Commentary. Lung scintigraphy vs spiral CT in the assessment of pulmonary emboli

Study of clinical profile and management of patients with pulmonary embolism - single center study

OBJECTIVE

To study the clinical profile, diagnostic methods and management in patients with symptomatic pulmonary embolism (PE).

METHODS

Retrospective assessment of clinical features and management of patients presenting with symptomatic pulmonary embolism from January 2005 to March 2012.

RESULTS

35 patients who were newly diagnosed to have pulmonary embolism with a mean age of 52.1 years were included in the study. Dyspnea (91.4%) and syncope (22.8%) were the predominant symptoms. Echocardiography was done in all patients. 30 patients (85.7%) had pulmonary arterial hypertension, 31 patients (88.5%) had evidence of RV dysfunction and 4 patients (16.7%) had evidence of thrombus in PA, RV. Out of 35 patients, 34 patients (97.14%) showed positive d-dimer reports. Among 35 patients, 24 (68.5%) had positive troponin values. V/Q scan was done in 14 patients (40%) and CT pulmonary angiogram (CTPA) was done in 24 patients (68.5%.). Thrombolysis was done is 24 patients (68.5%). All patients received low molecular weight heparin followed by warfarin. Of the 35 patients, 34 (97.1%) were discharged and were under regular follow up for 6 months and one patient died during the hospital stay.

CONCLUSION

Pulmonary embolism is a common problem and can be easily diagnosed provided it is clinically suspected. Early diagnosis and aggressive management is the key to successful outcome.

Radionuclide imaging of acute pulmonary embolism

Pulmonary embolism (PE) is a potentially fatal condition for which treatment is highly effective. The diagnosis of PE can be challenging and often requires diagnostic imaging. For many years, chest radiographs and ventilation-perfusion (V/Q) scintigraphy have been the primary imaging modalities used in the evaluation of patients with suspected acute PE. The combination of clinical assessment, plus results of V/Q scintigraphy and a noninvasive venous study of the lower extremities can provide clinicians with the information needed to direct treatment in the majority of patients with suspected PE. More recently, advances in computerized tomography (CT) angiography have allowed for the direct visualization of PE, and this technique has emerged as an important diagnostic test in the evaluation of patients with suspected PE. Proponents suggest that CT angiography should be used as the first line imaging test in patients with suspected PE. Others suggest that V/Q scanning should remain as the first line diagnostic imaging test and that CT angiography should be used in patient's in whom the diagnosis remains uncertain. The combination of CT angiography and CT venography has the potential to provide a single comprehensive study of patients with suspected venous thromboembolism.