Alternative diagnoses based on CT angiography of the chest in patients with suspected pulmonary thromboembolism.
Eleci Vaz Ferreira,Marcelo Basso Gazzana,Muriel Bossle Sarmento,P.A. Guazzelli,Mariana Costa Hoffmeister,Vinicius André Guerra,Renato Seligman,Marli Maria Knorst +7 more
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TLDR
Chest CTA is useful in cases of suspected PTE, because it can confirm the diagnosis and reveal findings consistent with an alternative diagnosis in a significant number of patients, according to this cross-sectional, retrospective study.Abstract:
Objective : To determine the prevalence of alternative diagnoses based on chest CT angiography (CTA) in patients with suspected pulmonary thromboembolism (PTE) who tested negative for PTE, as well as whether those alternative diagnoses had been considered prior to the CTA. Methods : This was a cross-sectional, retrospective study involving 191 adult patients undergoing CTA for suspected PTE between September of 2009 and May of 2012. Chest X-rays and CTAs were reviewed to determine whether the findings suggested an alternative diagnosis in the cases not diagnosed as PTE. Data on symptoms, risk factors, comorbidities, length of hospital stay, and mortality were collected. Results : On the basis of the CTA findings, PTE was diagnosed in 47 cases (24.6%). Among the 144 patients not diagnosed with PTE via CTA, the findings were abnormal in 120 (83.3%). Such findings were consistent with an alternative diagnosis that explained the symptoms in 75 patients (39.3%). Among those 75 cases, there were only 39 (20.4%) in which the same alterations had not been previously detected on chest X-rays. The most common alternative diagnosis, made solely on the basis of the CTA findings, was pneumonia (identified in 20 cases). Symptoms, risk factors, comorbidities, and the in-hospital mortality rate did not differ significantly between the patients with and without PTE. However, the median hospital stay was significantly longer in the patients with PTE than in those without (18.0 and 9.5 days, respectively; p = 0.001). Conclusions : Our results indicate that chest CTA is useful in cases of suspected PTE, because it can confirm the diagnosis and reveal findings consistent with an alternative diagnosis in a significant number of patients.read more
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Optimal Strategies for the Diagnosis of Acute Pulmonary Embolism: A Health Technology Assessment
A. Sinclair,K. Peprah,T. Quay,McInnis M,Lang E,Severn M,Sohail M. Mulla,L. Weeks,B. Tsoi,Herrington E,Manogaran M,S.E. Garland,Petropaganos A,Polisena J +13 more
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Estimation of right ventricular dysfunction by computed tomography pulmonary angiography: a valuable adjunct for evaluating the severity of acute pulmonary embolism.
Dong Jia,Xiaoming Zhou,Gang Hou +2 more
TL;DR: The logistic regression model analysis revealed that RVDaxial/LVDaxia ratio and interventricular septum deviation were correlated to right ventricular dysfunction with statistical significance, and the MPAD/AOD ratio is a potential adjunct to judge the severity of right Ventricular dysfunction in acute PE.
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Diagnosing pulmonary thromboembolism: Concerns and controversies
Jyotindu Debnath,Vivek Sharma +1 more
TL;DR: Concerns as well as controversies surrounding accurate diagnosis of Pulmonary thromboembolism as on date are discussed.
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Evaluating cardiopulmonary function following acute pulmonary embolism
Mads Dam Lyhne,Alison S. Witkin,Giridhar Dasegowda,Christopher Ray G. Tanayan,Mannudeep K. Kalra,David M. Dudzinski +5 more
TL;DR: This review provides clinicians with an overview of available contemporary imaging and physiologic modalities, their strengths and disadvantages, and how and when these investigations can support the clinical work-up of patients post-pulmonary embolism.
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Frequency of spontaneous detection of pulmonary arterial thrombi in unenhanced chest computed tomography in patients diagnosed with pulmonary embolism
Pedro Paulo Teixeira e Silva Torres1,Marcelo Fouad Rabahi2,Alexandre Dias Mançano3,Silvia Helena Rabelo dos Santos2,Edson Marchiori4 +4 more
References
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Guidelines on the Diagnosis and Management of Acute Pulmonary Embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC)
Adam Torbicki,Arnaud Perrier,Stavros Konstantinides,Giancarlo Agnelli,Nazzareno Galiè,Piotr Pruszczyk,Frank M. Bengel,Adrian J B Brady,Daniel Ferreira,Uwe Janssens,Walter Klepetko,Eckhard Mayer,Martine Remy-Jardin,Jean-Pierre Bassand,Alec Vahanian,John Camm,Raffaele De Caterina,Veronica Dean,Kenneth Dickstein,Gerasimos Filippatos,Christian Funck-Brentano,Irene Hellemans,Steen Dalby Kristensen,Keith McGregor,Udo Sechtem,Sigmund Silber,Michal Tendera,Petr Widimsky,José Luis Zamorano,José Luis Zamorano,Felicita Andreotti,Michael Ascherman,George Athanassopoulos,Johan De Sutter,David Fitzmaurice,Tamás Forster,Magda Heras,Guillaume Jondeau,Keld Kjeldsen,Juhani Knuuti,Irene Lang,Mattie J. Lenzen,Jose Lopez-Sendon,Petros Nihoyannopoulos,Leopoldo Pérez de Isla,Udo Schwehr,Lucia Torraca,Jean-Luc Vachiery +47 more
TL;DR: Non-thrombotic PE does not represent a distinct clinical syndrome but may be due to a variety of embolic materials and result in a wide spectrum of clinical presentations, making the diagnosis difficult.
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Acute pulmonary embolism: clinical outcomes in the international cooperative pulmonary embolism registry (ICOPER)
TL;DR: Data from ICOPER provide rates and highlight adverse prognostic categories that will help in planning of future trials of high-risk PE patients and highlight significant prognostic factors associated with death.
Journal ArticleDOI
2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism
Stavros Konstantinides,Adam Torbicki,David Fitzmaurice,Simón J,R. Gibbs,Menno V. Huisman,Marc Humbert,John Lekakis,Nicolas Meneveau,Lars Hvilsted Rasmussen,Thomas H. Schindler,Anton Vonk Noordegraaf,José Luis Zamorano,Maurizio Zompatori +13 more
TL;DR: Guidelines summarize and evaluate all available evidence at the time of the writing process, on a particular issue with the aim of assisting health professionals in selecting the best management strategies for an individual patient, with a given condition, taking into account the impact on outcome.
Journal ArticleDOI
Multidetector Computed Tomography for Acute Pulmonary Embolism
Paul D. Stein,Sarah E. Fowler,Lawrence R. Goodman,Alexander Gottschalk,Charles A. Hales,Russell D. Hull,Kenneth V. Leeper,John Popovich,Deborah A. Quinn,Thomas A. Sos,H. Dirk Sostman,Victor F. Tapson,Thomas W. Wakefield,John G. Weg,Pamela K. Woodard +14 more
TL;DR: In patients with suspected pulmonary embolism, multidetector CTA-CTV has a higher diagnostic sensitivity than does CTA alone, with similar specificity, and additional testing is necessary when the clinical probability is inconsistent with the imaging results.
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Venous thromboembolism (VTE) in Europe - The number of VTE events and associated morbidity and mortality
Alexander T. Cohen,Giancarlo Agnelli,Frederick A. Anderson,Juan I. Arcelus,David Bergqvist,Josef G. Brecht,Ian A. Greer,John A. Heit,Julia L. Hutchinson,Ajay K. Kakkar,Dominique Mottier,Emmanuel Oger,Meyer Michel Samama,Michael Spannagl +13 more
TL;DR: The estimated total number of symptomatic VTE events (range based on probabilistic sensitivity analysis) per annum within the six EU countries was 465,715; almost three-quarters of all VTE-related deaths were from hospital-acquired VTE.