Chest radiographs in acute pulmonary embolism

Pulmonary embolism [PE] is a serious clinical entity carrying significant morbidity and mortality. Clinically, it is a difficult condition to diagnose and remains under treated condition in Pakistan due to non-availability of objective tests and lack of awareness among physicians. This study was conducted to determine the chest radiographic presentation in known cases of acute PE presenting to a tertiary care hospital. hospital records of patients with a diagnosis of acute PE were reviewed from June 2000 until June 2004. fifty diagnosed cases of defect were selected. Two chest physicians reviewed the chest demonstrating an intraluminal-filling hospitalization. In case of discrepancy, a radiologist made final interpretation. The chest radiograph was interpreted as normal in only 18% of patients with acute PE. The most common chest radiographic abnormalities were cardiac enlargement [38%], pulmonary parenchymal infiltrates [34%], atelectasis [26%], pleural effusion [24%], and pulmonary congestion [24%]. Other rare findings were elevated hemi diaphragm [14%], pulmonary artery enlargement [14%], and focal oligemia [8%]. Cardiomegaly is the most common chest radiographic abnormality associated with acute pulmonary embolism. Its major role is in identification of alternative disease processes that can mimic thrombo-embolism

Outcome of home mechanical ventilation

To determine the outcome of patients discharged home on portable ventilator. The Aga Khan University Hospital, Karachi from January 2000 to December 2004. All ventilator-dependent patients discharged home were contacted. Survivors were administered the EQ-5D Quality-of-Life instrument. SPSS version 13 was used to analyze data. Eleven patients were discharged home on invasive ventilation. Mean age was 49 years [range10-98 years]. Cause of ventilatory failure were cervical spine trauma in 36%, primary neurological disease in 27%, critical illness neuropathy and respiratory failure in 18% each. Survival rate was 73%, with three deaths. Mean duration of ventilation was 9.45 months [95% CI 3.24, 15.67]. Rate of successful weaning after discharge was 36%, with 4 patients off all forms of ventilatory support and 2 on only nocturnal support. A 2.8 [95% CI 0.5, 16.6] relative risk towards successful weaning was associated with the presence of a family member as the primary care giver. Mean scores on the EQ-5D descriptive tool were; mobility 2 [ +/- 0.82], self-care 2 [ +/- 0.82], usual activities 1.86 [ +/- 0.69], pain/discomfort 1.43[ +/- 0.79], anxiety/depression 1.29 [ +/- 0.76]. Mean score on the EQ-VAS was 48.2[ +/- 27.3]. In carefully selected patients, home ventilation is a viable option with the expectation of successful weaning and survival. Patients discharged home on ventilation reported a reasonably good quality of life with proportionately more problems related to independence compared to overall well-being