Diagnostic Evaluation of Pulmonary Embolism: A Computerized Tomography Based Study

Abstract

Pulmonary embolism (PE) is potentially life threatening condition which requires adequate diagnosis. Since computerized tomography pulmonary angiography (CTPA) described the presence of a clot subjectively, an objective and quantification method to characterize plural parenchymal abnormality, pulmonary vessels and heart is needed (in order to diagnose PE). This study was directed to investigate whether the presence of plural parenchymal findings correlates with the PE and as well, it was designed to answer two basic questions based on CTPA findings done for clinical suspicion of PE: firstly, what are the plural parenchymal abnormalities associated with PE; secondly, correlation of PE with the presence of heart changes and pulmonary vessels measurements. CTPA scans were acquired for 55 patients suspected of having PE and another 50 subjects who were considered as control. The clinical signs and pleuroparenchymal abnormalities, pulmonary artery tree measurements, right ventricle and atrium diameters, Inter ventricular septum width as well as the myocardium thickening were characterized and correlated with PE. The results showed that the PE patients group has more dilated measurements than the normal control subjects. The right ventricle diameter changes were found to be significantly related to the presence of PE at p ≤ 0.001. Significant changes at p ≤ 0.005 were also noticed in the pulmonary trunk diameter as well as the right and left main pulmonary arteries with no significant changes detected in the distal portion of both pulmonary arteries diameters. The common complaints from PE patients were chest pain, shortness of breathing, lower limb swelling, tachycardia and syncope. Consolidation, ground glass opacifications, mosaic, right ventricle morphological changes and pleural effusion were present in the majority of patients undergoing CTPA for the clinical suspicion of PE. CTPA is considered as the diagnostic modality of choice in characterization of pulmonary vessels, atrium and ventricle changes as well as pleura parenchymal abnormalities in patients with or without PE.