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OBJECTIVES@#To explore the difference in CT values between pulmonary thromboembolism and postmortem clot in postmortem CT pulmonary angiography (CTPA) to further improve the application value of virtual autopsy.@*METHODS@#Postmortem CTPA data with the definite cause of death from 2016 to 2019 were collected and divided into pulmonary thromboembolism group (n=4), postmortem clot group (n=5), and control group (n=5). CT values of pulmonary trunk and left and right pulmonary artery contents in each group were measured and analyzed statistically.@*RESULTS@#The average CT value in the pulmonary thromboembolism group and postmortem clot group were (168.4±53.8) Hu and (282.7±78.0) Hu, respectively, which were lower than those of the control group (1 193.0±82.9) Hu (P<0.05). The average CT value of the postmortem clot group was higher than that of the pulmonary thromboembolism group (P<0.05).@*CONCLUSIONS@#CT value is reliable and feasible as a relatively objective quantitative index to distinguish pulmonary thromboembolism and postmortem clot in postmortem CTPA. At the same time, it can provide a scientific basis to a certain extent for ruling out pulmonary thromboembolism deaths.
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Humans , Autopsy , Thrombosis , Pulmonary Embolism/diagnostic imaging , Tomography, X-Ray Computed , Angiography , CadaverABSTRACT
ObjectiveTo explore the application value of CT pulmonary angiography (CTPA) in assessing the severity of acute pulmonary embolism (APE) and right heart function in rehabilitation patients. MethodsFrom January, 2013 to January, 2020, 133 inpatients (94 positive and 39 negative) who underwent CTPA examination in Beijing Bo'ai Hospital were involved. Positive patients were further divided into mild, moderate and severe groups based on the pulmonary artery obstruction index (PAOI). The clinical parameters and right heart function indicators were compared. Spearman correlation analysis was used to analyze the correlation between PAOI, and clinical parameters and right heart function indicators, and Logistic regression analysis was used to predict the risk factors of APE. ResultsThere was significant difference in lower extremity venous thrombosis, D-dimer, oxygen partial pressure, PAOI and left process of interventricular septum among four groups (H ≥ 12.350, P < 0.01). PAOI was moderately positively correlated with D-dimer (r = 0.443, P < 0.001) and left process of interventricular septum (r = 0.520, P < 0.001), and was weakly positively correlated with lower extremity venous thrombosis (r = 0.399, P < 0.001), left pulmonary artery diameter (r = 0.213, P = 0.014) and inferior vena cava regurgitation (r = 0.229, P = 0.008). Lower extremity venous thrombosis (OR = 7.708, P < 0.001) and left process of interventricular septum (OR = 3.641, P = 0.008) were independent risk factors for the onset of APE. The combination of the two indicators was effective for diagnosis of APE, and AUC was 0.795 (95% CI 0.715 to 0.874). ConclusionCTPA may be applied to evaluate the severity of APE and right heart function in rehabilitation patients.
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Introduction: Pulmonary embolism is one of the complications of COVID-19, with reported incidence ranging from 3 to 33 % in non-ICU patients to as high as 40% among ICU patients. Since the clinical presentations of COVID-19 and Pulmonary embolism overlap, it is difficult to differentiate between these cases. This study aimed to assess the incidence of pulmonary embolism and associated factors among confirmed Covid-19 Patients in Ethiopia. Methods: A nested case control study was conducted among 131 patients with COVID-19 (40 COVID-19 patients with Pulmonary embolism and 91 COVID-19 patients with no PE) who were on follow up from May, 2021 to May, 2022. Data was summarized using frequencies with percentages. A chi-square test/ Fisher's exact test was run to determine the presence of a significant difference between the exposure variables and the development of PE. To identify factors associated with the development of Pulmonary embolism, a multivariable Binary Logistic Regression model with sensitivity analysis was run. Results: The incidence of PE was 30.5% (95% CI, 22.9% - 37.4%) in the cohort of patients for whom upfront CTPA was performed. The Chi-square/ Fisher's exact test results showed a significantly higher proportion of patients with PE tend to present with shortness of breath, chest pain and anosmia/ageusia than those with no PE. However, in a subsequent regression analysis, only chest pain was found to be significantly associated with the development of PE in COVID-19 patients (AOR= 3.24, 95% CI= 1.10, 9.54, p-value=0.033). Conclusion: The incidence of PE among COVID-19 patients was found to be relatively lower than reports from other countries. Having chest pain was found to be a significant factor that indicates the development of PE, implying that in a setting where performing upfront CTPA is not practical, detailed symptom inquiry could serve as an important clinical criteria.
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COVID-19 , Pulmonary Embolism , Angiography , Incidence , Diagnosis , Pandemics , COVID-19 Nucleic Acid TestingABSTRACT
Pulmonary embolism is one of the common cardiothoracic vascular emergencies, and its main fatal complication is right ventricular dysfunction. CT pulmonary angiography is the preferred imaging method for clinical diagnosis of pulmonary embolism.This article reviews the imaging characteristics and mechanism of pulmonary embolism and right heart dysfunction in CT pulmonary angiography, the current clinical application status and limitations of CT pulmonary angiography, and the progress of CT pulmonary angiography technology.
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The development of CT and the clinical application of CT pulmonary angiography (CTPA) in diagnosing pulmonary embolism were introduced,and the methods for decreasing CTPA radiation dose and the importance of iterative reconstruction for low-dose scanning were analyzed.The development and application of contrast agent were described,and the ways to reduce contrast agent dose was expounded.Double-low CTPA combined with iterative reconstruction was pointed out to decrease greatly the radiation dose and contrast agent iodine dose while ensured image quality,and thus the damages to the patient by radiation and contrast agent could be lowered at the most.
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Pulmonary embolism (PE) refers to the endogenous or exogenous emboli blocking pulmonary trunk or branches, causing clinical and pathophysiological syndrome of pulmonary circulation disorder, the incidence rate is high. Sometimes PE patients were lack of specific symptoms and signs, or without any symptoms, which often result in misdiagnosis, un-timely diagnosis, and the delay of treatment. A PE case with syncope, vomiting and shock, which was proved to be pulmonary artery trunk and branch wide embolism later, was presented so as to improve the understanding of the disease.
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Objective To evaluate the clinical value of CTPA combined with V/Q imaging to guide the end point of anticoagulant therapy in reducing the recurrence rate of pulmonary embolism. Methods A total of 159 cases of pulmonary embolism diagnosed by CTPA were randomly divided into experimental group(n=80)and control group(n = 79). After the regular low molecular weight heparin and warfarin anticoagulation therapy ,the experimental group used the CTPA combined with V/Q imaging to evaluate the pulmonary embolism absorption ,to guide the end point of anticoagulant therapy and to evaluate the recurrence rate of pulmonary embolism at the end of 1-year treatment. But in control group ,only CTPA was used to guide the treatment and then the recurrence rate in 2 groups was compared. Results The anticoagulant treatment course of experimental group was(5.90 ± 1.80) months,which was significantly longer than that of control group(3.57 ± 1.09)months(P0.05).Conclusions CTPA combined with V/Q imaging to guide the end point of anticoagulant therapy for pulmonary embolismhas important clinical value in reducing the recurrence rate of pulmonary embolism.
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Objective:To explore the clinical efficacy and safety oflumbrokinase in the treatment of acute and moderate risk pulmonary thromboembolism.Methods:The clinical data of 60 patients with acute and moderate risk pulmonary thromboembolism,who were collected from January 2010 to October 2015 in Hunan Provincial People's Hospital,were retrospectively analyzed.According to the different treatments,60 patients were randomly divided into a lumbrokinase group (lumbrokinase in combination with low molecular heparin and sequential warfarin,n=30) and a control group (low molecular heparin and sequential warfarin,n=30).The clinical efficacy and safety were compared between the two groups.Results:Compared with the control group,maximum short axis,ratio of right and left ventricles,systolic pulmonary artery pressure,and the main pulmonary artery diameter in the lumbrokinase group were significant changed after the treatment for 10,20 and 30 d.NT-proBNP level in the lumbrokinase group after the treatment for 10,20 and 30 d was significantly reduced than that in the the control group (P＜0.05).However,the value of PO2 significantly increased after 10,20 and 30 d,and there was no significant difference between 20 d and 30 d (P＞0.05).D-dimer in the two groups was obviously increased after treatment for 10 d,but it was significantly reduced after treatment for 20 d or 30 d (P＜0.05).The clinical efficacy of the lumbrokinase group was better than that in the control group,with significant difference (P＜0.05).Conclusion:Combination of lumbrokinase with low molecular heparin and sequential warfarin is a safe and efficient strategy in treating the patients with acute and moderate risk pulmonary thromboembolism.It is worthy of clinical popularization and application.
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Objective To explore the correlative factors of sudden death in patients suspected with pulmonary thromboembolism (PTE) in emergency room (ER).Methods A retrospective analysis was conducted.The clinical data of 12 patients with sudden death suspected with PTE (sudden death group) in ER of the Air Force General Hospital from January 2011 to June 2014 were analyzed.The non-sudden death group included 35 patients during the same time period who were diagnosed with PTE based on findings of CT pulmonary arteriography (CTPA) and showed no sudden death in ER.Factors,including sex,age,previous operation,tumor,syncope,dyspnea,bilateral or unilateral edema of lower extremity,heart rate (HR),white blood cell count (WBC),D-dimer,arterial partial pressure of oxygen (PaO2),arterial partial pressure of carbon dioxide (PaCO2) and typical clinical manifestation of electrocardiogram (SⅠTⅢQⅢ),were compared between the two groups.The potential predictors of sudden death of PTE were analyzed by logistic regression analysis.Results Young age (years old:51.3±15.5 vs.62.3±14.4),lower PaO2 [mmHg (1 mmHg =0.133 kPa):49.9± 12.3 vs.62.7± 10.2],higher HR (bpm:122.0± 19.5 vs.89.1 ± 18.5) and higher WBC (× 109/L:13.8 ± 6.9 vs.7.2 ± 2.5) were found in sudden death group as compared with those in non-sudden death group (P ＜ 0.05 or P ＜ 0.01).There was no significant differences in D-dimer level and PaCO2 between sudden death group and non-sudden death group [D-dimer (pg/L):986 (891,3 230) vs.2089 (598,3 397),PaCO2 (mmHg):33.0 (28.6,43.4)vs.36.5 (32.9,41.0),both P ＞ 0.05].The syncope,antineoplaston treatment or tumor metastasis within 6 months,operation in previous 4 months,bilateral asymmetrical edema in sudden death group were more than those of the non-sudden death group,and chest pain was less (P ＜ 0.05 or P ＜ 0.01).Difference in gender,dyspnea and typical SⅠTⅢQⅢ in electrocardiogram were not significant between the two groups (all P ＞ 0.05).It was shown by multiple logistic regression analysis that higher HR [odds ratio (OR) =1.124,95％ confidence interval (95％CI) =1.024-1.235,P =0.014] and higher WBC (OR =1.347,95％CI =1.043-1.738,P =0.022) were identified as independent risk factors of sudden death for PTE.Conclusions Gender,dyspnea,typical S Ⅰ TⅢQⅢ in electrocardiogram,PaCO2 and D-dimer seem unrelated to sudden death of patients with PTE.Young age,chest pain,syncope,bilateral asymmetrical edema,antineoplaston treatment or tumor metastasis within 6 months,operation in previous 4 months and low PaO2 were potential predictors of sudden death according to the univariate analysis.Higher WBC and higher HR are independent risk factors of sudden death for PTE patients.
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Background: Pulmonary Thrombo-Embolism (PE) is a common and potentially lethal complication of deep venous Thrombosis (DVT). High sensitivity and specificity of Multi Detector Computed Tomography Pulmonary Angiography (MDCT-PA) in direct visualization of embolic material within the pulmonary arteries is due to its improved spatial and temporal resolution. Methods: We conducted a Prospective study to evaluate Non-invasive 256 Slice MDCT-PA in one hundred unselected patients with clinically suspected Pulmonary Embolism. Results: The total number of patients with thrombo-embolic disease in our study was 35 (35%), out of which acute PE & acute DVT were observed in 32% and 8% respectively. The percentage of Sub-segmental emboli among patients with acute PE was 34.37%, segmental thrombi was 87.5% and central thrombi was 96.87%.Conclusion: MDCT-PA possess the advantage of direct visualization and quantification of thrombo-embolic material and hence we advocate it to be the first-line imaging study for patients with clinically suspected PE.
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No abstract available.
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Objective To investigate the feasibility of CT pulmonary angiography (CTPA) with 80 kVp and contrast agent of iodixanol (270 mg I/ml) by filtered back projection(FBP) reconstruction.Methods In total,52 patients who underwent CTPA were randomly divided into two equally-sized groups,control group and experimental group.The volume computed tomography dose index (CTDIvol) and dose-length product (DLP)were recorded,and the weighted computed tomography dose index (CTDIw) and effective dose (E) were calculated.The image quality was visually evaluated and measured,and statistical analyses were performed on the image quality and the radiation dose.Results The sex,age,height,weight and body mass index (BMI) had no statistical difference between two groups (P ＞ 0.05).The average iodine dosage decreased by 22.9％ in the experimental group compared with the control group.Compared with the control group,the CTDIvol,DLP,CTDIw and E decreased by 73.5％,75.1％,73.5％ and 75.8％,respectively.The differences were statistically significant (t =＜0.001,30.5,＜ 0.001,-28.7,P ＜ 0.05).The image quality of the two groups met the requirement of diagnosis and there were no significant statistic differences between visually evaluating and objectively measuring the image quality (P ＞ 0.05).Conclusions Using 80 kVp and iodixanol for CTPA,FBP reconstruction image quality can meet diagnostic requirements.At the same time the radiation dose,the contrast agent dose and the X-ray tube wastage are reduced respectively.
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Optical coherence tomography (OCT) is a new imaging technique capable of obtaining high-resolution intravascular images and has been used in interventional cardiology. However, an application of OCT in pulmonary arteries had seldom been documented. In this case, OCT imaging is performed in peripheral pulmonary arteries and shows mural red thrombi. Subsequently, the red thrombi are aspirated and confirmed by a histological examination. These findings suggest that OCT may be a useful tool to depict peripheral pulmonary artery thrombi.
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Adult , Humans , Male , Angiography , Pulmonary Artery/pathology , Pulmonary Embolism/diagnosis , Tomography, Optical Coherence/methods , Tomography, X-Ray ComputedABSTRACT
@#BACKGROUND: This study was undertaken to identify the prevalence of pulmonary embolism (PE) in the emergency department (ED) of an urban teaching hospital and also to test a Bayesian model in estimating the number of CT pulmonary angiography (CTA) expected to be performed in an emergency department. METHODS: The data for this study was obtained through a retrospective review of electronic medical records for all ED patients suspected of PE who underwent chest CTA or ventilation perfusion scanning (V/Q) between 2009 and 2010. The data is presented as means and standard deviation for continuous variables and percentages with 95％ confidence intervals (95％CI) for proportions. The prevalence of PE was used as pre-test probability in the Bayesian model. Post-test probability was obtained using a Fagan nomogram and likelihood ratios for CTA. RESULTS: A total of 778 patients (560 females) with mean age of 50 years (range 18–98 years) were enrolled (98.3％ underwent chest CTA and 1.7％ underwent V/Q scan). A total of 69 patients had PE, rendering an overall prevalence of 8.9％ (95％CI, 7.1％ to 11.1％) for PE. We calculated that 132 CTA's per year could be avoided in our institution, without compromising safe exclusions of PE (keeping post-test probability of PE below 2％). CONCLUSIONS: Despite differences in our patient populations and /or study designs, the prevalence of PE in our institution is about average compared to other institutions. Our proposed model for calculating redundant chest CTA is simple and can be used by institutions to identify overuse of CTA.
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Objective: To evaluate the usefulness of spiral computed tomography (CT) in the diagnosis of pulmonary embolism (PE). Methods: A retrospective study was performed on 52 patients who underwent CT angiography (CTA) using spiral CT at our department from May 2000 to August 2003. A thoracic radiologist who was blinded to the database reviewed the radiological findings in all examinations from clinical data. A final diagnosis of PE was made by clinical conclusion from all other investigations, laboratory results and treatment outcome. Results: From 52 cases recruited into the study, 24 cases were suspected of PE before the examinations. Sixteen cases resulted in a final diagnosis of PE with acute PE in 7 cases and chronic PE in nine. The CTA correctly diagnosed PE in eleven cases, two cases were false-negative; CTA was proven to indentify PE that were detected through conventional angiography. Seventeen lesions of intraluminal filling defects were found, two of which were main pulmonary arteries (PA), four lobar and eleven segmental PA. The CT findings of clots consisted of six complete filling defects, two central clots and nine eccentric clots. The other findings, such as intraluminal web, calcification of clots, enlarged vessels and irregular thickening of vessel walls, were also demonstrated. Ancillary findings found in this study were atelectasis, oligemia, mosaic pattern and pleural effusion. Conclusion: Spiral CT is a useful method for the diagnosis of PE.