Detection Of Pulmonary Thromboembolism Research Articles

Role of Dual Energy Computed Tomography in Detection of Pulmonary Thromboembolism - A Prospective Observational Study in a Tertiary Care Centre of Central India

Role of Dual Energy Computed Tomography in Detection of Pulmonary Thromboembolism - A Prospective Observational Study in a Tertiary Care Centre of Central India

Detection of pulmonary thrombembolism and postmortem clotting on postmortem magnetic resonance imaging

The purpose of this study was to develop a feasible imaging protocol superior to postmortem computed tomography (PMCT) and to establish diagnostic parameters for diagnosing pulmonary thromboembolism (PE) on postmortem magnetic resonance imaging (PMMR).The study collective of 113 subjects was prospectively investigated by PMMR for the presence of PE and / or postmortem clotting (cruor). PE was detected in 20 cases; the remaining 93 cases were investigated for the morphology of cruor. Age grading was performed by PMMR, autopsy and histology. The postmortem sedimentation effect was used for the applied imaging protocol on PMMR (supine and prone position). Visual distension of the pulmonary arteries in PE was seen in all cases, but not in the controls. Re-positioning of the corpse from supine in prone position proved to be beneficial in 90 %. Postmortem motion artifacts are firstly described in 20.4 %. Hyperacute PE (grade 1) presented with a homogenous and hypointense signal on T2w images, acute PE (grade 2) with slightly heterogeneous, but still homogenous hypointense signal, subacute PE (grade 3) was with heterogeneous and slightly hyperintense signal and chronic PE (grade 4) with predominately homogenous with scarce portions of heterogeneous but hyperintense signal. PMMR allowed for the detection of PE and for in situ depiction of combined age grading.

Comparative study on Various Tube Voltages and Contrast Media Doses in CT Pulmonary Angiography to detect Pulmonary Thromboembolism

Background: Lowering the amount of iodinated contrast material and tube voltage may increase pulmonary artery opacification and thrombus identification without compromising picture quality. Objectives: To explore the efficiency of using lower tube voltage and a lower contrast medium dose for conducting computed tomography for pulmonary angiography (CTPA) aiming to increase its accuracy in detecting pulmonary thromboembolism (PTE). Subjects and Methods:100 patients scheduled for CTPA with a preoperative diagnosis of PTE were grouped into two: group A, (50 patients) got 1 mL/kg at 120 kV and group B, (50 patients) received 0.5 mL/kg at 80 kV.The technique of bolus tracking was implemented.Values of midpoint of multiple pulmonary artery divisions were used to assess attenuation.Significant values are those that exceed 300 Hounsfield units (HU). The dosage of radiation received by the patient, defined as the effective dose, was compared between groups. Results: Total mean attenuationdata for the pulmonary arteries have shown to be substantially greater in group-B compared to group-A (39110.4HU vs. 335.97.9HU, P=0.001). Moreover, total dose length product (DLP) values were substantially lower in group-B (934.9 mGy.cm vs. 384.443 mGy.cm, P=0.001). While effective dose values have shown to be significantly lower in group-B (2.90.3 mSv vs. 13.21.8 mSv, P 0.001). Conclusion: Low-kilovoltage technique and low quantity of iodinated contrast are useful in conducting (CTPA) with high accuracy in detection of pulmonary thromboembolism.

Abstract P105: Identification of Cardioembolic Sources and Myocardial Injury in Acute Ischemic Stroke With Delayed-Phase, Low-Dose Chest Ct by Means of a Dual-Layer Spectral Ct Scanner

Background: The COVID-19 pandemic has promoted adaptations in diagnostic algorithms. We explored the feasibility and accuracy of delayed phase (DP) chest computed tomography (CT) performed immediately after brain CT perfusion (CTP) for the identification of thrombotic complications and myocardial fibrosis among patients admitted with acute ischemic stroke (AIS). Methods: Since July, we have incorporated the use of low dose chest CT scans using a spectral CT scanner in all patients admitted with AIS, encouraging acquisitions, five min after brain CTP. All scans were non gated and comprised low dose chest CT scans, without additional contrast. Using virtual monochromatic imaging and iodine maps, we evaluated the presence of thrombotic complications, myocardial late enhancement, and myocardial extracellular volume (ECV), as a surrogate of edema and interstitial fibrosis. Results: We included 22 patients. The mean age was 66.2±19.6 years. In 5 patients, a cardioembolic (CE) source was later identified by transesophageal echocardiogram (TEE), [left atrial appendage (LAA) thrombus, n=1], transthoracic echocardiogram with agitated saline injection (patent foramen ovale n=2), or by EKG (atrial fibrillation). Seven patients further underwent either TEE or cardiac CT to identify CE sources. DP non gated chest CT had a sensitivity and specificity of 100% to identify CE sources, 1 LAA thrombus correctly detected. Chest CT identified pulmonary thromboembolism (PE), later confirmed with CT angiography. Chest CT identified myocardial late enhancement in 16 patients (80% in CE vs. 71% in non CE, p=0.68), myocardial fat in 1, and coronary calcification in 77% [with 2.6±2.2 vs 3.8±3.6 coronary calcified segments in CE vs. non CE strokes, p=0.36). The mean ECV was 35±4% in CE vs 32±6% in non CE strokes (p=0.17). The 2 patients with a positive PCR test for COVID-19 showed evidence of myocardial late iodine enhancement, and incremented ECV of the septal wall (38% and 40%, respectively). Conclusions: In this pilot study, DP, non ECG gated, low dose chest CT scan performed 5 min after brain CTP with a spectral scanner; enabled straightforward identification of CE sources among patients with AIS. This approach allowed detection of PE and myocardial injury.

The accuracy of non-contrast chest computed tomographic Scan in the detection of pulmonary thromboembolism

Background Pulmonary embolism (PE) is a critical chest disease resulting in high mortality rates if undetected. This study aimed to evaluate the role of noncontrast multislice computed tomography in the detection of PE. Patients and methods One hundred patients requested for computed tomography (CT) pulmonary angiography and underwent noncontrast and contrast-enhanced CT images of the chest, which were reviewed separately. The average CT attenuation differences between the high-attenuation clots and pulmonary arteries were computed. Findings in the noncontrast images were correlated with the contrast-enhanced images. Results Twenty-six of 100 patients were positive for PE in computed tomography angiography; the mean age (±SD) was 56.73 (±9.11) years, and 17 (65.4%) were female individuals. The hyperdense lumen sign has an overall sensitivity of 50% and specificity of 98.6%. As for the other 13 patients, 10 of them had more than one indirect sign. The peripheral wedge-shaped opacity was the most common indirect sign that revealed high specificity (91%) and was statistically significant. Conclusion Noncontrast chest CT scan has a good role in the evaluation of PE through detection of the hyperdense lumen sign, which is a good indicator of acute pulmonary thromboembolism, particularly in cases involving the central pulmonary arteries or peripheral wedge-shaped opacity, as a useful indirect sign.

Triple rule-out CT angiography protocol with restricting field of view for detection of pulmonary thromboembolism and aortic dissection in emergency department patients: simulation of modified CT protocol for reducing radiation dose

Background Triple rule-out computed tomography (TRO CT) is a CT protocol designed to simultaneously evaluate the coronary, aorta, and pulmonary arteries. Purpose To evaluate potential diagnostic performance of TRO CT with restricted volume coverage for detection of pulmonary thromboembolism (PTE) and aortic dissection (AD). Material and Methods This study included 1224 consecutive patients with acute chest pain who visited the emergency department and underwent TRO CT using a 128-slice dual-source CT. Image data were reconstructed according to the display field of view (DFOV) of coronary CT angiography (CCTA) and TRO CT protocols in each patient. The presence of PTE and AD was evaluated by independent observers in each DFOV. The radiation dose was calculated to evaluate the potential benefits by restricting z-axis coverage to cardiac scan range instead of the whole thorax. Results Among all patients, 22 cases with PTE (1.9%) and nine cases with AD (0.8%) were found. Except for one PTE case, all cases were detected on both DFOV of TRO CT and CCTA. Mean effective dose for evaluation of entire thorax and cardiac scan coverage were 5.9 ± 1.1 mSv and 3.5 ± 0.7 mSv, respectively. Conclusion Isolated PTE and AD outside the CCTA DFOV rarely occur. Therefore, modified TRO CT protocol using cardiac scan coverage can be adopted to detect PTE and AD with reduced radiation dose.

The validity of hyperdense lumen sign in non-contrast chest CT scans in the detection of pulmonary thromboembolism

It is possible to identify high-attenuation clots in pulmonary thromboembolism using non-contrast computed tomography (CT) of the chest. Such detection may be crucial for timely initiation of appropriate therapy. This study was undertaken to determine the validity of the hyperdense lumen (high-attenuation clot) sign in unenhanced chest CT in detecting pulmonary thromboembolism. Non-contrast and contrast-enhanced CT images of the chest of 121 patients who had undergone standard CT pulmonary angiography (pulmonary CTA) were reviewed separately. The absence or presence of luminal hyperdensities within the pulmonary arteries in the non-contrast images was determined. The average CT attenuation differences between the high attenuation clots and pulmonary arteries were computed. Findings in the non-contrast images were correlated with the contrast-enhanced images. Twenty-five patients were positive for pulmonary thromboembolism in the pulmonary CTAs. Of these 25 patients, nine were positive for the hyperdense lumen sign in the non-contrast CT images. The hyperdense lumen sign has an over-all sensitivity of 36.0%, specificity of 99.0%, PPV of 90.0%, and NPV of 85.6% (κ=0.449; P-value<0.001). In detecting central thromboembolism, the sensitivity, specificity, PPV, and NPV of this sign were 66.7, 99.1, 88.9, and 96.4%, respectively (κ=0.740; P-value<0.001). The sign was less sensitive in peripheral thromboembolism (κ=0.358; P-value<0.001). The mean (±SD) attenuation difference between the clot and pulmonary blood pool was 22.76 (±4.20) HU (P-value<0.001). The hyperdense lumen sign is a useful indicator of acute pulmonary thromboembolism in non-contrast chest CT scans particularly in cases involving the central pulmonary arteries.

Calcified pulmonary thromboembolism in a child with sickle cell disease: value of multidetector CT in patients with acute chest syndrome

The incidence of pulmonary embolism in children is not clearly known, but is believed to be low. Risk factors for pulmonary thromboembolism include central venous catheter, malignancy, surgery, infection, trauma, and congenital hypercoagulable disorders. Children with sickle cell disease are prothrombotic and are at an increased risk of thromboembolism. The incidence of this event is unknown because these children are often not thoroughly imaged. We report here a case of a calcified pulmonary thromboembolism in a child with sickle cell disease and emphasize the use of multidetector CT in detection of pulmonary thromboembolism in children with sickle cell disease.

Application of One Lung Ventilation in the Detection of Pulmonary Embolism during Operation

Intraoperative pulmonary thromboembolism (PTE) is rare, but is nevertheless one of the important causes of morbidity and mortality in patient undergoing surgery. However, The detection of PTE is difficult because it's clinical symptoms and signs are nonspecific during surgery, and specialized diagnostic tools are not readily available in the operating room. We report a case of PTE due to cancer emboli with thrombi encountered during a nephrectomy in patient with renal cell cancer, and demonstrate that one-lung ventilation can aid in the diagnosis of massive PTE when the evaluation is suspected.

The Pulmonary Echogram in the Study of Pulmonary Thromboembolism.

s1 May 1969The Pulmonary Echogram in the Study of Pulmonary Thromboembolism.Claude R. Joyner, M.D., F.A.C.P.Claude R. Joyner, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-70-5-1098_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe normal pattern of reflection of ultrasound A by the lung is changed by pulmonary thromboembolism with or without infarction. Pulmonary echograms were obtained from 50 normal subjects and 200 patients to determine the reliability of the method in the detection of pulmonary thromboembolism. The echogram from the normal chest is a display fading 2 to 3 cm from the skin-transducer interface. A deeper echo return (4 to 8 cm) is recorded from areas over ischemic lung. A deep pattern was found in 138 patients suspected of having pulmonary thromboembolism. Absolute confirmation of pulmonary thromboembolism was obtained by necropsy or... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Philadelphia, Pennsylvania PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 May 1969Volume 70, Issue 5Page: 1098-1098KeywordsInfarctionLungsPulmonary embolismThoraxUltrasound imaging Issue Published: 1 May 1969 PDF downloadLoading ...