CT venography versus doppler ultrasonography in suspected pulmonary embolism among acute exacerbation COPD patients

Pulmonary embolism [PE] and deep venous thrombosis [DVT] are different aspects of the same disease [VTE]. Variable diagnostic approaches have been used to diagnose VTE. However the latency, lack of accuracy and the recorded complications necessitate a rapid, safe and accurate procedure for the diagnosis. The primary aim of this study was to determine if CTV offers an accurate alternative to venous ultrasonography as a first line evaluation for DVT in the patients present with AECOPD with suspected PE as a single technique. Thirty-three patients presented with AECOPD were included in this study. All patients were undergoing spiral CT pulmonary angiography for the evaluation of PE. CTV was performed 3 minutes after initiation of the contrast bolus infusion and compared with Doppler ultrasonography of the lower extremities. The presence of PE or deep venous thrombosis [DVT] was recorded for all patients. The addition of CT venography to CT pulmonary angiography increases the detection rate of thromboembolic disease by 30%. This study support the use of CTV after spiral CT pulmonary angiography as an alternative to Doppler ultrasonography of the lower limbs in AECOPD patients presenting with suspected pulmonary embolism

Predictors for pulmonary embolism in patients with acute exacerbation of COPD

Diagnosis of pulmonary embolism [PE] is difficult in patients complaining of acute exacerbation of chronic obstructive pulmonary disease [AECOPD]. To detect the numerical predictors in clinical, gasometric and laboratory findings for PE in patients with AECOPD. Will be used cut-off point of the different factors to reach a definite clue for this diagnostic dilemma. Ninety patients with acute exacerbation of COPD who were admitted to Chest department or Respiratory Intensive Care Unit in Assiut University Hospitals. They were 66 males and 24 females with the mean age [61.9 years]. All of them underwent the following clinical examination chest X-ray CBC, ABG, ECG; echocardiography, Duppler US of the lower limbs to diagnose DVT. Spiral CT, pulmonary angiography was performed to all patients to confirm the diagnosis of PE. Indices of coagulation, fibrinolysis and platelet activity were performed to all patients. PE was present in 25 of 90 patients [27.8%] while DVT was diagnosed in 14 cases [15.6%]. Ten patients [11.1%] have both DVT and PE. Spiral CT pulmonary angiography [SCTPA] was the diagnostic tool and the patients were divided into positive for PE 25 [27.8%] and negative [65 [72.2%]]. The Cut off points were used to give the definite diagnosis of PE among those critical patients with AECOPD as the following: Respiratory rate >35 cycles/min, heart rate > 120 beats. Hematocrite value > 56%, platelet count < 200.000/mm3, mean pulmonary artery pressure >60mmHg, P [A-a] O2 >25mmHg, D-dimer >1000ng/ml, thrombin >15mg/dL, B-Thromboglobulin > 80 IU/mL, P-selectin > 300ng/mL, duration of illness > 12 years, frequency of exacerbation > 5/year, no. of hospital admission > 4/year. This study showed a 27.8% prevelance of PE in patients with COPD hospitalized for severe exacerbation. These clinical and laboratory cut-off points can facilitate the diagnosis by a high sensitivity yield with a highly significant importance [P<0.001 - <0.02]