ABSTRACT
【Objective】 To compare the value of CT pulmonary angiography (CTPA) and echocardiography in predicting the degree pulmonary hypertension (PH). 【Methods】 Fifty-four patients in our hospital who underwent right heart catheterization, CTPA and echocardiography for suspected or confirmed PH from November 2013 to April 2021 were retrospectively recruited. Pulmonary artery systolic pressure (PASP) and mean pulmonary artery pressure (PAMP) were measured by right heart catheterization. According to PAMP, the patients were divided into non-PH group and mild, moderate, and severe PH groups. The three-dimensional model of the pulmonary artery was obtained by computer-aided segmentation, and the best fitting circle diameter (Dfit), inscribed circle diameter (Dmin), circumscribed circle diameter (Dmax), hydraulic diameter (Dh), cross-sectional area (Area), circumference (Scf), and the largest area and largest short diameter of the right ventricle were measured. Echocardiography was used to estimate PASP. The differences in the above parameters between different PH groups were compared, the correlations of the above parameters with PASP and PAMP were analyzed, and statistically significant indicators were included to establish three predictive models of PAMP (Model 1: CTPA pulmonary artery; Model 2: CTPA pulmonary artery+CTPA right ventricle; Model 3: CTPA pulmonary artery+CTPA right ventricle+echocardiography), and receiver operating characteristic (ROC) curves were used to compare the diagnostic performance of the three models. 【Results】 Some parameters of main pulmonary artery (Dfit, Dmin, Dmax, Dh, Area, Scf), right pulmonary artery (Dmax, Dh, Area, Scf), left pulmonary artery (Dfit), and right ventricular short diameter increased with the increase of PAMP (P<0.05). Dfit, Dmin, Dh, and area of main pulmonary artery, right pulmonary artery and left pulmonary artery were positively correlated with PASP and PAMP (P<0.05). Right ventricular short diameter and right ventricular maximum area were positively correlated with PASP (P<0.05), and right ventricular short diameter was positively correlated with PAMP (P<0.05). The estimated value of pulmonary artery systolic blood pressure in echocardiography was positively correlated with PASP and PAMP (P<0.05). Model 1, Model 2 and Model 3 could all be used to identify mild PH and moderate PH, among which Model 3 had the best performance in identifying non-PH and mild PH, moderate PH and severe PH. 【Conclusion】 CTPA and echocardiography are helpful in assessing the degree of PH, and the combination of the two has better accuracy in distinguishing non-PH from mild PH, moderate and severe PH.
ABSTRACT
Background: Pulmonary embolism is a common and potentially life threatening condition. Most patients who succumb to pulmonary embolism do so within the first few hours of the event. The aim of the study was to observe the clinical profile, management and outcome in patients of pulmonary embolism.Methods: A prospective observational study was conducted in the Department of Medicine in a Tertiary care hospital in Western Maharashtra for a period of two years. 55 patients with confirmed diagnosis on CTPA (Computed tomography pulmonary angiography) were included in our study. A detailed history, examination and investigations like D dimer were done in all cases.Results: Mean age of the study cases was 44.98 years with 40% of the cases between 31-50 years of age. Overall male predominance was seen (83.6%). Most common associated co-morbidity was diabetes (32.7%). The commonest risk factor seen in the present study was history of smoking (29.1%). Dyspnoea was the most common presenting complaint (72.7%). Commonest presenting sign was tachycardia (43.6%). In present study, mortality rate among cases of pulmonary embolism was observed as 3.6%..Conclusions: Mean age of the study cases was 44.98 years with 40% of the cases between 31-50 years of age. Overall male predominance was seen (83.6%). Most common associated co-morbidity was diabetes (32.7%). The commonest risk factor seen in the present study was history of smoking (29.1%). Dyspnoea was the most common presenting complaint (72.7%). Commonest presenting sign was tachycardia (43.6%). In present study, mortality rate among cases of pulmonary embolism was observed as 3.6%.
ABSTRACT
ABSTRACT Objective: This study was undertaken to determine the positive rate for computed tomography pulmonary angiograms (CTPAs) at the University Hospital of the West Indies (UHWI), to compare the positive rate at the UHWI to that reported in the literature and to compare the rates of positive CTPAs between the genders. Method: Data were obtained from the databases of the Radiology Department of the UHWI. All CTPAs performed to confirm a clinical diagnosis of pulmonary embolism and the results issued during the period January 1st 2013 and December 31st 2013 inclusive were reviewed. Only initial examinations of adequate diagnostic quality were included in the study. Results: Three hundred and thirteenth CTPAs were performed for initial diagnosis of pulmonary embolism. Sixteen examinations were excluded for inadequate diagnostic quality. Two hundred and ninety-seven examinations on 223 females and 74 males were included in the study. The means for age were 49.7 years and 55.1 years, respectively; the difference in the means was significant (p < 0.05). Ninety-four examinations (31.6%) on 22 males (7.4%, mean age 58.4 years) and 72 females (24.2%, mean age 57.5 years) were positive for pulmonary embolism. The difference in the means was not significant (p = 0.8). On Chi-squared test there was no significant difference in the percentage of positive CTPAs between males and females (p = 0.7). Conclusions: The percentage of positive CTPAs at the UHWI is high. There was no significant difference between the genders in the percentage of positive CTPAs or the mean age at which pulmonary emboli were detected.
ABSTRACT Objetivo: Este estudio se llevó a cabo con el propósito de determinar la tasa positiva de las angiografías pulmonares por tomografía computarizada (APTC) en el Hospital Universitario de West Indies (UHWI), comparar la tasa positiva en el UHWI con la que se reporta en la literatura, y comparar las tasas de APTC positivas entre géneros. Método: Se obtuvieron datos de las bases del Departamento de Radiología de UHWI. Se examinaron todas las APTC realizadas para confirmar un diagnóstico clínico de embolia pulmonar y los resultados emitidos durante el período del 1ero de enero de 2013 y 31 de diciembre de 2013 inclusive. En el estudio se incluyeron únicamente exámenes iniciales de calidad diagnóstica adecuada. Resultados: Trecientos trece APTC fueron realizadas para el diagnóstico inicial de embolia pulmonar. Se excluyeron 16 exámenes por poseer una calidad diagnóstica inadecuada. Doscientos noventa y siete exámenes de 223 hembras y 74 varones fueron incluidos en el estudio. Los promedios de edad fueron 49.7 años y 55.1 años respectivamente. La diferencia de los promedios fue significativa (p < 0.05). Noventa y cuatro exámenes (31.6%) de 22 varones (7.4%, edad promedio 58.4 años) y 72 hembras (24.2%, edad promedio 57.5 años) fueron positivos a la embolia pulmonar. La diferencia de los promedios no fue significativa (p = 0.8). En la prueba de Chi-cuadrado no hubo diferencias significativas en el porcentaje de APTC positivas entre varones y hembras (p = 0.7). Conclusiones: El porcentaje de APTC positivas en el UHWI es alto. No hubo diferencias significativas de género en el porcentaje de APTC positivas o la edad promedio a la que se detectaron los émbolos pulmonares.
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Pulmonary Embolism/diagnostic imaging , Computed Tomography Angiography , Sex Factors , Sensitivity and Specificity , Hospitals, UniversityABSTRACT
We report a case of a 29-year-old female with a history of asthma, post-partumARDS, and pulmonary hypertension who presents with severe shortness of breath. The patient describes her shortness of breath as progressive over the past 10 years. Chest radiography and CT angiography of the thorax showed findings consistent with fibrosing mediastinitis with severe stenosis of the left main pulmonary artery. This resulted in appearance of unilateral absent left lung perfusion on quantitative Tc-99-MAA perfusion and Xe-133 ventilation (V/Q) scan.
Subject(s)
Adult , Female , Humans , Angiography , Asthma , Constriction, Pathologic , Dyspnea , Histoplasma , Hypertension, Pulmonary , Lung , Mediastinitis , Perfusion , Pulmonary Artery , Radiography , Thorax , VentilationABSTRACT
Objective To retrospectively analyze the clinical features,diagnostic experience and therapy of pulmonary embolism for reduction of misdiagnosis and missed diagnosis,and for improving the cure rate.Methods The data of clinical features,findings by auxiliary examination and therapeutic efficacy of 67 patients with pulmonary embolism admitted to the First Affiliated Hospital of General Hospital of PLA were summarized.The usual clinical manifestations were summarized based on the clinical symptoms of and the frequency of objective signs in the patients with the correct diagnosis.Auxiliary examinations included routine and sophisticated examinations such as CT pulmonary angiography(CTPA) and emission computed tomography(ECT),which were specially emphasized for summing up and optimizing the diagnosis.Comparisons were made of the therapeutic efficacy and complications between the treatment with thrombolysis combined with anticoagulation and simple anticoagulation.Results The primary clinical manifestations of the patients with pulmonary embolism included dyspnea,cough,chest pain,fever and hemoptysis,etc.Findings of D-Dimer assay might serve as a sensitive but not specific indicator in screening the suspected patients.For the sophisticated examinations,CTPA confirmed the diagnosis in 28 out of 31(90.32%) patients,and ECT confirmed the diagnosis in 39 out of 51(76.47%).All the patients who had undergone lung angiography received the final diagnosis,but the majority of them were reluctant to accept this examination because of potential risk of the technique.The total cure rate of thrombolysis combining anticoagulation was 90.62%(29/32),in which the administration of recombinant tissue-type plasminogen activator(rt-PA)-2h was most efficacious(with 100% of cure rate).Simple anticoagulation therapy gave a lower cure rate(68.57%,24/35) but a higher incidence of hemorrhagic complication(31.25%).After the administration of thrombolysis combined with anticoagulation therapy,both PaO2 and CTPA examinations showed significant changes for the better after the treatment compared with that before the treatment(P