Value of structured clinical and scintigraphic protocols in acute pulmonary embolism

Abstract

By applying a model of combined clinical and scintigraphic probabilities for PE, the diagnosis is ruled in when the combined probability is high, and ruled out when the combined probability is low. However, nearly half of the patients will still have an uncertain diagnosis for which further diagnostic procedures may be allocated.

Barometric Pressure and the Incidence of Pulmonary Embolism

“…However, the diagnosis of PE can definitely be confirmed or excluded in only a minority of patients by isotope lung scanning. 11 Although isotope lung scanning has high negative and positive predictive values when patients have low and high pretest probabilities, respectively, only 34% of patients suspected to have PE are within these categories. 10 A normal lung scan result does not fully exclude the diagnosis of PE, and a high-probability scan result may have a false-positive result for the diagnosis of PE.…”

“…10 This means that the diagnosis of PE can definitely be confirmed or excluded in only a minority of typical patients by isotope lung scanning. 11 A normal lung scan result does not fully exclude the diagnosis of PE, while a high-probability scan result may have a false-positive result for the diagnosis of PE. 12 Helical CT angiography is slowly replacing isotope lung scanning for the diagnosis of PE because of its higher specificity and interobserver agreement, especially in patients with preexisting cardiopulmonary disease.…”

Ventilation/perfusion lung scintigraphy: what is still needed? A review considering technetium-99m-labeled macro-aggregates of albumin

“…Its especial value lies in its high negative predictive value (NPV) of 96-100% [1,62,67,68,[73][74][75]. The incidence rate of venous thrombo-embolic events (VTEs) after a normal scintigraphic result was correspondingly low ( Table 1): 0.3% according to the meta-analysis by van Beek et al [69], whereas fatal VTEs were very rare (0.15%).…”

“…The frequency of IP assignments varies greatly (up to 51% [2], generally 10-30% [29,75,76,78,79,84]) according to patient pre-selection (e.g., reason for investigation, experience of the physician); the use of the modifi ed PIOPED criteria reduced the frequency of such assignments [16,17,21,65,66,77].…”

Hämatothorax nach plötzlichem Brustkorbschmerz

“…50 % [10,12] Hematothorax after sudden chest pain 5 History: A 75-year-old woman was admitted to hospital because of the sudden onset of acute chest pain and dyspnea after defecation.…”