Acute pulmonary embolism: ancillary findings at spiral CT.

Coche, Emmanuel; Müller, N L; Kim, K I; Wiggs, Barry; Mayo, John R.

doi:10.1148/radiology.207.3.9609900

Cited by 151 publications

(107 citation statements)

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“…17,18 The frequency of sub-segmental PE is reported to be 6% . 19,20 In our study we observed six patients with sub-segmental emboli in the group of patients without syncope (10% ).…”

Section: Discussionmentioning

confidence: 59%

Syncope in patients with pulmonary embolism: comparison between patients with syncope as the presenting symptom of pulmonary embolism and patients with pulmonary embolism without syncope

et al. 2003

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Syncope in patients with pulmonary embolism: comparison between patients with syncope as the presenting symptom of pulmonary embolism and patients with pulmonary embolism without syncope R Castellia , P Tarsia a , C Tantardini a , G Pantaleo b , A Guariglia a and F Porro a Abstract: Syncope as an initial presentation of pulmonary embolism occurs in 10% of patients. We compared clinical and instrumental parameters in patients with syncope as the presenting symptom of pulmonary embolism and in patients with documented pulmonary embolism without syncope. Seventy patients with the diagnosis of pulmonary embolism and apparently stable clinical conditions were evaluated. They were divided in two groups: 10 patients with syncope as the presenting symptom of pulmonary embolism (group 1) and 60 patients without syncope (group 2). Patients with syncope showed a more pronounced tendency to present with main pulmonary artery embolus than patients without syncope (contingency coef cientˆ0.301, p < 0.04; one-tailed). However, despite the evidence that patients with syncope have signi cant reductions in systolic and=or diastolic blood pressure, shock was not observed in any patient. In no case was thrombolytic treatment given and all patients received standard anticoagulation with unfractioned heparin and oral anticoagulant. We suggest that syncope in the setting of non-massive pulmonary embolism may be due to vaso-vagal mechanism that can lead to a reduction of arterial blood pressure when central artery thrombosis is involved.

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“…17,18 The frequency of sub-segmental PE is reported to be 6% . 19,20 In our study we observed six patients with sub-segmental emboli in the group of patients without syncope (10% ).…”

Section: Discussionmentioning

confidence: 59%

Syncope in patients with pulmonary embolism: comparison between patients with syncope as the presenting symptom of pulmonary embolism and patients with pulmonary embolism without syncope

et al. 2003

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“…1). Spiral CT can also help detect indirect signs of PE such as pleural-based densities, linear densities, or plate-like atelectases, central or peripheral dilatation of pulmonary arteries, and pleural effusions [16] ( fig. 2).…”

Section: Image Interpretationmentioning

confidence: 99%

“…The only single parenchymal finding that is significantly associated with PE is a subpleural wedgeshaped density, commonly known as a Hampton9s hump ( fig. 2) [16]. Pitfalls in the interpretation of spiral CT arteriograms may be due to insufficient or heterogeneous vascular opacification in patients with cardiovascular and/or pulmonary comorbidity, breathing artifacts, and prominent lymphoid tissue in close vicinity to pulmonary arteries in the hilar area.…”

Section: Image Interpretationmentioning

confidence: 99%

Spiral computed tomography of pulmonary embolism

Herold¹

2002

Eur Respir J

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Spiral computed tomography of pulmonary embolism. C.J. Herold. #ERS Journals Ltd 2002. ABSTRACT: Within the last several years, spiral computed tomography angiography (SCTA) of the pulmonary arteries has emerged as a noninvasive angiographic modality for the evaluation of patients with suspected pulmonary embolism (PE). SCTA is based on continuous computed tomography (CT) data acquisition during patient transport through the rotating X-ray tube and detector system, where scanning is performed in the time period in which the injected contrast material passes through the pulmonary arteries. Single detector spiral CT has a sensitivity of y85-90% and a specificity between 88-95%. Sensitivity and specificity are very likely to increase with the use of multidetector spiral CT scanners that allow scanning of large lung volumes with a scan collimation as narrow as 1 mm.Currently, SCTA is most commonly used as a primary imaging method in patients with suspected PE, and as a second-line method in cases with inconclusive ventilation/ perfusion scintigraphy results. SCTA has proven to be cost-effective, especially in combination with ultrasound of the lower extremities.Limitations of the method include a decreased sensitivity for the detection of small isolated clots in the peripheral pulmonary arterial bed, and a potentially reduced image quality in patients with coexistent cardiopulmonary disorders.Despite these limitations, several studies have now documented that, in patients with suspected pulmonary embolism, it is safe to withhold anticoagulation therapy if a spiral computed tomography exam of the pulmonary arteries is negative and no lower extremity venous thrombosis is present. In the future, multislice computed tomography scanning of the pulmonary arteries with multiplanar reformation and one-stop shopping, i.e. scanning of the pulmonary arteries and the lower extremity veins in a single session, will further enhance the role of computed tomography angiography in the examination of patients with suspected pulmonary embolism. Pulmonary embolism (PE) is often encountered both in the hospital setting and in private clinical practice. Because untreated PE is associated with a greatly increased mortality risk, accurate diagnosis of PE is of critical importance [1,2]. However, because clinical findings, laboratory tests, and signs and symptoms at physical examination are often nonspecific, imaging methods are a significant part of the diagnostic evaluation of patients with suspected PE.Since PE is not an isolated disorder but, rather, a symptom of the entire venous thromboembolism complex, imaging studies of the lower extremities and the pelvis, the most common source of pulmonary emboli, are a fundamental requirement for the diagnostic work-up of patients with suspected PE. Various imaging modalities have been attempted in this evaluation process within the last few decades. For many years, ventilation/perfusion (V/Q) scintigraphy has served as the noninvasive procedure of choice for the assessment of patients with susp...

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“…[13,22,23] Klinik olarak pnömo-nik infiltrasyonlar ile pulmoner embolinin oluşturduğu dispne, taşipne, plörotik göğüs ağrısı ve hipoksemi gibi semptomlar birbirine oldukça benzerlik göstermektedir. Kabrhel ve ark.…”

Section: Discussionunclassified

The analysis of non-thromboembolic findings encountered in multidetector computed tomography pulmonary angiography studies in patients with suspected pulmonary embolism

et al. 2011

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ÖZET AmaçPulmoner emboli ön tanısı ile çok kesitli bilgisayarlı tomografi (ÇKBT) pulmoner anjiyografi tetkiki yapılan olgularda pulmoner emboli sıklığının belirlenmesi ve emboli saptanmayan olgularda tanı ve tedaviye katkı sağlayan diğer bulguların analiz edilmesidir. Gereç ve YöntemBu geriye dönük çalışma için onay hastanemizin yerel etik kurulundan alındı. Çalışmaya pulmoner emboli ön tanısı ile Aralık 2009 -Kasım 2010 tarihleri arasında ÇKBT pulmoner anjiyografi tetkiki yapılan 223 olgu (128 erkek, 95 kadın, ortalama yaş: 58.6) dahil edildi. Pulmoner BT anjiyografi tetkiki 64 dedektörlü ÇKBT cihazı ile, 70-100 ml non-iyonik iyotlu kontrast madde kullanılarak yapıldı. Bütün olguların görüntüleri geriye dönük olarak değerlendirildi. Olgularda pulmoner emboli olup olmadığı, pulmoner emboli olmayan olgularda hastanın semptomları ile ilişkili olan ya da rastlantısal olarak saptanan bütün bulgular kaydedildi. BulgularOlguların %11.7 sinde (26/223) pulmoner emboli mevcuttu. Pulmoner emboli saptanmayan 197 olgunun 154'ünde (%78.2) akciğerler, mediastinal yapılar, toraks duvarı yapıları ve üst batın organları ile ilgili, semptom ve klinik bulguları açıklayan (%62.5) ve semptomlar ile ilişkisiz rastlantısal (%37.5) çeşitli bulgular saptandı. En sık saptanan bulgular akciğer infiltrasyonu-konsolidasyon (%15.1), atelektazi (%13.5) ve plevral efüzyondu (%13.1). Kırk üç (%21.8) olguda ise ÇKBT pulmoner anjiyografi ile herhangi bir bulgu saptanmadı. SonuçPulmoner emboli ön tanısı ile ÇKBT pulmoner anjiyografi tetkiki yapılan olguların büyük çoğunluğunda pulmoner emboli tespit edilmemesine karşın, semptom ve klinik bulguları açıklayan ya da rastlantısal bir çok veri tespit edilebilmektedir. Bu nedenle ÇKBT anjiyografi tetkiklerinde pulmoner vasküler yapılar yanın-da görüntü alanına giren diğer yapıların dikkatli değerlendirilme-si ve bulguların doğru yorumlanması doğru tanı ve tedavi yaklaşı-mı açısından önemlidir.Anahtar sözcükler: Atelektazi; çok kesitli bilgisayarlı tomografi; infiltrasyon; pulmoner anjiyografi; pulmoner emboli. SUMMARY Objectives To determine the frequency of pulmonary embolism in patients evaluated with multidetector computed tomography (MDCT) pulmonary angiography for suspected pulmonary embolism, and to analyze other MDCT findings that contributed to the diagnosis and treatment in these patients. Methods Approval for this retrospective study was obtained from the local ethical committee of our hospital. A total of 223 patients (128 male

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Acute pulmonary embolism: ancillary findings at spiral CT.

Abstract: Parenchymal findings may suggest further investigations when results of spiral CT are inconclusive in diagnosis of PE.

Cited by 151 publications

References 0 publications

Syncope in patients with pulmonary embolism: comparison between patients with syncope as the presenting symptom of pulmonary embolism and patients with pulmonary embolism without syncope

Syncope in patients with pulmonary embolism: comparison between patients with syncope as the presenting symptom of pulmonary embolism and patients with pulmonary embolism without syncope

Spiral computed tomography of pulmonary embolism

The analysis of non-thromboembolic findings encountered in multidetector computed tomography pulmonary angiography studies in patients with suspected pulmonary embolism

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