][55][56][57][58][59][60] (Table 2).…”