Alternative diagnoses based on CT angiography of the chest in patients with suspected pulmonary thromboembolism

Abstract

Objective: To determine the prevalence of alternative diagnoses based on chest CT angiography (CTA) in patients with suspected pulmonary thromboembolism (PTE) who tested negative for PTE, as well as whether those alternative diagnoses had been considered prior to the CTA. Methods: This was a cross-sectional, retrospective study involving 191 adult patients undergoing CTA for suspected PTE between September of 2009 and May of 2012. Chest X-rays and CTAs were reviewed to determine whether the findings suggested an alternative diagnosis in the cases not diagnosed as PTE. Data on symptoms, risk factors, comorbidities, length of hospital stay, and mortality were collected. Results: On the basis of the CTA findings, PTE was diagnosed in 47 cases (24.6%). Among the 144 patients not diagnosed with PTE via CTA, the findings were abnormal in 120 (83.3%). Such findings were consistent with an alternative diagnosis that explained the symptoms in 75 patients (39.3%). Among those 75 cases, there were only 39 (20.4%) in which the same alterations had not been previously detected on chest X-rays. The most common alternative diagnosis, made solely on the basis of the CTA findings, was pneumonia (identified in 20 cases). Symptoms, risk factors, comorbidities, and the in-hospital mortality rate did not differ significantly between the patients with and without PTE. However, the median hospital stay was significantly longer in the patients with PTE than in those without (18.0 and 9.5 days, respectively; p = 0.001). Conclusions: Our results indicate that chest CTA is useful in cases of suspected PTE, because it can confirm the diagnosis and reveal findings consistent with an alternative diagnosis in a significant number of patients.

CT pulmonary angiography findings in HIV-infected patients referred for suspected pulmonary thrombo-embolic disease

“…This finding shows that PE is seen two decades earlier than in non-HIV patients where the mean age of presentation is 67-62 years. 5,6,7,9 This is in keeping with other literature on HIV-infected patients where the mean ages for PE were younger than the general population, ranging from 40 to 45 years. 2,3,10,11,12 Presenting symptoms in this study were typical of that described in the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED II) trial, including shortness of breath, syncope, chest pain and haemoptysis -all of which are non-specific.…”

“…A few previous studies on the HIV prevalence in PE-positive patients have reported much lower percentages in the general population of other countries, ranging from 9.5% to 24.6%. 5,6,7,9,14 This indicates that CTPAs are, indeed, a relevant investigation in the evaluation of respiratory distress in both HIV-infected and HIV-negative patients.…”

“…This is higher than the 45% in the study on HIVinfected patients by Ramlakhan et al 11 , as well as higher than the 25.8% in the study by Sharma et al 14 studies carried out on both HIV-infected and -negative populations. 7,11,14 These findings are traditionally thought to be due to PE. This study demonstrated an increased RV:LV ratio in nine of the 14 PE-positive patients (22.5%).…”

Performance Spect-Ct and Angio-Ct for Diagnosis of Pulmonary Thromboembolism in a Tertiary Oncology Centre

“…In Brazil, the estimated incidence is 0.6 cases per 1,000 inhabitants per year, while the worldwide incidence in 2003 was 0.5 cases per 1,000 inhabitants per year. 1,2 Cancer is a risk factor for both TEP and venous thromboembolism, and there is a four-times higher risk of developing TEP in cancer patients than in the general population. If the patient is undergoing chemotherapy, this risk increases up to six times.…”

Vascular reperfusion in pulmonary thromboembolism: certainties and uncertainties

“…Between 2001 and 2009, the incidence of PTE increased from 29 to 78 cases per year; this increase is partly due to an increase in the number and quality of imaging tests, particularly chest CT angiography, as well as to incidental findings of pulmonary embolism on routine examinations for other diseases, such as cancer. 1 , 2 Despite technological advances, the diagnosis of PTE remains a challenge; autopsy studies have shown that the prevalence of PTE cases undiagnosed in life is 84.6%. 3…”