scholarly journals Pulmonary embolism during the COVID-19 pandemic

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
BV Silva ◽  
T Rodrigues ◽  
N Cunha ◽  
J Brito ◽  
P Alves Da Silva ◽  
...  
Keyword(s):  
Physical Activity ◽  
Pulmonary Embolism ◽  
Hospital Admissions ◽  
Reference Group ◽  
Group Versus ◽  
Pulmonary Angiography ◽  
Reference Period ◽  
Funding Sources ◽  
Clinical Probability

Abstract Funding Acknowledgements Type of funding sources: None. Background During the COVID-19 pandemic many countries have imposed lockdown restrictions to movement. Since the 18th of March in Portugal, thousands of people have been confined to their homes. While hospital admissions for COVID-19 patients increased exponentially, admissions for non-COVID-19 patients decreased dramatically. However, it remains unclear whether lockdown-related immobility can contribute to the increased incidence of pulmonary embolism. Purpose To compare the incidence of pulmonary embolism (PE) during the lockdown period (Abril 1 to May 31, 2020) compared to the reference period in 2019. Methods Retrospective study of consecutive outpatients who presented to the emergency department and underwent computed tomography pulmonary angiography (CTPA) due to suspicion of PE. Results Compared to the same period of 2019, the lockdown period was associated with a significant increase in PE diagnosis (29 versus 18 patients). PE patients during lockdown were older (median age 71 years; interquartile range [IQR][60-85] versus 59 years [44-76]; p = 0.046) and have lower prevalence of active cancer (14% versus 33% in the reference period). Women represent 55% (n = 16) of patients in lockdown group (versus 50% in 2019 group). Clinical probability (GENEVA score) was similar in both groups (median score 2.72 in lockdown group and 2.50 in reference group, p = 0.452). None of the patients with PE was diagnosed with COVID-19. Conclusion We have observed a marked increase (62%) in PE diagnosis during lockdown period compared to the reference period, which can be explained by the reduction in physical activity due to teleworking and closure of gyms and sports activities. These data reinforce the importance of promoting physical activity programs at home. The role of pharmacological or mechanical thromboprophylaxis in this scenario remains unclear.

scholarly journals A comparative analysis of the diagnostic performances of four clinical probability models to rule out pulmonary embolism

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
BV Silva ◽  
C Mendonca ◽  
P Silverio Antonio ◽  
A Ferreira ◽  
N Cunha ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Angiography ◽  
Probability Models ◽  
Vein Thrombosis ◽  
Funding Sources ◽  
Clinical Probability ◽  
Low Probability ◽  
Deep Vein ◽  
Rule Out ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Background  Ruling out pulmonary embolism (PE) through a combination of clinical assessment and Ddimer is crucial to avoid excessive computed tomography pulmonary angiography (CTPA), and different algorithms should be considered as an alternative to the fixed cutoff to achieve that goal. Purpose  To compare diagnostic performance of 4 algorithms to rule out PE: fixed Ddimer cutoff, age-adjusted, YEARS and PEGeD. Methods  Retrospective study of consecutive outpatients who presented to the emergency department and underwent CTPA for PE suspicion from April 2019 to May 2020. In fixed and age-adjusted cut-off, high probability patients are directly selected for CTPA. Low to moderate probability patients perform CTPA if Ddimer ≥500µg/L in fixed cutoff, and in age-adjusted cutoff if Ddimer ≥500µg/L in patients who are ≤ 50 years of age, and if Ddimer level was more than 10 times the patient’s age in patients older than 50 years. YEARS includes 3 items (signs of deep vein thrombosis, haemoptysis and whether PE is the most likely diagnosis): patients without any YEARS items and Ddimer ≥1000ng/mL or with ≥1 items and Ddimer 500ng/mL perform CTPA. In the PEGeD, patients with high clinical probability or with intermediate and Ddimers >500µg/L or low probability and Ddimer >1000 µg/L are selected for CTPA. Results We enrolled 571 patients and PE was confirmed by CTPA in 172. Compared with a fixed Ddimer cutoff, age-adjusted was associated with a significant increase of specificity (p < 0.001), correctly avoiding 38 CTPAs, without losing sensitivity. YEARS and PEGED resulted in a increase in specificity, compared to the fixed cutoff, but with an impairment of sensitivity (p < 0.001). PEGeD had the worst sensitivity (13 more false negatives (FN) than the fixed cutoff). Despite the lack of difference between PEGed and YEARS strategies regarding sensitivity, PEGED had a significantly higher specificity (p < 0.001) and allowed to correctly avoid a higher number of CTPA (95 vs 85), compared to the fixed cutoff. Conclusion  Compared to fixed d-dimer cutoff, all algorithms were associated with an increased specificity. Age-adjusted cutoff was the only that is not associated with a significant decrease in sensitivity when compared to fixed cutoff, allowing to safely reduce the need to perform CTPA. Sen(%)Spec(%)Correctly avoid CTPAs(n)FN(n)Fixed cutoff251017Age-adjusted933513912YEARS894718619PEGED884919620

scholarly journals CECT in Pulmonary Thrombolism

2021 ◽  
pp. 284-293
Author(s):  
Shaha Pramod ◽  
Ragi Skanda ◽  
Bhoite Amol ◽  
Tamboli Asif ◽  
Gautama Amol
Keyword(s):  
Pulmonary Embolism ◽  
Public Health Problem ◽  
Pulmonary Angiography ◽  
High Morbidity ◽  
Major Public Health Problem ◽  
Medical Sciences ◽  
Non Invasive ◽  
Highly Sensitive ◽  
Associated Conditions

Introduction: Pulmonary embolism (PE) is the third most common acute heart disease after myocardial infarction and stroke and is a major public health problem. PE is a disease that has high morbidity and mortality, yet it is challenging to obtain a diagnosis. Objective: The study aims to assess the role of MDCT-PA in the diagnosis of pulmonary embolism, and it's associated conditions in suspected cases of pulmonary embolism. Materials and Methods: The study was conducted in the department of radiology in KRISHNA INSTITUTE OF MEDICAL SCIENCES DEEMED TO BE UNIVERSITY situated in KARAD equipped with a 16 slice MDCT scanner (EMOTION) manufactured by Siemens. Results: Through the study period of one and half year and have met the inclusion criteria, a total of 90 consecutive patients who presented with suspicion of PE were referred for MDCT-PA in the department of radio-diagnosis, Krishna Hospital, Karad. A review of all the cases was done, and the results were presented in the form of tables. Conclusion: Multidetector computed tomography pulmonary angiography can be used to confidently diagnose pulmonary embolism in which it is not contraindicated. MDCT-PA is the investigation of choice because it is a rapid, non-invasive study, highly sensitive and specific.

scholarly journals CORRELATION OF D-DIMER LEVEL WITH THE PRESENCE AND SEVERITY OF PULMONARY EMBOLISM ON COMPUTED TOMOGRAPHY PULMONARY ANGIOGRAPHY

2020 ◽  
pp. 33-34
Author(s):  
Mantavya Patel ◽  
Sanjay Paliwal ◽  
Rachit Saxena
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Early Diagnosis ◽  
Pulmonary Angiography ◽  
Clinical Suspicion ◽  
Early Prediction ◽  
Computed Tomography Pulmonary Angiography ◽  
Negative Prediction ◽  
D Dimer

Introduction: Early diagnosis of pulmonary embolism can reduce morbidity and motility. D-dimer is well known parameter having high negative prediction value. This study focused on role of D-dimer in early prediction of presence and severity of pulmonary embolism. Material and Methods: Thirty patients with clinical suspicion of pulmonary embolism along with high D-dimer value were included in this study. All selected patients underwent computed tomography pulmonary angiography assessment. D-dimer value was correlated with presence and proximity of pulmonary embolism. Results: Out of thirty selected patients 50% had pulmonary embolism on computed tomography pulmonary angiography assessment. D-dimer value correlated well with presence and proximity of pulmonary embolism. Conclusion: D-dimer value more than 4000 ng/ml had high positive prediction value (79%) in suspected clinical cases. Value more than 8000 ng/ml further improve value to nearly 100% in suspected cases.

scholarly journals Influence of specific alternative diagnoses on the probability of pulmonary embolism

2006 ◽  
Vol 95 (06) ◽  
pp. 958-962 ◽  
Author(s):  
Ariane Testuz ◽  
Grégoire Le Gal ◽  
Marc Righini ◽  
Henri Bounameaux ◽  
Arnaud Perrier
Keyword(s):  
Pulmonary Embolism ◽  
Reference Group ◽  
Diagnostic Testing ◽  
Diagnostic Category ◽  
Prediction Rule ◽  
Important Variable ◽  
Alternative Diagnosis ◽  
Clinical Probability ◽  
Medical Centers ◽  
Specific Alternative

SummaryThe presence and likelihood of an alternative diagnosis to pulmonary embolism is an important variable of the Wells’ prediction rule for establishing clinical probability. We assessed whether evoking specific alternative diagnoses would reduce the probability of pulmonary embolism enough to forego further testing. We retrospectively studieda cohort of 965 consecutive patients admitted for suspicion of pulmonary embolism at three medical centers in Europe in whom the presence of an alternative diagnosis at least as likely as pulmonary embolism was recorded before diagnostic testing. We divided the patients into 15 categories of alternative diagnoses evoked. We then assessed the prevalence of pulmonary embolism in each diagnostic category and compared it to the prevalence of pulmonary embolism ina reference group (patients with no alternative diagnosis or a diagnosis less likely than pulmonary embolism). The prevalence of pulmonary embolism in the reference group was 48%. The presence of an alternative diagnosis as or more likely strongly reduced the probability of pulmonary embolism (OR 0.15, 95% CI: 0.1–0.2, p<0.01). In almost every diagnostic category, the prevalence of pulmonary embolism was much lower than in the reference group whith an odds ratio below or near 0. 2. Bronchopneumonia (OR 0.4, 95% CI 0.2 to 0.7) and cancer (OR 0.6, 95% CI 0. 3 to 1.5) reduced the likelihood of pulmonary embolism toa lower extent. Evoking an alternative diagnosis at least as likely as pulmonary embolism reduces the probability of the disease, but this effect is never large enough to allow ruling it out without further testing, especially when bronchopneumonia or cancer are the alternative diagnoses considered.

Diagnosis of acute pulmonary embolism and evolving imaging modalities

ESC CardioMed ◽  
2018 ◽  
pp. 2761-2766
Author(s):  
Helia Robert-Ebadi ◽  
Grégoire Le Gal ◽  
Marc Righini
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Angiography ◽  
Thoracic Imaging ◽  
Diagnostic Strategies ◽  
Computed Tomographic ◽  
Vein Thrombosis ◽  
Clinical Probability ◽  
Venous Compression ◽  
Computed Tomographic Pulmonary Angiography ◽  
Deep Vein

Modern non-invasive diagnostic strategies for pulmonary embolism rely on the sequential use of clinical probability assessment, D-dimer measurement, and thoracic imaging tests. Planar ventilation/perfusion scintigraphy was the cornerstone test for the diagnosis of pulmonary embolism for more than two decades and has now been replaced by computed tomographic pulmonary angiography (CTPA). Diagnostic strategies using CTPA are very safe to rule out pulmonary embolism and have been well validated in large prospective management outcome studies. Venous compression ultrasonography is the cornerstone test to diagnose deep vein thrombosis but is not mandatory for the diagnosis of pulmonary embolism when using multidetector CTPA.

Performance of magnetic resonance angiography in suspected acute pulmonary embolism

2005 ◽  
Vol 93 (03) ◽  
pp. 503-511 ◽  
Author(s):  
Abdelouahab Bellou ◽  
Francis Guillemin ◽  
Philippe Douek ◽  
Marie-Claude Laprévote-Heully ◽  
Denis Wahl ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Spiral Ct ◽  
Diagnostic Value ◽  
Pulmonary Angiography ◽  
Observer Agreement ◽  
Prospective Clinical Study ◽  
Diagnostic Strategy ◽  
Clinical Probability

SummaryPulmonary embolism (PE) is a common and potentially fatal disorder. Non-specific findings make the clinical diagnosis of PE difficult. To assess the diagnostic value and inter-observer agreement of magnetic resonance angiography (MRA) in a cohort of patients with suspected PE, we conducted a prospective clinical study. MRA was compared for sensitivity and specificity to a diagnostic strategy including clinical probability, D-dimer testing, spiral CT, ultrasound leg compression and pulmonary angiography. A total of 89 patients with clinically suspected PE were included: the clinical probability of PE was intermediate or high in 78, and low in the remaining 11. All patients underwent mono-or multi-slice spiral CT and MRA with gadolinium injection (both within 24 hours of entry to the study). Anticoagulation was withheld in patients concerned about the strategy. All subjects were followed up for 3 months. MRA was read independently by two experienced teams of radiologists: one local and one from another university centre. Spiral CT was positive in 62 of 63 cases of confirmed PE. No patient with negative CT findings was positive ultrasonographically. Only one patient with a negative CT (and negative ultrasound) had a recurrent thromboembolic event. The first team diagnosed PE with MRA in 47 cases, with a sensitivity of 71% and a specificity of 92%; the second team obtained the diagnosis in 23 cases, with a sensitivity of 31% and a specificity of 85%. Inter-observer agreement between MRA reading was low: Kappa = 0.16 (-0.01 to 0.33); p = 0.07. In conclusion, compared with a non-invasive strategy based on spiral CT, the diagnostic value of MRA is limited by poor inter-observer agreement.

Role of Helical CT Pulmonary Angiography in Risk Stratification for Patients With Pulmonary Embolism

2011 ◽  
Vol 18 (5) ◽  
pp. 230-237
Author(s):  
Thomas H. Urbania ◽  
Michael B. Gotway ◽  
Michael D. Hope ◽  
David M. Naeger ◽  
Karen G. Ordovas ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Risk Stratification ◽  
Helical Ct ◽  
Pulmonary Angiography ◽  
Ct Pulmonary Angiography
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