Diagnostic strategies for suspected pulmonary embolism

Rossum, Astrid B. Donkers–van

doi:10.1183/09031936.01.00248601

Cited by 11 publications

(8 citation statements)

References 77 publications

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“…Using optimal technique on single-detector scanners the sensitivity and specificity of spiral CT in the diagnosis of acute PE is y90% [1,9]. Several studies have shown that spiral CT is clearly superior to scintigraphy but it does have limitations particularly in the diagnosis of subsegmental PE.…”

Section: Pulmonary Embolismmentioning

confidence: 99%

“…Based on recent reviews on the subject by DONKERS-VAN ROSSUM [1] and other investigators [9,10], it seems reasonable to make the following recommendations for imaging of patients with suspected PE. 1) Patients who have symptoms or signs of deep vein thrombosis (DVT) should first undergo ultrasound of the legs.…”

Section: Pulmonary Embolismmentioning

confidence: 99%

“…It is likely that spiral CT will be used most often in inpatients with underlying pulmonary disease because D-dimer has a very low specificity in these patients and scintigraphy has a greater likelihood of intermediate probability scans [1,11]. However, a large number of questions remain to be answered and will require careful evaluation in the near future.…”

Section: Pulmonary Embolismmentioning

confidence: 99%

“…In recent months the European Respiratory Journal has published a series of articles on advances in imaging [1][2][3][4][5][6][7][8]. These articles have reviewed the current role of imaging in the diagnosis and management of various airway and pulmonary diseases and have highlighted potential areas of research.…”

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confidence: 99%

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Advances in imaging

Müller¹

2001

European Respiratory Journal

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In recent years there have been major advances in chest imaging. These include significant refinements in previously available techniques such as computed tomography (CT) and magnetic resonance (MR) imaging and the introduction of new techniques into the clinical armamentarium, particularly positron emission tomography (PET) imaging.These advances have led to changes in the diagnostic approach to a number of conditions, particularly pulmonary embolism, lung cancer, diseases of the large and small airways, and diffuse lung disease. They have also brought new insights into the pathophysiology of lung disease.State of the art CT and MR imaging now allow objective quantification of lung disease and assessment of regional changes in ventilation and perfusion caused by airway and parenchymal abnormalities.The aim of this article is to summarize the most important clinical applications of the recent advances in imaging and to emphasize the topics of imaging research likely to attract particular attention from radiologists and clinicians in the near future. In recent months the European Respiratory Journal has published a series of articles on advances in imaging [1][2][3][4][5][6][7][8]. These articles have reviewed the current role of imaging in the diagnosis and management of various airway and pulmonary diseases and have highlighted potential areas of research. The present article will only consider what the author deems to be the most important clinical applications and the most pressing topics of imaging research. The article will focus on imaging in pulmonary embolism, lung cancer, airway diseases, and parenchymal lung disease. The discussion will be based on recent advances in computed tomography (CT) and magnetic resonance (MR) technology and the introduction of positron emission tomography (PET) imaging.The main developments of CT in the chest have been the introduction of high-resolution CT (HRCT), spiral CT and, more recently, multislice CT.HRCT is defined as thin-section CT (1-2-mm collimation scans) optimized by using a high spatialresolution (edge enhancing) algorithm. Several studies have shown that HRCT closely reflects the macroscopic (gross) pathological findings. HRCT presently has the best sensitivity and specificity of any imaging method for the assessment of focal and diffuse lung diseases. Spiral (helical) CT provides continuous scanning while the patient is being moved continuously through the CT gantry. It allows true volumetric scanning of the entire lung during a single breath hold and has replaced the slice-by-slice acquisition of conventional CT. Spiral CT permits for reconstruction of images in any plane as well as three-dimensional (3D) display of structures. With the use of graphics based software programs, spiral CT allows depiction of the luminal surface of the airways with images that resemble those of bronchoscopy (CT bronchoscopy) or bronchography (CT bronchography). The combination of spiral CT with administration of intravenous contrast (CT angiography) allows visualizat...

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Section: Pulmonary Embolismmentioning

confidence: 99%

Section: Pulmonary Embolismmentioning

confidence: 99%

Section: Pulmonary Embolismmentioning

confidence: 99%

mentioning

confidence: 99%

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Advances in imaging

Müller¹

2001

European Respiratory Journal

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“…Acute pulmonary embolism (PE) is a major cause of sudden death worldwide and is often di cult to diagnose because of the variable clinical presentations, particularly in patients with pre-existing cardiopulmonary disease (1). Massive or high risk PE, de ned as PE resulting in hemodynamic instability, carries a high mortality rate, ranging from 30% for patients with cardiogenic shock to 70% for those that required cardiopulmonary resuscitation (CPR) (2).…”

Section: Introductionmentioning

confidence: 99%

Clinical course and outcome of patients with acute pulmonary embolism rescued by veno-arterial extracorporeal membrane oxygenation: a retrospective review of 21 cases

Chen

Yen

et al. 2020

Preprint

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Background Veno-arterial extracorporeal membrane oxygenation (ECMO) is increasingly being utilized in patients with massive pulmonary embolism (PE). However, the efficacy and the safety remain uncertain. This study aimed to investigate clinical courses and outcomes in ECMO-treated patients with acute PE. Methods Twenty-one patients with acute PE rescued by ECMO from January 2012 to December 2019 were retrospectively analysed. Clinical features, laboratory biomarkers, and imaging findings of these patients were reviewed, and the relationship with immediate outcome and clinical course was investigated. Results Sixteen patients (76.2%) experienced refractory circulatory collapse requiring cardiopulmonary resuscitation (CPR) or ECMO support within 2 hours after the onset of cardiogenic shock, and none could receive definitive reperfusion therapy before ECMO initiation. Before or during ECMO support, more than 90% of patients had imaging signs of right ventricular (RV) dysfunction. In normotension patients, the computed tomography (CT) value was a valuable predictor of rapid disease progression compared with cardiac troponin I level. Ultimately, in-hospital death occurred in 10 patients (47.6%) and 90% of them died of prolonged CPR-related brain death. Cardiac arrest was a significant predictor of poor prognosis (p = 0.001). Conclusions ECMO appears to be a safe and effective circulatory support in patients with massive PE. Close monitoring in intensive care unit is recommended in patients with RV dysfunction and aggressive use of ECMO may reduce the risk of sudden cardiac arrest and improve clinical outcome.

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Management der Lungenembolie

Schmidt

Schellong

2005

Internist

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Venous thromboembolism is often triggered by transient episodes of increased risk but may occur spontaneously in patients with permanently increased risk. Pulmonary embolism may cause impairment of respiratory and circulatory function which can vary in severity from silent to catastrophic. The diagnosis can be feasibly established by detecting vein thrombosis. If this approach fails, demonstration of pulmonary emboli by lung scans becomes necessary to establish the diagnosis. A D-dimer-test can select patients in whom imaging of pulmonary perfusion is required. Immediate therapeutic anticoagulation with heparins is mandatory in confirmed thromboembolism, and is followed by a vitamin K antagonist. In the initial work-up, patients also have to be evaluated for systemic thrombolytic therapy by hemodynamic parameters and echocardiography. In a triggered episode of venous thromboembolism, duration of anticoagulation is confined to several months while spontaneous or recurrent events require prolonged or indefinite treatment.

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Diagnostic strategies for suspected pulmonary embolism

Cited by 11 publications

References 77 publications

Advances in imaging

Advances in imaging

Clinical course and outcome of patients with acute pulmonary embolism rescued by veno-arterial extracorporeal membrane oxygenation: a retrospective review of 21 cases

Management der Lungenembolie

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