Clinical presentation and diagnostic work up of suspected pulmonary embolism in a district hospital emergency centre serving a high HIV/TB burden population

Bulajic, Bojana; Welzel, Tyson; Vallabh, K.

doi:10.1016/j.afjem.2019.05.003

Cited by 8 publications

(7 citation statements)

References 22 publications

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“…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. 13 The CTPA prevalence of PE in an HIV-infected study population in this study was found to be 35%.…”

Section: Discussionmentioning

confidence: 59%

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

Wiese

Rajkumar

Lucas

et al. 2022

South African Journal of Radiology

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Paradoxically, studies of CTPA findings for suspected PE have also demonstrated that many alternate findings do not provide a strong rationale for its increased use. 5,6 A study conducted in Brazil in 2016 revealed that a significant proportion of patients who had undergone CTPA for suspected PE had reported alternate findings compatible with an different diagnosis. 7 This is a relevant consideration for resource-poor settings such as that of South Africa.Background: South Africa bares a significant burden of HIV and imaging is commonly performed as part of the workup for respiratory distress. Objectives:The aim of this study was to document the prevalence of pulmonary thromboembolic disease (PTED) and other findings in HIV-infected patients referred for CT pulmonary angiography (CTPA) for suspected PTED.Method: Forty CTPA studies of documented HIV-infected individuals investigated for suspected PTED during a 1-year period were retrieved, anonymised and interpreted by three consultant radiologists. Inter-reader reliability was calculated using Free Marginal multi-rater Kappa.Results: Fourteen of the forty cases (35%) were positive for PTED. In the pulmonary embolism (PE)-positive group, 57.14% had peripheral disease and 42.86% had both peripheral and central disease. Associated findings in the PE-positive cases were pulmonary infarcts (17.5%), mosaic attenuation (17.5%) and linear atelectasis (7.5%). The most common incidental findings were solid pulmonary nodules (52.5%), non-wedge-shaped consolidation (45%), cardiomegaly (52.5%) and enlarged intra-thoracic lymph nodes (52.5%). Thirty per cent of the study population had findings related directly to the presence of PTED, whilst most cases in the study (77.5%) had pulmonary findings unrelated to PTED. In the PE-negative cases, 55% reported emergent findings that warranted immediate or urgent medical attention. Conclusion:Computed tomography pulmonary angiography imaging is critical for diagnosing PE. However, further investigation into the judicious application of CTPA in HIV-infected patients with suspected PTED is required, as CTPA findings in most of the cases in this study were unrelated to PE.

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Section: Discussionmentioning

confidence: 59%

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

Wiese

Rajkumar

Lucas

et al. 2022

South African Journal of Radiology

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“…12 Clinical prediction rules such as Well's and Geneva criteria to determine pretest probability for PE are validated in well-resourced countries but seem to fall short in terms of applicability in low resource settings. 7,13 Clinical prediction rules have also been shown to be unreliable in pregnancy where D-dimer had a sensitivity of 88.4% and low specificity of 8% using a standard cut off. 14 Multiple studies have been conducted to determine the diagnostic accuracy of the d-dimer assay in diagnosis of PE.…”

Section: Discussionmentioning

confidence: 99%

“…6 The diagnosis of pulmonary embolism in resource limited settings may be challenging as evidenced by the search for clinical decision rules by various set ups. 7 The D-dimer is a breakdown product of the cross linked fibrin mesh and can be used to rule out pulmonary embolism in patients with low pretest clinical probability based on specified cut off levels e.g 1000ng/ml. 6 This finding has also been found to be true in children.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy of D-Dimer Assay in Pulmonary Embolism Using Ctpa as Gold Standard

Aziz

Junaid

Nadeem

et al. 2022

PAFMJ

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Objective: To determine the sensitivity and specificity of D-dimer assay for the diagnosis of PE in resource limited settings using CTPA as a gold standard for comparison. Study Design: Cross-sectional study. Place and Duration of Study: Department of Radiology, Combined Military Hospital, Peshawar, from Feb 2019 to Jul 2020. Methodology: A sample of 114 cases of clinically suspected PE presenting in ED were collected by non-probability sampling as per QUADAS 2 domains. D-dimer and CTPA reporting done by separate teams, compilation of data by third team. Using SPSS 23.0, 2×2 contingency table was used to calculate the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of D-dimer in diagnosing PE. Results: Age range 20-50 years (mean: 40.54 ± 5.02 years). Sixty patients were female (52.3%). D- Dimer levels for the diagnosis of PE: Sensitivity: 92.86%, specificity 89.66%, positive predictive value (PPV): 89.66% and negative predictive value (NPV): 92.86%. Conclusion: The D-Dimer levels are significantly sensitive and specific in the diagnosis of PE: however keeping in view the high mortality of PE, diagnostic accuracy may be further improved by using D-Dimer levels in conjunction with pretest clinical probability rules.

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“…CTPA is the gold standard for diagnosing PE [16]. However, there may be financial and logistic limitations in accessing CTPA especially in resource restrained settings, with the added challenge of exposure of technicians to COVID-19 patients [13,28]. These hindrances may lead to delayed/missed diagnosis and increased chances of mortality.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Associated Pulmonary Thromboembolic Events in Anti-Coagulated Patients: Case Series from a Tertiary Facility in Ghana

Yasmine¹,

Emmanuel²,

Kwaku³

et al. 2022

Med Clin Case Rep

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Severe/critical Coronavirus Virus Disease 2019 (COVID-19) patients face increased risk of pulmonary embolism (PE) and other thromboembolic events. This risk exists even in patients who are on prophylactic and therapeutic doses of anticoagulant. We present three cases of Severe/critical COVID-19 patients who developed PE despite being placed on prophylactic doses of anticoagulants. Clinicians should be keenly aware of this and urgently institute appropriate diagnostic measures if PE is suspected

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Clinical presentation and diagnostic work up of suspected pulmonary embolism in a district hospital emergency centre serving a high HIV/TB burden population

Cited by 8 publications

References 22 publications

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

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

Diagnostic Accuracy of D-Dimer Assay in Pulmonary Embolism Using Ctpa as Gold Standard

COVID-19 Associated Pulmonary Thromboembolic Events in Anti-Coagulated Patients: Case Series from a Tertiary Facility in Ghana

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