Predictors of an intermediate ventilation/perfusion lung scan in patients with suspected acute pulmonary embolism.

BACKGROUND: An intermediate ventilation/perfusion (V/Q) lung scan lacks diagnostic utility in excluding acute pulmonary embolism (PE). OBJECTIVE: To identify the potential predictors of an intermediate V/Q lung scan in patients with suspected acute PE. METHODS: A review of the medical records of 306 consecutive patients with suspected acute PE, in whom a V/Q lung scan was performed (interpretation using modified Prospective Investigation of Pulmonary Embolism Diagnosis criteria). RESULTS: A total of 274 patients (89.5%) had a non-intermediate V/Q lung scan: 88 (28.8%) high probability, 149 (48.7%) low probability, and 37 (12.1%) near normal/normal. Thirty-two patients (10.5%) had an intermediate V/Q lung scan. Patients with an intermediate V/Q lung scan presented a significantly greater frequency of age greater than 70 years (81.2 versus 50.4%, P=0.01), previous cardiopulmonary disease (75 versus 46.3%, P=0.003), chronic obstructive pulmonary disease (34.4 versus 15.7%, P=0.01), and chest radiograph evidence of emphysema (18.7 versus 4.7%, P=0.008). We found no other significant differences in the rest of the characteristics studied between patients with an intermediate and a non-intermediate V/Q lung scan. CONCLUSION: The possibility of an intermediate V/Q lung scan is higher in elderly patients and in patients with previous cardiopulmonary disease (especially with chronic obstructive pulmonary disease). Emphysema is the only chest radiograph abnormality associated with a greater possibility of an intermediate V/Q lung scan.

Syncope in acute pulmonary embolism.

BACKGROUND: Syncope is a possible but little known presenting manifestation of acute pulmonary embolism (PE). The importance of syncope at the presentation of acute PE is not known. OBJECTIVES: To report the frequency and to establish the prognostic significance of syncope at the presentation of acute PE. METHODS: A retrospective review of the records of 154 consecutive patients admitted to an Internal Medicine service with acute PE. RESULTS: Fourteen patients with acute PE (9.1%) had syncope at presentation. Epidemiological and clinical characteristics (including respiratory failure, right heart failure and arterial hypotension), and hospital mortality were similar in patients with or without syncope. CONCLUSIONS: Syncope is not an uncommonly presenting manifestation of acute PE. Patients with acute PE and syncope have similar characteristics to those without syncope. Syncope does not seem to determine a poor prognosis.

Low-grade and high-grade fever at presentation of acute pulmonary embolism.

We retrospectively reviewed the medical records of 154 consecutive patients with acute pulmonary embolism (PE) admitted to an Internal Medicine Service. At presentation, fever (temperature > 37 degrees C) without other identified causes was present in 28 patients (18.2%): 27 patients had low-grade fever (temperature 37-39 degrees C) and one patient had high-grade fever (temperature > 39 degrees C). Epidemiological and clinical characteristics, electrocardiographic and chest radiograph abnormalities and mortality rate were similar in patients with and without fever. Fever, including high-grade fever, is a possible presenting feature in patients with acute PE. Patients with acute PE and fever have similar characteristics compared with those without fever.

Wheezing in patients with acute pulmonary embolism with and without previous cardiopulmonary disease.

BACKGROUND: Wheezing is a little known but possible presentation feature of acute pulmonary embolism. PATIENTS AND METHODS: A retrospective review of the records of 154 consecutive patients with acute pulmonary embolism, who survived long enough for diagnostic evaluation. RESULTS: Fourteen patients with acute pulmonary embolism (9.1%) had wheezing at presentation. Wheezing was more frequent in patients with previous cardiopulmonary disease than in those without previous cardiopulmonary disease, although this did not reach statistical significance (13.5 versus 6.9%; P=0.17). Dyspnoea, cough and respiratory failure were more frequent with statistical significance in our patients with wheezing than in those without wheezing. The hospital mortality rate was similar in both groups. CONCLUSION: Wheezing in acute pulmonary embolism may be more frequent in patients with previous cardiopulmonary disease. However, wheezing also occurs in patients with acute pulmonary embolism without previous cardiopulmonary disease. Wheezing may be a sign of severity in acute pulmonary embolism.

[Clinical probability evaluation models in patients with pulmonary thromboembolism]. / Modelos de valoración de la probabilidad clínica en pacientes con tromboembolia pulmonar.

BACKGROUND: The evaluation of the clinical probability (CP) of pulmonary thromboembolism (PTE) is useful in patients with suspected PTE. METHOD: We assessed the CP of PTE using 3 different models (described by Miniati et al., Wells et al. and Wicki et al.) in a series of 154 patients with PTE. RESULTS: A high CP and a low CP were present in 11.7%, 39% and 14.3%, and in 0.6%, 0% and 1.9% of patients with PTE according to the first, second and third models, respectively. The frequency of high CP was not significantly different between patients older or younger than 70 years, between both sexes, nor between patients with or without cardiopulmonary disease. There was, however, a significantly lower frequency of high CP, according to the second model, in patients older than 70 years (31.1% vs 50%, p = 0.03). CONCLUSIONS: The CP evaluation models studied are comparable. A low CP makes highly improbable a diagnosis of PTE. Only up to approximately one third of patients with PTE hare a high CP.