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At least 163 records · Page 9Linked to original sources
PubMed2004

Bronchial artery dilatation on MDCT scans of patients with acute pulmonary embolism: comparison with chronic or recurrent pulmonary embolism.

OBJECTIVE: The purpose of our study was to compare the bronchial arteries of patients with acute pulmonary embolism with those of patients with chronic or recurrent pulmonary embolism. MATERIALS AND METHODS: Twenty-seven patients with acute pulmonary embolism and 14 patients with chronic or recurrent pulmonary embolism were retrospectively identified from 700 consecutive patients with suspected pulmonary embolism. The case data for the patients were assessed by two thoracic radiologists whose final judgments were reached by consensus. On the MDCT pulmonary angiograms obtained in these patients, the bronchial arteries were assessed by finding enhancing, small, round or curvilinear structures within the mediastinum and tracing their paths along the bilateral main bronchi. Bronchial arteries with a diameter greater than 1.5 mm were considered to be dilated. RESULTS: The diameters of the bronchial arteries in the group with chronic or recurrent pulmonary embolism were significantly larger than diameters of the bronchial arteries in the group with acute pulmonary embolism (p = 0.0002). Dilatation of bronchial arteries was observed in two of the 27 patients with acute pulmonary embolism and in seven of 14 patients with chronic or recurrent pulmonary embolism. This difference was statistically significant (p = 0.004). No dilated bronchial arteries were seen in patients who had acute pulmonary embolism but had no a history of deep venous thrombosis. CONCLUSION: Acute pulmonary embolism did not appear to cause dilatation of bronchial arteries, whereas chronic or recurrent pulmonary embolism was frequently associated with dilated bronchial arteries. In patients in whom the distinction between acute and chronic or recurrent pulmonary embolism on MDCT pulmonary angiography is clinically unclear and in whom the bronchial arteries are dilated, a diagnosis of chronic or recurrent pulmonary embolism should be favored.

Acute Disease↗
PubMed1998

Acute Pulmonary Embolism Presenting as Pulmonary Hemorrhage/Infarction Syndrome in the Elderly.

PURPOSE: The purpose of this investigation was to determine the characteristics of the history, physical examination, chest radiograph, electrocardiogram, and the ventilation/perfusion lung scan probability in elderly patients with pulmonary embolism who present with the syndrome of pulmonary infarction or hemorrhage. BACKGROUND: In considering a possible diagnosis of acute pulmonary embolism, it is helpful to focus on the characteristics of the patient in terms of the characteristics of the presenting syndrome. The syndrome of pulmonary hemorrhage or pulmonary infarction is the most common syndrome of acute pulmonary embolism. It is defined by the presence of pleuritic pain or hemoptysis. Whether there are features of the pulmonary hemorrhage/infarction syndrome that are specific to elderly patients, or would suggest or tend to exclude a diagnosis is unknown. Therefore, this investigation was undertaken. METHODS: Patients reported in this investigation participated in the national collaborative trial of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED). All had pulmonary embolism diagnosed by pulmonary angiography. Patients with associated cardiac pulmonary disease were excluded. Elderly patients (N equals 17) were defined as patients at or above 70 years of age. Comparisons were made with patients age 40-69 years (N equals 67) and with patients under 40 years of age (N equals 35). RESULTS: In elderly patients, malignancy was a frequent predisposing factor (29%) in addition to immobilization (76%). Dyspnea or tachypnea, in addition to pleuritic pain or hemoptysis, were present in 94% of elderly patients. Among elderly patients with the pulmonary hemorrhage/infarction syndrome, pleuritic pain was more frequent than hemoptysis (88% vs. 12%). The electrocardiogram was normal in 62% of elderly patients. If abnormal, the most frequent abnormalities were nonspecific ST segment or T-wave changes (38%). The chest radiograph showed atelectasis or a pulmonary parenchymal abnormality in 82% of elderly patients. The central pulmonary artery dilated in 29% of elderly patients. A normal chest radiograph was uncommon, occurring in only 6%. The ventilation/perfusion lung scan was useful and was interpreted as high probability for pulmonary embolism in 41% of elderly patients. Elderly patients had a higher pulmonary artery mean pressure (25 Â+/-9 vs. 17 Â+/-7 mm Hg) and lower partial pressure of oxygen in arterial blood (64 Â+/-10 vs. 81 Â+/-14 mm Hg) than patients less than 40 years, and elderly patients tended to have more mismatched segmental perfusion defects on the ventilation/perfusion lung than patients less than 40 years (4.8 Â+/-5.5 vs. 2.1 Â+/-2.9 mismatched perfusion defects). CONCLUSIONS: Although a few clinical features of the pulmonary hemorrhage/infarction syndrome of pulmonary embolism in elderly patients differ from patients less than 40 years of age, in general, the clinical characteristics are comparable to younger patients.

Journal Article↗
PubMed2006

Outpatient diagnosis of pulmonary embolism: the MIOPED (Manchester Investigation Of Pulmonary Embolism Diagnosis) study.

BACKGROUND AND OBJECTIVES: Pleuritic chest pain, a symptom of pulmonary embolism, is a common presenting symptom in the emergency department. The aim of this study was to validate an algorithm for the diagnosis of pulmonary embolism in emergency department patients with pleuritic chest pain. METHODS: This was a prospective, diagnostic cohort study conducted in a large UK city centre emergency department. A total of 425 patients with pleuritic chest pain presenting to the emergency department between February 2002 and June 2003 were recruited. Patients scoring a low modified Wells clinical probability of pulmonary embolism, who had a normal latex agglutination D-dimer, were discharged. All others followed a diagnostic imaging protocol to exclude and diagnose pulmonary embolism using PIOPED interpreted ventilation-perfusion scanning, CT pulmonary angiography, and digital subtraction pulmonary angiography. All patients were followed up for three months for evidence of pulmonary embolism or deep vein thrombosis. An independent adjudication committee reviewed all deaths. RESULTS: A total of 408 patients completed the diagnostic algorithm; 86.5% (353/408) were investigated as outpatients, 5.4% (22/408) were diagnosed as having pulmonary embolism, and 98.8% (403/408) were followed up for three months. Of the 381 patients without pulmonary embolism who completed follow up, the incidence of thromboembolic disease was 0.8% (95% CI 0.3% to 2.3%): two patients had pulmonary embolism and one had a deep vein thrombosis. CONCLUSIONS: The MIOPED (Manchester Investigation Of Pulmonary Embolism Diagnosis) diagnostic protocol can safely exclude pulmonary embolism in outpatients with pleuritic chest pain.

Adult↗
PubMed2000

Availability of diagnostic facilities in the Netherlands for patients with suspected pulmonary embolism. ANTELOPE Study Group. Advances in New Technologies Evaluating the Localisation of Pulmonary Embolism.

Pulmonary embolism remains a complex diagnostic problem. Although accurate and cost-effective, the 'Dutch consensus' strategy is not widely applied. We assessed the availability and investment plans of the different facilities used in this strategy. Furthermore, the current and future availability of new diagnostic modalities was investigated. A questionnaire was sent to all Dutch hospitals. The questionnaire contained separate sections with questions for the hospital management and the medical practitioners at the departments of radiology, nuclear medicine, internal medicine and pulmonology. Five hundred and eighty-four questionnaires were sent out (response rate 68%). Forty-three percent of the hospitals had no nuclear medicine facility, 11% had no pulmonary angiography facility, and 59% had no spiral CT scan (SCTA). Forty-six percent of the responding hospitals had a nuclear medicine facility; and 5% used Technegas for ventilation studies. Strategies with SCTA were available in about 27% of the hospitals. Due to future investments this number will increase to approximately 55%. Strategies with Technegas were available in 2.4% of the hospitals, this number might increase to 25% if Technegas is proven accurate. The 'Dutch consensus' strategy is available in two-thirds of the hospitals. All other strategies were less feasible. Several equivalent strategies for diagnosing pulmonary embolism should be developed. These strategies should be accurate, widely available and accepted.

Algorithms↗