Prevalence of acute pulmonary embolism in CT pulmonary angiography of patients with clinically suspected acute pulmonary embolism at Sunprasitthiprasong Hospital

Authors

  • Somrutai Pongam Department of Radiology, Sunprasitthiprasong Hospital

Keywords:

Acute pulmonary embolism, Computed tomography of pulmonary artery, Clinical pre-test probability group, Wells criteria

Abstract

The purposes of this research were to assess the prevalence of acute pulmonary embolism in CT pulmonary angiography (CTPA) of patients with clinically suspected acute pulmonary embolism at Sunprasitthiprasong Hospital and to assess significant CTPA findings in acute pulmonary embolism of all severity groups. The descriptive retrospective study was composed of all patients with clinically suspected acute pulmonary embolisms and sent for CTPA at Sunprasitthiprasong Hospital from January 2017 to March 2020. There were 195 patients with clinically suspected acute pulmonary embolism and those sent for CTPA. Acute pulmonary embolism was found in 65 patients. The prevalence of acute pulmonary embolism was 33.3%. For subgroups by clinical probability based on Wells criteria, the prevalence of acute pulmonary embolism in the low, moderate, and high probability group were 15.2%, 38.6%, and 73.3%, respectively. The patients with acute pulmonary embolism were subsequently divided into three groups of severity by risk stratification: low risk, intermediate (submassive pulmonary embolism), and high risk (massive pulmonary embolism). The CTPA findings in patients with acute pulmonary embolism of statistical significance (p < 0.05) were the ratio of the transverse diameter of right ventricular chamber and left ventricular chamber more than 1.0 and abnormal position of the interventricular septum, which found 71.1% and 68.4% in intermediate-risk, and 76.2% and 90.5% in high risk. This study supported the importance of effective triage in proper CTPA usage.

References

Cohen AT, Agnelli G, Anderson FA, Arcelus JI, Bergqvist D, Brecht JG, et al. Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost 2007;98(4):756-64.

Aniwan S, Rojnuckarin P. High incidence of symptomatic venous thromboembolism in Thai hospitalized medical patients without thromboprophylaxis. Blood Coagul Fibrinolysis 2010;21(4):334-8.

กมลวรรณ เอี้ยงฮง, ชิดชนก เปลี่ยนศรี, กรกฏ อภิรัตน์วรากุล. อาการทางคลินิกและผลการรักษาของผู้ป่วยที่ได้รับการวินิจฉัยว่าเป็นโรคลิ่มเลือดอุดกั้นในปอดเฉียบพลันที่ห้องฉุกเฉิน โรงพยาบาลระดับมหาวิทยาลัย ภาคตะวันออกเฉียงเหนือ ประเทศไทย. ศรีนครินทร์เวชสาร 2563;35:141-6.

Shujaat A, Shapiro JM, Eden E. Utilization of CT Pulmonary Angiography in Suspected Pulmonary Embolism in a Major Urban Emergency Department. Pulm Med 2013;2013:915213.

van Belle A, Buller HR, Huisman MV, Huisman PM, Kaasjager K, Kamphuisen PW, et al. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA 2006;295(2):172-9.

Wolf SJ, McCubbin TR, Feldhaus KM, Faragher JP, Adcock DM. Prospective validation of Wells Criteria in the evaluation of patients with suspected pulmonary embolism. Ann Emerg Med 2004;44(5):503-10.

Ferreira EV, Gazzana MB, Sarmento MB, Guazzelli PA, Hoffmeister MC, Guerra VA, et al. Alternative diagnoses based on CT angiography of the chest in patients with suspected pulmonary thromboembolism. J Bras Pneumol 2016;42(1):35-41.

Vongchaiudomchoke T, Boonyasirinant T. Positive Pulmonary Computed Tomography Angiography in Patients with Suspected Acute Pulmonary Embolism: Clinical Prediction Rules, Thromboembolic Risk Factors, and Implications for Appropriate Use. J Med Assoc Thai 2016;99(1):25-33.

Wells PS, Anderson DR, Rodger M, Stiell I, Dreyer JF, Barnes D, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med 2001;135(2):98-107.

Ceriani E, Combescure C, Le Gal G, Nendaz M, Perneger T, Bounameaux H, et al. Clinical prediction rules for pulmonary embolism: a systematic review and meta-analysis. J Thromb Haemost 2010;8(5):957-70.

Qanadli SD, El Hajjam M, Vieillard-Baron A, Joseph T, Mesurolle B, Oliva VL, et al. New CT index to quantify arterial obstruction in pulmonary embolism: comparison with angiographic index and echocardiography. AJR Am J Roentgenol 2001;176(6):1415-20.

Vedovati MC, Germini F, Agnelli G, Becattini C. Prognostic role of embolic burden assessed at computed tomography angiography in patients with acute pulmonary embolism: systematic review and meta-analysis. J Thromb Haemost 2013;11(12):2092-102.

Meinel FG, Nance JW, Jr., Schoepf UJ, Hoffmann VS, Thierfelder KM, Costello P, et al. Predictive Value of Computed Tomography in Acute Pulmonary Embolism: Systematic Review and Meta-analysis. Am J Med 2015;128(7):747-59 e2.

Dogan H, de Roos A, Geleijins J, Huisman MV, Kroft LJ. The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism. Diagn Interv Radiol 2015;21(4):307-16.

Bach AG, Nansalmaa B, Kranz J, Taute BM, Wienke A, Schramm D, et al. CT pulmonary angiography findings that predict 30-day mortality in patients with acute pulmonary embolism. Eur J Radiol 2015;84(2):332-7.

Konstantinides SV, Meyer G. The 2019 ESC Guidelines on the Diagnosis and Management of Acute Pulmonary Embolism. Eur Heart J 2019;40(42):3453-5.

Donze J, Le Gal G, Fine MJ, Roy PM, Sanchez O, Verschuren F, et al. Prospective validation of the Pulmonary Embolism Severity Index. A clinical prognostic model for pulmonary embolism. Thromb Haemost 2008;100(5):943-8.

Moore AJE, Wachsmann J, Chamarthy MR, Panjikaran L, Tanabe Y, Rajiah P. Imaging of acute pulmonary embolism: an update. Cardiovasc Diagn Ther 2018;8(3):225-43.

Aviram G, Rogowski O, Gotler Y, Bendler A, Steinvil A, Goldin Y, et al. Real-time risk stratification of patients with acute pulmonary embolism by grading the reflux of contrast into the inferior vena cava on computerized tomographic pulmonary angiography. J Thromb Haemost 2008;6(9):1488-93.

นรินทร อู่ทรัพย์. ผลการตรวจทางรังสีวิทยากับปัจจัยทำนายความรุนแรงของผู้ป่วยโรคลิ่มเลือดอุดกั้นในปอดเฉียบพลัน โรงพยาบาลสมเด็จพระยุพราชสระแก้ว. วารสารศูนย์การศึกษาแพทยศาสตร์คลินิก โรงพยาบาลพระปกเกล้า 2563;37(2):105-14.

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Published

2021-12-19

How to Cite

Pongam, S. (2021). Prevalence of acute pulmonary embolism in CT pulmonary angiography of patients with clinically suspected acute pulmonary embolism at Sunprasitthiprasong Hospital. Journal of Medicine and Public Health, Ubon Ratchathani University, 5(1), 22–34. Retrieved from https://he01.tci-thaijo.org/index.php/jmpubu/article/view/252572

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Section

Research Articles