Use Of Pulmonary Angiography Research Articles

Adherence to PIOPED II Investigators' Recommendations for Computed Tomography Pulmonary Angiography

BackgroundComputed tomography (CT) pulmonary angiography use has increased dramatically, raising concerns for patient safety. Adherence to recommendations and guidelines may protect patients. We measured adherence to the recommendations of Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED II) investigators for evaluation of suspected pulmonary embolism and the rate of potential false-positive pulmonary embolism diagnoses when recommendations of PIOPED II investigators were not followed. MethodsWe used a structured record review to identify 3500 consecutive CT pulmonary angiograms performed to investigate suspected pulmonary embolism in 2 urban emergency departments, calculating the revised Geneva score (RGS) to classify patients as “pulmonary embolism unlikely” (RGS≤10) or “pulmonary embolism likely” (RGS>10). CT pulmonary angiograms were concordant with PIOPED II investigator recommendations if pulmonary embolism was likely or pulmonary embolism was unlikely and a highly sensitive D-dimer test result was positive. We independently reviewed 482 CT pulmonary angiograms to measure the rate of potential false-positive pulmonary embolism diagnoses. ResultsA total of 1592 of 3500 CT pulmonary angiograms (45.5%) followed the recommendations of PIOPED II investigators. The remaining 1908 CT pulmonary angiograms were performed on patients with an RGS≤10 without a D-dimer test (n=1588) or after a negative D-dimer test result (n=320). The overall rate of pulmonary embolism was 9.7%. Potential false-positive diagnoses of pulmonary embolism occurred in 2 of 3 patients with an RGS≤10 and a negative D-dimer test result. ConclusionsNonadherence to recommendations for CT pulmonary angiography is common and exposes patients to increased risks, including potential false-positive diagnoses of pulmonary embolism.

Effect of Computerized Clinical Decision Support on the Use and Yield of CT Pulmonary Angiography in the Emergency Department

To determine the effect of evidence-based clinical decision support (CDS) on the use and yield of computed tomographic (CT) pulmonary angiography for acute pulmonary embolism (PE) in the emergency department (ED). Institutional review board approval was obtained for this HIPAA-compliant study, which was performed between October 1, 2003, and September 30, 2009, at a 793-bed quaternary care institution with 60,000 annual ED visits. Use (number of examinations per 1000 ED visits) and yield (percentage of examinations positive for acute PE) of CT pulmonary angiography were compared before and after CDS implementation in August 2007. The authors included all adult patients presenting to the ED and developed and validated a natural language processing tool to identify acute PE diagnoses. Linear trend analysis was used to assess for variation in CT pulmonary angiography use. Logistic regression was used to determine variation in yield after controlling for patient demographic and clinical characteristics. Of 338,230 patients presenting to the ED, 6838 (2.0%) underwent CT pulmonary angiography. Quarterly CT pulmonary angiography use increased 82.1% before CDS implementation, from 14.5 to 26.4 examinations per 1000 patients (P<.0001) between October 10, 2003, and July 31, 2007. After CDS implementation, quarterly use decreased 20.1%, from 26.4 to 21.1 examinations per 1000 patients between August 1, 2007, and September 30, 2009 (P=.0379). Overall, 686 (10.0%) of the CT pulmonary angiographic examinations performed during the 6-year period were positive for PE; subsequent to CDS implementation, yield by quarter increased 69.0%, from 5.8% to 9.8% (P=.0323). Implementation of evidence-based CDS in the ED was associated with a significant decrease in use, and increase in yield, of CT pulmonary angiography for the evaluation of acute PE.

Analysis the reasons of pulmonary embolism after spine surgery in eleven patients

To discuss the clinical characteristics, early diagnosis and treatment for pulmonary embolism after spine surgery. From January 1995 to May 2006, 11 cases suffered pulmonary embolism after spine surgery in the total of 10 993 patients. The clinical characteristics, diagnosis and treatment of these 11 cases were retrospectively analyzed. The incidence of pulmonary embolism was 0.1% after spine surgery. Pulmonary embolism was found during 5 to 14 days after spine surgery (mean 9.8 days). All of them show characteristic syndrome of pulmonary embolism, such as difficult breathe, cardiopalmus, thoracodynia, hemoptysis. Five patients died, and the mortality was 45.5%. The earlier use of pulmonary angiography and embolectomy by catheter device, the lower mortality will be. It is significantly. Pulmonary embolism is one of the serious complications after spine surgery. It is the period of high happening on deadly PE and the mortality during 1 to 2 weeks after spine surgery. Pulmonary angiography and interventional therapy take an important part in the early diagnosis and treatment.

Diagnosis of pulmonary embolism in outpatients by sequential noninvasive tools.

Considerable progress has been made in pulmonary embolism (PE) diagnosis during the last 10 years. New, noninvasive tools such as D-dimer measurement and lower limb venous compression ultrasonography have been introduced as diagnostic strategies. Clinical evaluation of the likelihood of PE has been rehabilitated and has proven to be accurate and useful. The interpretation of lung scan results has become more standardized and clear to clinicians. Finally, two diagnostic strategies have been validated in large scale outcome studies. Both rely on a sequential combination of the aforementioned instruments and have safely treated more than 90% of patients without use of pulmonary angiography. The 3-month venous thromboembolic risk in patients in whom PE was ruled out and, hence, who did not undergo anticoagulation was less than 1% in both studies. In the absence of a formal comparison of their respective cost-effectiveness, choosing between these strategies rests on local preferences or logistics. Finally, spiral computed tomography (CT) seems promising and might modify the diagnostic work-up of PE in the near future. However, it is insufficiently validated, and its place in a rational diagnostic algorithm is not defined.

Pulmonary Embolism in Total Joint Arthroplasty

With a greater understanding of the prevention of thromboembolic complications, the incidence of fatal pulmonary embolism after total joint arthroplasty has declined. Although much of our knowledge is centered around deep vein thrombosis and its use as a marker for thromboembolic complications, little is known about the natural history of both symptomatic and asymptomatic pulmonary embolism. Although differing methods of prophylaxis have shown some success, the ideal agent has yet to be discovered. The use of serial lung scanning has shown great use in the diagnosis of pulmonary embolism. Additional studies using effective diagnostic tools are needed to evaluate the risk of recurrent embolism. Only then can the duration of treatment and prophylaxis be determined. Despite the many unanswered questions, the following conclusions can be drawn: (1) fatal pulmonary emboli are a preventable complication of total joint arthroplasty; (2) fatal emboli are often preceded by small and frequently asymptomatic emboli; (3) detection and appropriate therapeutic measures for asymptomatic emboli are possible with the use of serial lung scans and judicious use of pulmonary angiography; and (4) low-dose coumadin has proven to be the most effective agent in lowering the risk of asymptomatic, symptomatic, and fatal pulmonary emboli.

Survey on the use of pulmonary scintigraphy and angiography for suspected pulmonary thromboembolism in the UK

A survey of UK radiologists in 360 acute hospitals was undertaken to assess the current use of pulmonary angiography and radionuclide lung scanning in the investigation of suspected pulmonary thromboembolism (PTE). Replies were received from 340 (94%) hospitals, of which 48 (out of 50) were teaching hospitals or centres which perform cardiothoracic surgery. Lung scintigraphy was provided by 200 (59%) hospitals and angiography by 120 (35%), with 99 (29%) providing both. Twenty-two hospitals which could undertake angiography had not performed more than one angiogram for suspected PTE in the preceding 3 years. Average numbers of lung scans performed in each hospital were 21.8 per month, in contrast with an average of 4.1 angiograms (including digital subtraction angiography) per year performed for suspected PTE over the previous 3 years. The total number of V/Q lung scans performed for the diagnosis of PTE per year was approximately 47,000 compared with 490 pulmonary angiograms.

Echocardiographic diagnosis and surgical treatment of postpartum pulmonary embolism

Pulmonary embolism remains a problem in the United States in terms of both morbidity and mortality New diagnostic modalities to make rapid diagnosis are now available, and allow for bedside diagnosis of pulmonary embolism without the use of pulmonary angiography. As a reference, a case involving a postpartum patient is reviewed. Use of echocardiography, a device readily available even in small institutions, allowed for early diagnosis and institution of therapy in this particular case and in others. Diagnostic features of pulmonary embolism are discussed and the literature is reviewed.

Pulmonary Scintigraphy and the Diagnosis of Pulmonary Embolism: A Perspective

The authors attempt to demonstrate those circumstances for which perfusion scintigraphy, by itself, or in combination with ventilation scintiscanning, offers the best adjunctive information in excluding or confirming the presence of pulmonary embolism. They then identify those circumstances in which scintiscanning does not or cannot contribute significantly to the medical decision-making process. In these cases, the use of pulmonary angiography or possibly peripheral venography is not only recommended but, if warranted clinically, is absolutely necessary.

Pulmonary Angiography in Lung Diseases

The early clinical studies with angiocardiography included cases of pulmonary tuberculosis and other chest diseases, 1 but cardiologists have been the major users of contrast visualization of the heart and great vessels—primarily to identify abnormal blood vessels, pathologic intracardiac chamber communications, altered valve function, and obstruction to flow through the coronary arteries. The diagnostic usefulness of pulmonary angiography in disease of the lungs is becoming increasingly important—particularly in patients with bronchogenic carcinoma 2 or pulmonary embolism. 3 Patients with lung tumors that involve major pulmonary vessels have such a poor prognosis following surgical resection that angiographic demonstration of such involvement may well be sufficient to contraindicate surgical therapy. 4 The use of cardiopulmonary bypass has made it possible to remove embolic obstructions within the pulmonary vascular bed. Angiographic verification of an obstruction is essential prior to such an attempt. The general value, common hazards, and technical principles of pulmonary angiography

PULMONARY ANGIOGRAPHY IN THE DIAGNOSIS OF THROMBOEMBOLIC DISEASE.

PULMONARY angiography is potentially the most positive means for diagnosing thromboembolism of the lung. The importance of such a procedure can hardly be overstated when one is dealing with a diagnosis that is missed more often than it is made1 and in which recurrences may subsequently prove to be fatal. Since current therapy has been shown to improve prognosis significantly2 early diagnosis becomes especially important. The present report was prompted by the successful use of pulmonary angiography in 8 of 11 patients in whom the diagnosis of thromboembolic disease was suspected. Five cases of the group studied are presented in . . .