CT pulmonary angiography: increasingly diagnosing less severe pulmonary emboli.

Background: It is unknown whether the observed increase in computed tomography pulmonary angiography (CTPA) utilization has resulted in increased detection of pulmonary emboli (PEs) with a less severe disease spectrum.

Methods: Trends in utilization, diagnostic yield, and disease severity were evaluated for 4,048 consecutive initial CTPAs performed in adult patients in the emergency department of a large urban academic medical center between 1/1/2004 and 10/31/2009. Transthoracic echocardiography (TTE) findings and peak serum troponin levels were evaluated to assess for the presence of PE-associated right ventricular (RV) abnormalities (dysfunction or dilatation) and myocardial injury, respectively.

An evaluation of the feasibility of assessment of volume perfusion for the whole lung by 128-slice spiral CT.

Background: Lung perfusion based on dynamic scanning cannot provide a quantitative assessment of the whole lung because of the limited coverage of the current computed tomography (CT) detector designs.

Purpose: To evaluate the feasibility of dynamic volume perfusion CT (VPCT) of the whole lung using a 128-slice CT for the quantitative assessment and visualization of pulmonary perfusion.

Material And Methods: Imaging was performed in a control group of 17 subjects who had no signs of disturbance of pulmonary function or diffuse lung disease, and 15 patients (five patients with acute pulmonary embolism and 10 with emphysema) who constituted the abnormal lung group.

Clinical features in patients with pulmonary embolism at a community hospital: analysis of 4 years of data.

The aim of this study is to assess the various clinical features, risk factors, and electrocardiographic (EKG) findings associated with acute pulmonary embolism (PE). Knowledge gained from the study may enable health care providers in diagnosis of PE, thus allowing them to carry out appropriate diagnostic testing and treatment after recognition of this potentially lethal disease. PE is common but frequently under-diagnosed clinical problem, associated with potentially fatal outcomes.

Prognostic significance of multidetector CT in normotensive patients with pulmonary embolism: results of the protect study.

Background: In patients with acute pulmonary embolism (PE), rapid and accurate risk assessment is paramount in selecting the appropriate treatment strategy. The prognostic value of right ventricular dysfunction (RVD) assessed by multidetector CT (MDCT) in normotensive patients with PE has lacked adequate validation.

Methods: The study defined MDCT-assessed RVD as a ratio of the RV to the left ventricle short axis diameter greater than 0.

Occurrence of pulmonary embolism among 260 in-patients of acute geriatric department aged 65+ years in 2005-2010.

Unlabelled: Pulmonary embolism (PE) is after myocardial infarction and cerebrovascular events the third most frequent cardiovascular cause of death. Simultaneously it belongs to at least often correctly diagnosed cardiovascular diseases.

The Aim Of The Study: The retrospective analysis of the database of inpatients with the target assess the clinical course of PE according to prevalence, mortality, average duration of stay, risk factors, used diagnostic methods and kinds of therapy.

One-shot diagnostic and prognostic assessment in intermediate- to high-risk acute pulmonary embolism: the role of multidetector computed tomography.

Introduction: Contrast-enhanced multidetector computed tomography (MDCT) is useful for the diagnosis of pulmonary embolism (PE). However, current guidelines do not support its use for risk assessment in acute PE patients.

Objectives: We compared the prognostic impact of MDCT-derived indices regarding medium-term mortality in a population of intermediate- to high-risk PE patients, mostly treated by thrombolysis.

Mimics of acute coronary syndrome on MDCT.

Acute coronary syndrome (ACS) encompasses a spectrum of unstable coronary artery disease ranging from transmural myocardial infarction to unstable angina. The immediate management of these patients is dictated by the presence/absence of ST segment changes on electrocardiogram. More and more patients with non-ST elevation ACS are bypassing traditional diagnostic pathways to undergo urgent coronary catheter angiography.

The influence of acute pulmonary embolism on early and delayed prognosis for patients with chronic heart failure.

Background: Patients with acute pulmonary embolism (APE) with concomitant chronic heart failure (CHF) are characterized by higher mortality rates than APE patients without CHF. The aim of this study is to evaluate the potential impact of APE on early and long-term prognosis in patients with CHF.

Methods: This study included 87 patients with CHF with suspected APE.

CT pulmonary angiography in elderly patients: outcomes in patients aged >85 years.

Aim: To assess the quality, safety, and outcomes following computed tomography pulmonary angiography (CTPA) performed in elderly patients.

Materials And Methods: CTPA examinations were performed in 140 patients aged >85 years in three UK acute National Health Service (NHS) hospitals. Images were assessed for quality, pulmonary emboli, and other disease entities.

Acute and chronic pulmonary embolism: an in-depth review for radiologists through the use of frequently asked questions.

In this article, the authors review the role of the different imaging modalities in the diagnostic workup of patients with suspected acute or chronic pulmonary embolism (PE). The authors also discuss the current guidelines for the diagnosis of acute PE based on the pretest probability clinical assessment and outline the current recommendations for special patient populations. The recent guidelines from the American Thoracic Society/Society of Thoracic Radiology for the assessment of suspected PE in pregnancy are also reviewed.

Prognostic value of computed tomographic pulmonary angiography and the pulmonary embolism severity index in patients with acute pulmonary embolism.

Pulmonary embolism is a serious and potentially fatal disorder. Pulmonary embolism risk stratification may allow early hospital discharge and outpatient treatment for low-risk patients. Also, it may prevent death by early medical intervention in high-risk groups.

Long-term prognostic value of residual pulmonary vascular obstruction at discharge in patients with intermediate- to high-risk pulmonary embolism.

Background: We evaluated prognostic value at 6 months of residual pulmonary vascular obstruction (RPVO) measured before discharge in patients with intermediate- or high-risk pulmonary embolism (PE).

Methods And Results: Prospective registry including 416 consecutive patients with intermediate- or high-risk PE who survived the acute phase. Patients with previous cardiopulmonary disease were excluded.

Relationship between cardiac troponin-T and right ventricular Tei index in patients with hemodynamically stable pulmonary embolism: an observational study.

Objective: The role of increased troponin level in risk stratification of acute pulmonary embolism (PE) is well documented. However, relation between right ventricular (RV) myocardial performance (Tei) index and cardiac troponin-T (cTn-T) has not been well investigated. The purpose of this observational prospective study was to assess the relationship between the RV Tei index and cTn-T in patients with acute normotensive PE.

Diagnosis of pulmonary embolism: Advances and pitfalls.

The signs and symptoms of patients with pulmonary embolism (PE) form a wide spectrum and considerably overlap with other cardiopulmonary diseases. Timely recognizing of this disease therefore remains challenging, but is of vital importance to avoid PE-related morbidity and mortality. To aid and standardize the initial diagnostic approach of patients with suspected PE, clinical probability rules have been developed and simplified for use in clinical practice.

Neutrophil gelatinase-associated lipocalin, cystatin C and eGFR indicate acute kidney injury and predict prognosis of patients with acute pulmonary embolism.

Objective: Risk stratification in acute pulmonary embolism (APE) includes the assessment of clinical status, right ventricular dysfunction and troponin concentrations. Since acute renal impairment is one of the important predictors of mortality in cardiovascular diseases, the authors hypothesised that it is an independent mortality marker in APE.

Material And Methods: The authors observed 142 consecutive patients (52 M/90 F, 64±18 years) with APE diagnosed with contrast enhanced multislice CT.

Comparison of helical and axial mode indirect computed tomographic venography in patients with pulmonary thromboembolism.

Objective: To compare the helical and axial modes of indirect computed tomographic (CT) venography (CTV) for accuracy for diagnosing deep venous thrombosis (DVT) of the lower extremities as well as for their radiation burden in patients proven to have pulmonary thromboembolism (PTE) on CT pulmonary angiography (CTPA).

Subjects And Methods: Of patients evaluated with CTPA for suspected acute PE, 20 of patients who were found to have PTE underwent both indirect CTV of the lower extremities and color Doppler examination. For indirect CTV, patients were randomly assigned to helical and axial modes.

Multidetector CT scan for acute pulmonary embolism: embolic burden and clinical outcome.

Background: In patients with acute pulmonary embolism (PE), the correlation between the embolic burden assessed by multidetector CT (MDCT) scan and clinical outcomes remains unclear. Patients with symptomatic acute PE diagnosed based on MDCT angiography were included in a multicenter study aimed at assessing the prognostic role of the embolic burden evaluated with MDCT scan.

Methods: Embolic burden was assessed as (1) localization of the emboli as central (saddle or at least one main pulmonary artery), lobar, or distal (segmental or subsegmental arteries) and (2) the obstruction index by the scoring system of Qanadli.

Venous thrombosis in emergency department: diagnosis, treatment, and disposition.

Aim: The Authors describe diagnosis, treatment and therapy of deep venous thrombosis in Emergency Department following the last guidelines indications.

Discussion: Deep venous thrombosis of the legs, ranges from asymptomatic, incidentally discovered emboli to massive embolism causing immediate death. Chronic sequelae of venous thromboembolism (deep venous thrombosis and pulmonary embolism) include the post-thrombotic syndrome and chronic thromboembolic pulmonary hypertension.

Helical computerized tomography and NT-proBNP for screening of right ventricular overload on admission and at long term follow-up of acute pulmonary embolism.

Background: Right ventricular dysfunction (RVD) in acute pulmonary embolism (APE) can be assessed with helical computerized tomography (CT) and transthoracic echocardiography (TTE). Signs of RVD and elevated natriuretic peptides like NT-proBNP and cardiac troponin (TnT) are associated with increased risk of mortality. However, the prognostic role of both initial diagnostic strategy and the use of NT-proBNP and TnT for screening for long-term probability of RVD remains unknown.

Diagnostic accuracy of magnetic resonance imaging for an acute pulmonary embolism: results of the 'IRM-EP' study.

Background: Magnetic resonance imaging (MRI) has not been validated as an alternative diagnostic test to computed tomography angiography (CTA) in patients with suspicion of a pulmonary embolism (PE).

Objectives: To evaluate performance of current MRI technology in diagnosing PE, in reference to a 64-detector CTA.

Patients/methods:   Prospective investigation including 300 patients with a suspected PE, referred for CTA after assessment of clinical probability and D-dimer testing.

CT detection of pulmonary embolism and aortic dissection.

Triage of patients with acute, potentially life-threatening chest pain is one of the most daunting challenges currently facing emergency department physicians. Acute aortic syndrome and pulmonary embolism are two potentially underlying causes. For both, computed tomography has become the de facto clinical reference standard for diagnosis.

Association of deep vein thrombosis type with clinical phenotype of chronic thromboembolic pulmonary hypertension.

Background: Chronic thromboembolic pulmonary hypertension (CTEPH) has been considered to be caused by single or recurrent pulmonary embolism (PE) arising from deep vein thrombosis (DVT). In Japan, female predominance and association of HLA-B*5201 with CTEPH unrelated to DVT were reported. In acute PE residual proximal DVT is associated with larger obstruction of pulmonary arteries.

Venous lower-limb evaluation in patients with acute pulmonary embolism.

Objectives: Compressive ultrasonography (CUS) of the lower limbs is the first choice for identifying deep venous thrombosis (DVT) in patients with symptomatic pulmonary embolism (PE). The aim of this study was to uncover clinical characteristics and CUS findings in patients with proven PE and their correlations with PE extent.

Methods: A total of 524 consecutive cases of proven symptomatic PE diagnosed between January 1996 and December 2006 were reviewed.