An Analysis of Patients That Underwent Computed Tomography Pulmonary Angiography with the Prediagnosis of Pulmonary Embolism in the Emergency Department

Abstract

Introduction. The purpose of this study is to analyze the frequency of other diagnoses and findings in patients that were diagnosed with or not diagnosed with PE following the CTPA in the ED and to analyze the relationship between diagnosis and D-dimer. Instrument and Method. This study involves all patients that presented to the ED that underwent CTPA with the prediagnosis of PE. The items considered in this study were their reason for presenting to the ED and pretest clinical risks for PE, D-dimer, and CTPA results. Findings. Of the 696 cases, the most common cause was shortness of breath (59.3%). The CTPA showed that 145 (20.83%) patients were suffering from PE. Among the remaining cases, 464 (66.66%) patients had pathological findings other than PE and 87 (12.5%) patients were reported as normal. The most common pathological results other than PE found in CTPA were atelectasis in 244 (39.9%) and ground glass in 165 (23.7%), as well as nonpulmonary results in 70 (10.05%) patients. The differences in D-dimer results of patients diagnosed with PE, patients diagnosed with another pathology, and patients with normal CTPA results were statistically significant (P < 0.001). Conclusion. CTPA scanning, performed on the basis of assessment scoring, helps in discovering other fatal pathologies in addition to PE.

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

“…The prevalence of PTE in our study was comparable to that seen in other studies (19.0-24.3%), ( 11 , 20 , 21 , 23 ) but it was higher than that reported by other authors (8.6-9.5%). ( 16 , 18 , 24 ) Factors such as level of clinical suspicion and compliance with guidelines for the investigation of PTE can affect the prevalence rate of the disease.…”

“…( 18 , 21 , 23 ) In our study, the major abnormal findings on the CTA scans that were negative for PTE were atelectasis, pulmonary nodules, pleural effusion, consolidation, and emphysema. Of note is the significant proportion of nodules and micronodules in our study relative to those reported in other studies, ( 16 , 18 , 20 , 23 , 24 ) which might be related to the high prevalence of granulomatous diseases in Brazil. ( 29 ) Such incidental findings, which were not associated with the patient's acute status, often might require further investigation or long-term follow-up.…”

“…The prevalence of hemoptysis in the patients in our study is within the range of prevalence levels reported in other previous studies of patients with PTE (1.9%-6.0%). ( 4 , 9 , 18 , 23 , 27 )…”

“…A prevalência de TEP observada em nosso estudo foi comparável à de outras séries (19.0-24,3%), ( 11 , 20 , 21 , 23 ) mas foi superior à descrita por outros autores (8,6-9,5%). ( 16 , 18 , 24 ) Fatores como o grau de suspeita clínica e o seguimento de diretrizes para a investigação de TEP podem influenciar na taxa de prevalência da doença.…”

“…( 18 , 21 , 23 ) Os nossos principais achados anormais nos exames negativos para TEP foram atelectasia, nódulo pulmonar, derrame pleural, consolidação e enfisema. Chama a atenção a significativa proporção de nódulos e micronódulos na nossa série em relação às demais, ( 16 , 18 , 20 , 23 , 24 ) o que pode estar relacionado com a alta prevalência de doenças granulomatosas no nosso meio. ( 29 ) Esses achados incidentais, que não estavam associados ao quadro agudo dos pacientes, com frequência podem necessitar de investigação adicional ou seguimento em longo prazo.…”