Resolution of Pulmonary Embolism on CT Pulmonary Angiography

Stein, Paul D.; Yaekoub, Abdo Y.; Matta, Fadi; Janjua, Muhammad; Patel, Rushi M.; Goodman, Lawrence R.; Groß, Martin; Denier, James E.

doi:10.2214/ajr.09.3410

Cited by 48 publications

(43 citation statements)

References 15 publications

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“…However, studies using CT have shown differing results. In a previous study, emboli resolved at a faster rate in the main and lobar pulmonary arteries than in the segmental branches [19]. In another study, clots resolved faster in the peripheral arteries than in the central pulmonary arteries [17].…”

Section: Discussionmentioning

confidence: 82%

Factors determining clot resolution in patients with acute pulmonary embolism

Choi

Cha

Shin

et al. 2016

Blood Coagulation &Amp; Fibrinolysis

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There are limited data on the rate of clot resolution after acute pulmonary embolism and risk factors for residual emboli. The aim of the present study was to investigate the rate of clot resolution over time and identify risk factors of residual emboli in pulmonary embolism patients. We retrospectively analyzed pulmonary embolism patients with follow-up computed tomography (CT) scans taken between day 3 and day 90. The patients were classified into three cohorts, depending on the time of CT scan: day 3-7, day 8-21, and day 22-90. Each cohort was regrouped into the residual embolus and complete resolution groups. The rate of complete resolution of pulmonary emboli was 24% at 3-7 days, 47% at 8-21 days, and 78% at 22-90 days. In a multivariate analysis, independent predictors in each cohort were lobar or larger pulmonary artery pulmonary embolism and a right ventricle/left ventricle diameter ratio within 1 week, lobar or larger pulmonary artery pulmonary embolism at 1-3 weeks, and central pulmonary embolism at 3 weeks to 3 months. The rate of venous thromboembolism (VTE) recurrence, frequency of an adverse outcome, and in-hospital mortality did not differ between the two groups in each cohort. Complete resolution of pulmonary emboli occurred in most pulmonary embolism patients. Regardless of the time interval, larger pulmonary artery involvement by pulmonary emboli was only independent predictor of residual emboli. The presence of residual emboli was not associated with an adverse outcome of pulmonary embolism and rate of VTE recurrence.

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Section: Discussionmentioning

confidence: 82%

Factors determining clot resolution in patients with acute pulmonary embolism

Choi

Cha

Shin

et al. 2016

Blood Coagulation &Amp; Fibrinolysis

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“…Another possible explanation for a normal D-dimer result in patients with delayed presentation may be the complete or almost complete resolution of the pulmonary embolus. Stein et al 13 and Aghayev et al 14 performed retrospective reviews of patients diagnosed with PE and had a follow-up CTPA. Stein et al 13 found that there was complete PE resolution within 2–7 days of initial imaging in 40% of patients and Aghayev et al 14 report complete PE resolution within 14 days in 57% of patients.…”

Section: Discussionmentioning

confidence: 99%

“…Stein et al 13 and Aghayev et al 14 performed retrospective reviews of patients diagnosed with PE and had a follow-up CTPA. Stein et al 13 found that there was complete PE resolution within 2–7 days of initial imaging in 40% of patients and Aghayev et al 14 report complete PE resolution within 14 days in 57% of patients. In all the time intervals studied, both studies found that decrease in clot burden and resolution was higher in the peripheral arterial emboli compared with central pulmonary artery emboli.…”

Section: Discussionmentioning

confidence: 99%

Misinterpreting risk and test results delays diagnosis in a patient with pulmonary embolism

Babak

Sriram

2014

BMJ Case Reports

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We report the case of a middle-aged man where a diagnosis of pulmonary embolism (PE) was delayed due to initial underestimation of risk and over-reliance on D-dimer testing. The patient presented with pleuritic chest pain after a 5 h domestic flight. The treating clinicians presumed that this duration of immobilisation was insufficient to cause a PE, D-dimer was not measured and the patient was discharged home. One week later, the patient re-presented due to persistence of chest pain. On this occasion, D-dimer was measured and it was normal, which was interpreted as excluding a PE. Subsequently, a CT pulmonary angiogram was performed, which demonstrated a subsegmental PE. This case highlights the importance of accurate assessment of PE-risk factors and following clinical guidelines, since a delayed diagnosis of PE is associated with increased mortality.

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“…IPCs in the main and lobar pulmonary arteries are reported to resolve more quickly than those in the segmental branches [23], whereas other results have shown that peripheral clots resolve faster than clots in the main and lobar arteries [24]; however, these differences may be due to the limited spatial resolution or wide reconstruction slice-thickness of CTPA. The presence of residual IPCs did not have an effect on right heart strain in this study.…”

Section: Figmentioning

confidence: 91%