Ancillary Findings on CT Pulmonary Angiograms that are Negative for Pulmonary Embolism

Paul D Stein ,Fadi Matta,Kristen N Owen,Mary J Hughes,Nasheed S Fakhouri,Casey Lyons,Julie Lata,Ethan R Saffer,Mathew A Warpinski,Laura A Warner,Damien Carracedo,Kevin A Jutzy,Brody A Deming,Keith Cronovich ,Patrick G Hughes ,Brett J Gerstner ,Michael Q Doyle ,Edward Kakish ,William Corser ,Ian P Skinner ,Jerome P Long ,Corion L Jones ,Christopher Trigger

doi:10.51894/001c.11769

Abstract

CONTEXTOne advantage of computed tomographic pulmonary angiograms (CTPA) is that they often show pathology in patients in whom pulmonary embolism (PE) has been excluded. In this investigation, we identified the ancillary findings on CTPAs that were negative for PE to obtain an impression of the type of findings shown.METHODSThis was a retrospective analysis of findings on CTPAs that were negative for PE obtained in nine emergency departments between January 2016 - February 2018. Ancillary findings were assessed by review of the radiographic reports.RESULTSAncillary findings were identified in N=338 (40.9%) of 825 patients with CTPAs that were negative for PE. Most ancillary findings, 254 (75.1%) of 338 were pulmonary or pleural abnormalities. Liver, gall bladder, kidney, or pancreatic abnormalities were shown in 26 (7.7%) cases, and abnormalities of the heart or great vessels were shown in 23 (6.8%) of cases. Abnormalities of the esophagus or intestine were shown in 12 (3.6%), abnormalities of the thyroid in 10 (3.0%) and abnormalities of bone or soft tissue lesions were shown in three (0.9%) cases. Inferential statistical procedures demonstrated that the occurrence of ancillary findings in patients with negative CTPAs was proportionately greater in patients who were 50 years and older (p < 0.001), although not between genders (p = 0.145).CONCLUSIONSAncillary findings on CTPAs that were negative for PE were frequently reported. Future studies might focus of the extent to which ancillary findings on CTPA assisted physicians in management of the patient.

Highlights

Pulmonary embolism (PE) is obstruction of a pulmonary artery or one or more of its branches that is produced by a thrombus
This was a retrospective analysis of findings on computed tomographic pulmonary angiography (CTPA) that were negative for PE obtained in nine emergency departments between January 2016 - February 2018
Ancillary findings were identified in N=338 (40.9%) of 825 patients with CTPAs that were negative for PE

Summary

Introduction

Pulmonary embolism (PE) is obstruction of a pulmonary artery or one or more of its branches that is produced by a thrombus (blood clot). Signs and symptoms are nonspecific[1] and the diagnosis is made by appropriate imaging techniques, usually computed tomographic pulmonary angiography (CTPA). Computed tomographic pulmonary angiography is a minimally invasive radiographic procedure in which images of the pulmonary arteries are generated by synthesis of x-ray transmission data obtained in many different directions in a given plane. It is minimally invasive, in that only an intravenous injection of contrast material is required. The risks of conventional pulmonary angiography for the diagnosis of PE,[2] which requires catheterization of the pulmonary arteries, are eliminated. With CTPA there remain the risks of allergy and nephrotoxicity from contrast material[3] and the risks associated with ionizing radiation.[4]

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