Pulmonary embolism in pregnancy: a diagnostic dilemma

Abstract

The diagnosis of PE in pregnancy poses a challenge due to pregnancy-related physiological changes. Missing the PE or wrongly treating a pregnant woman for PE has serious clinical consequences. There has been concern over the use of radiation-based imaging modalities due to risk of teratogenicity and oncogenicity. This review is focused on various diagnostic options and risks of radiation to the fetus and mother from radiation-based procedures.

State-of-the-Art Imaging in Pulmonary Embolism: Ventilation/Perfusion Single-Photon Emission Computed Tomography versus Computed Tomography Angiography — Controversies, Results, and Recommendations from a Systematic Review

“…The controversies mostly relate to the concern for radiation exposure both to the mother and the fetus, and as with the generally increased use of CT, a survey reported an increase of 107% in the use of radiation-based modalities for pregnancyrelated suspected PE over a 10-year period from 1996 to 2006. 67,[75][76][77] Generally speaking, the absorbed fetal dose is less with CTA compared with V/Q scans, especially in the first trimester, whereas the absorbed dose to the mother, particularly to the breast tissue, is substantially higher with CTA. However, the absorbed fetal dose is generally considered low from either examination, that is, 0.06 to 0.66 mGy with CTA versus 0.36 to 0.56 mGy with V/Q scan, and both techniques can be modified to further reduce the dose.…”

Thromboembolic complications during pregnancy and delivery

“…U slučaju masivne plućne embolije i hemodinamičke nestabilnosti trudnice, terapijski pristup treba individualizovati. Kardio-pulmonalni bajpas i hiruška embolektomija, a nakon toga carski rez bile bi metode izbora u najtežim slučajevima, međutim ove intervencije su ograničene na vrlo mali broj ekspertskih centara [36]. Tromboliza nije kontraindikovana i do sada je bila uspešna u 172 objavljena slučaja [37].…”

Automated synthesis of [68Ga]oxine, improved preparation of68Ga-labeled erythrocytes for blood-pool imaging, and preclinical evaluation in rodents

“…Blood pool imaging by positron emission tomography (PET) and single photon emission computed tomography (SPECT) have been used for the investigation of infection, 1 gastrointestinal bleeding, 2 cardiac function, [3][4][5] and to measure changes in vascularity and perfusion of tumors and organs. 6,7 Radiolabeled small molecules and blood proteins (such as human serum albumin (HSA)) have been widely used for this purpose, [8][9][10] but radiolabeled erythrocytes in particular have been demonstrated to have numerous applications in nuclear medicine.…”