Rarity of isolated pulmonary embolism and acute aortic syndrome occurring outside of the field of view of dedicated coronary CT angiography

Lee, Hwa Yeon; Song, In Sup; Yoo, Seung Min; Rho, Ji Young; Moon, Jae Youn; Kim, In Jai; Lim, Sang Wook; Sung, Jung Hoon; Hun, Dong; White, Charles S.

doi:10.1258/ar.2011.100361

Cited by 12 publications

(7 citation statements)

References 31 publications

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“…For these reasons, Lee et al suggested that the use of dedicated coronary CT angiography (DTCA), instead of a TRO protocol, is equally safe when triaging patients with nonspecific acute chest pain. 4 Pulmonary transit time needs to be taken into account when performing DTCA in this scenario to avoid a false-negative diagnosis of PE. 5 …”

Section: Discussionmentioning

confidence: 99%

Successful Repair of Concomitant Acute Type A Aortic Dissection and Saddle Pulmonary Embolism

Ramponi

Papps

Edwards

2018

Aorta

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Patients presenting with acute onset of chest pain require prompt diagnosis and rapid establishment of a management plan. Acute aortic dissection and acute pulmonary embolism are life-threatening emergencies that can mimic each other at presentation. Correct identification of this uncommon scenario is crucial to initiate the appropriate interventions. The authors present a unique case of concomitant acute type A aortic dissection and acute saddle pulmonary embolism; the patient underwent successful aortic repair and pulmonary embolectomy.

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Section: Discussionmentioning

confidence: 99%

Successful Repair of Concomitant Acute Type A Aortic Dissection and Saddle Pulmonary Embolism

Ramponi

Papps

Edwards

2018

Aorta

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“…Surveys have shown a very low yield of unexpected diagnoses in such cases (ie, an aortic dissection in intermediate-risk patients with acute chest pain). 118,119 This result argues against routine use of this procedure.…”

Section: Introductionmentioning

confidence: 99%

SCCT guidelines on radiation dose and dose-optimization strategies in cardiovascular CT

Halliburton

Abbara

Chen

et al. 2011

Journal of Cardiovascular Computed Tomography

441

271

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Over the last few years, computed tomography (CT) has developed into a standard clinical test for a variety of cardiovascular conditions. The emergence of cardiovascular CT during a period of dramatic increase in radiation exposure to the population from medical procedures and heightened concern about the subsequent potential cancer risk has led to intense scrutiny of the radiation burden of this new technique. This has hastened the development and implementation of dose reduction tools and prompted closer monitoring of patient dose. In an effort to aid the cardiovascular CT community in incorporating patient-centered radiation dose optimization and monitoring strategies into standard practice, the Society of Cardiovascular Computed Tomography has produced a guideline document to review available data and provide recommendations regarding interpretation of radiation dose indices and predictors of risk, appropriate use of scanner acquisition modes and settings, development of algorithms for dose optimization, and establishment of procedures for dose monitoring.

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“…The CCTA DFOV covers the lower two-thirds of the thorax, so theoretically chance of missing isolated upper lobe PTE exists when performing evaluation with z-axis coverage of CCTA. However, considering most of the pulmonary arterial blood flow is directed into the lower lungs, isolated PTE in the upper lobe is expected to be uncommon (10). Isolated PTE in our study were also all located in lower lobes.…”

Section: Discussionmentioning

confidence: 99%

Triple rule-out CT angiography protocol with restricting field of view for detection of pulmonary thromboembolism and aortic dissection in emergency department patients: simulation of modified CT protocol for reducing radiation dose

Kim

Jae

et al. 2016

Acta Radiol

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Background Triple rule-out computed tomography (TRO CT) is a CT protocol designed to simultaneously evaluate the coronary, aorta, and pulmonary arteries. Purpose To evaluate potential diagnostic performance of TRO CT with restricted volume coverage for detection of pulmonary thromboembolism (PTE) and aortic dissection (AD). Material and Methods This study included 1224 consecutive patients with acute chest pain who visited the emergency department and underwent TRO CT using a 128-slice dual-source CT. Image data were reconstructed according to the display field of view (DFOV) of coronary CT angiography (CCTA) and TRO CT protocols in each patient. The presence of PTE and AD was evaluated by independent observers in each DFOV. The radiation dose was calculated to evaluate the potential benefits by restricting z-axis coverage to cardiac scan range instead of the whole thorax. Results Among all patients, 22 cases with PTE (1.9%) and nine cases with AD (0.8%) were found. Except for one PTE case, all cases were detected on both DFOV of TRO CT and CCTA. Mean effective dose for evaluation of entire thorax and cardiac scan coverage were 5.9 ± 1.1 mSv and 3.5 ± 0.7 mSv, respectively. Conclusion Isolated PTE and AD outside the CCTA DFOV rarely occur. Therefore, modified TRO CT protocol using cardiac scan coverage can be adopted to detect PTE and AD with reduced radiation dose.

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Rarity of isolated pulmonary embolism and acute aortic syndrome occurring outside of the field of view of dedicated coronary CT angiography

Abstract: As isolated PE, AAS, and significant non-cardiac pathology outside of the DCTA FOV rarely occur, DCTA may replace TRO in the evaluation of patients with non-specific acute chest pain and a low pre-test probability of PE or aortic dissection.

Cited by 12 publications

References 31 publications

Successful Repair of Concomitant Acute Type A Aortic Dissection and Saddle Pulmonary Embolism

Successful Repair of Concomitant Acute Type A Aortic Dissection and Saddle Pulmonary Embolism

SCCT guidelines on radiation dose and dose-optimization strategies in cardiovascular CT

Triple rule-out CT angiography protocol with restricting field of view for detection of pulmonary thromboembolism and aortic dissection in emergency department patients: simulation of modified CT protocol for reducing radiation dose

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