Predictors of an intermediate ventilation/perfusion lung scan in patients with suspected acute pulmonary embolism

Calvo-Romero, José Marı́a; Lima-Rodríguez, Esther María; Bureo-Dacal, Pedro; Pérez-Miranda, Manuel

doi:10.1097/00063110-200506000-00007

Cited by 17 publications

(5 citation statements)

References 7 publications

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“…In unselected patients, rate of non diagnostic lung scan is higher in elderly patients (Calvo-Romero et al 2005). The diagnostic yield of lung scan decreases from 68% in patients under 40 years to 42% in the patients aged 80 years and older (Righini et al 2000).…”

Section: Resultsmentioning

confidence: 99%

Pulmonary embolism in the elderly: a review on clinical, instrumental and laboratory presentation

Masotti¹

2008

VHRM

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Objective: Diagnosis of pulmonary embolism (PE) remains diffi cult and is often missed in the elderly due to nonspecifi c and atypical presentation. Diagnostic algorithms able to rule out PE and validated in young adult patients may have reduced applicability in elderly patients, which increases the number of diagnostic tools use and costs. The aim of the present study was to analyze the reported clinical presentation of PE in patients aged 65 and more. Materials and Methods: Prospective and retrospective English language studies dealing with the clinical, instrumental and laboratory aspects of PE in patients more than 65 and published after January 1987 and indexed in MEDLINE using keywords as pulmonary embolism, elderly, old, venous thromboembolism (VTE) in the title, abstract or text, were reviewed. Results: Dyspnea (range 59%-91.5%), tachypnea (46%-74%), tachycardia (29%-76%), and chest pain (26%-57%) represented the most common clinical symptoms and signs. Bed rest was the most frequent risk factor for VTE (15%-67%); deep vein thrombosis was detected in 15%-50% of cases. Sinus tachycardia, right bundle branch block, and ST-T abnormalities were the most frequent ECG fi ndings. Abnormalities of chest X-ray varied (less than 50% in one-half of the studies and more than 70% in the other one-half). Arterial blood gas analysis revealed severe hypoxemia and mild hypocapnia as the main fi ndings. D-Dimer was higher than cut-off in 100% of patients in 75% of studies. Clinical usefulness of D-Dimer measurement decreases with age, although the strategies based on D-Dimer seem to be cost-effective at least until 80 years. Conclusion: Despite limitations due to pooling data of heterogeneous studies, our review could contribute to the knowledge of the presentation of PE in the elderly with its diagnostic diffi culties. A diagnostic strategy based on reviewed data is proposed.

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Section: Resultsmentioning

confidence: 99%

Pulmonary embolism in the elderly: a review on clinical, instrumental and laboratory presentation

Masotti¹

2008

VHRM

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“…Patients with COVID positive test and a need for a ventilation scan after perfusion may be triaged to pulmonary CTA or consider the use of perfusion SPECT CT imaging for further evaluation of acute PE ( Kan et al, 2015 ; Bajc et al, 2009 ). Our results showed only six patients’ scans were interpreted as intermediate probability (4.7%) and only four of them required ventilation studies, but the ventilation part was performed in only two of them ( Kember et al, 1997 ; Quinn et al, 1991 ; Calvo et al, 2005 ). Clinical findings and/or pulmonary CTA were used in the remaining 4 patients to make the final diagnosis ( Quinn et al, 1991 ; Cueto et al, 2001 ; Powell et al, 2003 ; Robinson, 1996 ).…”

Section: Discussionmentioning

confidence: 59%

Perfusion lung scans during the pandemic: COVID-19 experience in a large trauma hospital

Gayed

Browne

Kaur

2022

Journal of Radiation Research and Applied Sciences

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“…18,19,36 This was also evident in the current study as renal function was the strongest predictor choosing CTPA as the diagnostic modality in patients with suspected PE. However, V/Q scans are associated with a higher proportion of nondiagnostic results, particularly in older patients (partly owing to the presence of significant underlying cardiopulmonary disease) 37,38 who also suffer more from renal impairment.…”

Section: Discussionmentioning

confidence: 99%

Risk of Acute Kidney Injury after Intravenous Contrast Media Administration in Patients with Suspected Pulmonary Embolism: A Propensity-Matched Study

Elias

Aronson

2020

Thromb Haemost

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Background Although computed tomography pulmonary angiography (CTPA) is the preferred diagnostic procedure in patients with suspected pulmonary embolism (PE), some patients undergo ventilation/perfusion (V/Q) lung scan due to concern of contrast-associated acute kidney injury (AKI). Methods The study used a cohort of 4,565 patients with suspected PE. Patients who received contrast during CTPA were compared with propensity score-matched unexposed control patients who underwent V/Q lung scanning. AKI was defined as ≥50% increase in serum creatinine during the first 72 hours after either CTPA or V/Q lung scan. Results Classification and regression tree analysis demonstrated that baseline creatinine was the strongest determinant of the decision to use CTPA. Propensity-score matching yielded 969 patient pairs. There were 44 AKI events (4.5%) in patients exposed to contrast media (CM) and 33 events (3.4%) in patients not exposed to CM (risk difference: 1.1%, 95% confidence interval [CI]: −0.6 to 2.9%; odds ratio [OR]: 1.39, 95% CI: 0.86–2.26; p = 0.18). Using different definitions for AKI and extending the time window for AKI diagnosis gave similar results. In a sensitivity analysis with the inverse probability weighting method, the OR for AKI in the CTPA versus V/Q scan was 1.14 (95% CI: 0.72–1.78; p = 0.58). Conclusion Intravenous contrast material administration was not associated with an increased risk of AKI in patients with suspected PE. Given the diagnostic superiority of CTPA, these results are reassuring with regard to the use of CTPE in patients with suspected PE perceived to be at risk for AKI.

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Predictors of an intermediate ventilation/perfusion lung scan in patients with suspected acute pulmonary embolism

Cited by 17 publications

References 7 publications

Pulmonary embolism in the elderly: a review on clinical, instrumental and laboratory presentation

Pulmonary embolism in the elderly: a review on clinical, instrumental and laboratory presentation

Perfusion lung scans during the pandemic: COVID-19 experience in a large trauma hospital

Risk of Acute Kidney Injury after Intravenous Contrast Media Administration in Patients with Suspected Pulmonary Embolism: A Propensity-Matched Study

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