Difficulties in diagnosing pulmonary embolism in the obese patient: A literature review

Abstract

Several of the signs and symptoms of pulmonary embolism, such as dyspnea, tachypnea, and tachycardia, are common in the obese population, so these patients are frequently suspected of having a pulmonary embolism. Establishing an accurate diagnosis in this situation is often difficult. We performed a review of the literature examining the difficulty of diagnosing pulmonary embolism in obese patients. Several factors compromise the ability of clinicians to accurately diagnose pulmonary embolism in obese patients. When patients weigh over 350 lbs (159 kg), thoracic imaging often cannot be performed because of the weight limitations of the scanning equipment. If equipment is available that can scan these patients, image quality is often poor. The literature that is available to guide the clinician in this difficult clinical scenario is sparse. Access to radiology equipment that can image morbidly obese patients is improving, but questions about image quality remain. Further research on both imaging and outcomes is needed.

Association of Body Mass Index With Increased Cost of Care and Length of Stay for Emergency Department Patients With Chest Pain and Dyspnea

“…2,21,22 Third, for patients with high BMI whose pretest probability or D-dimer result mandate imaging, systems should have BMI-specific protocols in place, such as increasing the volume of iodinated contrast to reduce the rate of indeterminate image results on CT angiography. 23,24 This study is limited in its estimate of radiation exposure on a per-procedure basis. As described previously, we chose this method over using data from the console report from the CT scan because we found these data unreliable and exclusive of nuclear and fluoroscopic studies, and we could find no device to directly measure radiation on or in the patient.…”

“…For example, obesity increases the probability of indeterminate findings on electrocardiography, 8 nuclear scintillation scanning of the heart or lungs, 9 and computerized tomographic pulmonary angiography (CTPA). 10,11 A study performed in navy-enlisted personnel found that evaluation for chest pain was consistently in the top 5 diagnostic-related group codes in terms of total economic expenditures for the care of obese patients of all age groups. 12 Obesity has been found to prolong the length of stay for numerous acute medical and surgical conditions.…”

Thursday 4 September 2014

“…The two groups were: intubated, mechanically ventilated patients, and conscious non-intubated patients. Elements that contribute to suboptimal quality of CTPA studies have previously been identified as motion artefact [1][2][3][4][5] , poor peripheral pulmonary contrast flow [4,[6][7][8] , and poor contrast enhancement of the main pulmonary trunk [4,[9][10][11][12][13] .…”

Critical Care Management of Obese Patients

“…61 In practice the diagnosis is often made on clinical grounds once alternative diagnoses have been excluded. Commonly used radiologic imaging modalities such as computed tomography scanning are unhelpful, partly because of poor image quality in obese patients and partly because of weight limits on the scanner table.…”