Prevalence and Significance of Nonthromboembolic Findings on Chest Computed Tomography Angiography Performed to Rule Out Pulmonary Embolism: A Multicenter Study of 1,025 Emergency Department Patients

Abstract

In ED patients with suspected PE, the CT angiogram frequently provides evidence suggesting an important alternative diagnosis to PE. Pulmonary infiltrate suggesting pneumonia was the most common non-PE finding.

Variation in the utilization and positivity rates of CT pulmonary angiography among emergency physicians at a tertiary academic emergency department

“…Our cohort's alternative diagnosis rate was 32.9 %, at the lower end of previously reported range of 33-52 % [10,16,19,20,30]. Similar to the previous studies, the majority of non-thrombotic pathology in our patient population was infection, nodule, and pleural effusion [10,19,30]. For all studies to date, the likelihood of alternative findings on CTPA was much higher than that of PE.…”

“…3 a Pie chart showing the divisions of chest radiograph results ("Not done", "Normal", "Incongruent diagnosis", and "Same diagnosis") in the 266 patients whose CTPA scans showed alterative findings. b Pie chart showing the divisions of diagnosis in the chest radiographs that reported the same diagnosis as CTPA ("Infection", "Pulmonary Edema", "Effusion", and "Tumour") symptoms, which has been used to justify its high utilization rate [16,19,29]. Our cohort's alternative diagnosis rate was 32.9 %, at the lower end of previously reported range of 33-52 % [10,16,19,20,30].…”

“…b Pie chart showing the divisions of diagnosis in the chest radiographs that reported the same diagnosis as CTPA ("Infection", "Pulmonary Edema", "Effusion", and "Tumour") symptoms, which has been used to justify its high utilization rate [16,19,29]. Our cohort's alternative diagnosis rate was 32.9 %, at the lower end of previously reported range of 33-52 % [10,16,19,20,30]. Similar to the previous studies, the majority of non-thrombotic pathology in our patient population was infection, nodule, and pleural effusion [10,19,30].…”

Comprehensive evaluation of CT pulmonary angiography for patients suspected of having pulmonary embolism

“…The reported frequency of detecting alternative diagnosis by using CTPA in the emergency department is 25.4% [2]. These alternative diagnoses include life-threatening conditions such as pneumonia, aortic diseases, heart failure and undiagnosed malignancy [2,3]. Several previous articles mention the incidental findings of CTPA, but they focus only on vascular anomalies and cardiac diseases [4,5].…”

“…CT pulmonary angiography (CTPA) has become the most important diagnostic imaging modality for pulmonary embolism in recent years [1]. However, due to overlapping of the symptoms between pulmonary embolism and many other cardiopulmonary diseases, finding or excluding alternative diagnoses is vital in clinical practice [2][3][4][5]. The reported frequency of detecting alternative diagnosis by using CTPA in the emergency department is 25.4% [2].…”