Spiral computed tomography for the diagnosis of pulmonary embolism in critically ill surgical patients: a comparison with pulmonary angiography

Archives of Surgery
G C VelmahosD Demetriades

Abstract

Spiral computed tomographic pulmonary angiography (CTPA) is sensitive and specific in diagnosing pulmonary embolism (PE) in critically ill surgical patients. Prospective study comparing CTPA with the criterion standard, pulmonary angiography (PA). Surgical intensive care unit of an academic hospital. Twenty-two critically ill surgical patients with clinical suspicion of PE. The CTPAs and PAs were independently read by 4 radiologists (2 for each test) blinded to each other's interpretation. Clinical suspicion was classified as high, intermediate, or low according to predetermined criteria. All but 2 patients had marked pulmonary parenchymal disease at the time of the event that triggered evaluation for PE. Computed tomographic pulmonary angiography and PA in 22 patients, venous duplex scan in 19. Eleven patients (50%) had evidence of PE on PA, 5 in central and 6 in peripheral pulmonary arteries. The sensitivity and specificity of CTPA was, respectively, 45% and 82% for all PEs, 60% and 100% for central PEs, and 33% and 82% for peripheral PEs. Duplex scanning was 40% sensitive and 100% specific in diagnosing PE. The independent reviewers disagreed only in 14% of CTPA and 14% of PA interpretations. There were no differences in ris...Continue Reading

Citations

May 31, 2003·Thorax·UNKNOWN British Thoracic Society Standards of Care Committee Pulmonary Embolism Guideline Development Group
Jan 31, 2007·Annals of Family Medicine·Jodi B SegalEric B Bass
Nov 18, 2004·AJR. American Journal of Roentgenology·John EngEric B Bass
Feb 21, 2002·Lancet·J Kelly, B J Hunt
Sep 26, 2003·The New England Journal of Medicine·Peter F Fedullo, Victor F Tapson
Mar 15, 2002·Journal of the American College of Surgeons·David B Hoyt
Mar 31, 2015·PloS One·Wei HuangAlexander T Cohen
Apr 11, 2003·Clinics in Chest Medicine·Ana T Rocha, Victor F Tapson
May 25, 2011·Journal of Intensive Care Medicine·Peter S MarshallMark D Siegel
Mar 6, 2003·Scottish Medical Journal·J M C Yeung, K Lingam

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