The Correlation Between the D-Dimer Values and Anatomical Distribution of Pulmonary Embolism.

Background: Pulmonary Embolism (PE) represents a life-threatening medical emergency that, given the serious complications, requires urgent application of anticoagulant therapy. In addition to other factors that are taken into account when choosing a therapy for treatment of PE, the anatomical distribution of thrombi is also considered-whether it is a central, lobar, segmental or subsegmental PE. D-dimer is an intermediate product of degradation of fibrin molecules and its values in the plasma are increased in the case of PE, but also in other diseases. Objective: To determine whether there is a difference in D-dimer values in subjects with different anatomical distribution of PE. Methods: The study included 100 subjects with diagnosed PE by using MSCT and/or V/P SPECT and with measured values of D-dimer. Results: Out of 100 subjects, PE was not diagnosed in 37 subjects, while 63 subjects PE was diagnosed. All subjects with diagnosed PE were divided into 3 groups regarding the anatomical localization of thrombus: lobar, segmental or subsegmental. Average D-dimer values were calculated for all 3 groups. Statistical analysis showed that there was no significant difference in D-dimer values between subjects with different anatomical distribution of PE. Conclusion: There is no significant difference in D-dimer values between subjects with different anatomical distribution od PE-lobar, segmental and subsegmental PE.

Diagnostic accuracy and complication rates of percutaneous CT-guided coaxial needle biopsy of pulmonary lesions.

PURPOSE: The aim of this retrospective study was to evaluate and compare diagnostic accuracy and complication rates of percutaneous computed tomography (CT)-guided biopsies of pulmonary lesions 10-35 mm, 35-50 mm, and >50 mm, using the coaxial biopsy technique. METHODS: Over a 4-year period, 235 lung biopsies were performed using the coaxial biopsy technique with 18G semi-automated true-cut needle. There were 163 (69.4%) male and 72 (30.6%) female patients, with a mean age of 64.01±9.18 years (18-85 years). The mean lesion size was 59.6±29.3 mm. The lesions were stratified into three groups according to size: lesions <35 mm (n=42, 17.9%), lesions 35-50 mm (n=53, 22.5%), and lesions >50 mm (n=140, 59.6%). Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for all biopsies, and for each group separately, as well as the incidence of complications. RESULTS: The overall diagnostic accuracy was 95.4%, with 95.52% sensitivity, 100% specificity, 100% PPV, and 47.37% NPV. For lesions <35 mm, diagnostic accuracy, sensitivity, and PPV were 100%. The lowest diagnostic accuracy was 93.9% in lesions >50 mm, with 93.65% sensitivity, 100% specificity, 100% PPV, and 42.86% NPV. An adequate sample was obtained in 219 core biopsies (93.2%), while 16 biopsies (6.8%) were nondiagnostic due to necrosis (4.25%) and insufficient biopsy material (2.55%). The most frequent complication was minor pneumothorax, which was seen at a rate of 19.1%; pneumothorax requiring chest tube placement occurred in 3 patients (1.3%). CONCLUSION: Diagnostic accuracy decreased with increasing lesion size. On the other hand, complication rates were higher in smaller lesions, more distanced from the pleura.