Abstract
Aim
In this retrospective study, we assess the current role and future potential of computed
tomography (CT) in the diagnostic algorithm of acute pulmonary embolism (PE).
Materials and methods
Two hundred patients underwent 64-multidetector-row spiral CT of the chest, pelvis,
and thigh for suspected PE. CT scans were reviewed, and the degree of contrast enhancement
and the presence of PE and/or (deep) venous thrombosis were recorded. In the case
of PE, the level of thrombus was noted as central, main, or lobar. If the scan yielded
a positive result for thrombosis, intravenous localization was also determined. Patient
age, length of admission, clinical course, clinical indication, and incidental findings
were registered as well.
Results
PE was detected in 60 of the 200 patients with a high clinical probability of having
PE (30%). Thirty-four patients had a positive CT scan result for venous thrombosis
(17%). Twenty-four of the 60 patients had proximal deep venous thrombosis (40%), and
2 patients had arm venous thrombosis (3%). Thirty-four of the 60 patients had PE without
venous thrombosis (57%). Eight of the 200 patients had deep venous thrombosis without
suspicion of PE (4%). The distribution of the proximal thrombi showed 15 in a central
artery (25%), 13 in a main pulmonary artery (22%), and 32 in a lobar segmental artery
(53%). There was diffuse allocation of the thrombus in all lobes. Furthermore, CT
scan noted a total of 120 incidental findings.
Conclusion
Our study indicates the potential clinical use of a diagnostic strategy for ruling
out PE based on D-dimer testing and multidetector-row CT. A larger outcome study is needed before this
approach can be adopted.
Keywords
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Article info
Publication history
Published online: April 24, 2008
Accepted:
January 30,
2008
Received:
August 2,
2007
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
