Radiographic findings with radiologic predictor of severity of acute pulmonary embolism in Sakaeo Crown Prince Hospital
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Abstract
Background: Acute pulmonary embolism (APE) is a major public health problem that may present as a clinically challenging or life-threatening condition.
Objectives: To determine radiographic findings with a radiologic predictor of the severity of APE in Sakaeo Crown Prince Hospital.
Methods: Clinical and radiological data of 79 patients with APE were analyzed. All patients were classified by severity into massive and non-massive PE.
Result: 79 patients were recruited to participate in the study. Out of these 79 patients, 21.5% (17/79) were diagnosed with massive APE. The mean age was 56.30±14.90 years old (range 27 - 88). The most common chief complaint was dyspnea (62.0%). The most frequent risk factor was malignancy. Chest radiographic outcomes showing prominent central PA, a decrease in the vascularity of affected areas, and the presence of Knuckle sign were shown to be significantly related to massive PE (p<0.05). CTPE outcomes show that pulmonary obstructive index, RV/LV ratio, VSB grade 2, IVC reflux , decrease width LA/ pulmonary vein , SVC diameter, RA chamber diameter, intraluminal high attenuation and dilatation of central and segmental pulmonary arteries are significantly related to massive PE (p<0.05) . Furthermore, dilatation of the RA chamber and prominent central PA and IVC reflux grade 4-6 were statistically significant factors in the prediction of the severity of APE in multivariate analysis.
Conclusions: An increase in the diameter of the RA chamber (ranging from 57.00 mm(52.00, 61.00)), Prominent central PA(cut off >3.32 cm) and IVC Reflux: Grade 4-6 can predict the severity of acute pulmonary embolism.
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References
Sista AK, Kuo WT, Schiebler M, Madoff DC. Stratification, imaging and management of acute massive and submassive pulmonary embolism. Radiology 2017;284:5-24.
Pussadhamma B. Acute pulmonary embolism.Srinagarind Med J 2014;29: 485-96.
Belohlavek J, Dytrych V, Linhart A. Pulmonary embolism, part I: Epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism. Exp Clinical cardiology 2013;18 :129-38.
British Thoracic Society Standards of Care Committee Pulmonary Embolism Guideline Development Groups. British Thoracic Society guidelines for the management of suspected acute pulmonary embolism.Thorax 2003;58:470-83.
Ghaye B, Ghuysen A, Bruyere PJ, D'Orio V, Dondelinger RF. Can CT pulmonary angiography allow assessment of severity and prognosis in patients presenting with pulmonary embolism? what the radiologist needs to know.Radiographics 2006;26:23-39.
Araoz PA, Gotway MB, Harrington JR, Harmsen WS, Mandrekar JN. Pulmonary embolism: prognostic CT Findings. Radiology 2007;242: 889-97.
Berghaus TM, Haeckel T, Behr W, Wehler M, von Scheidt W, Schwaiblmair M. Central thromboembolism is a possible predictor of right heart dysfunction in normotensive patients with acute pulmonary embolism. Thromb Res 2010;126:201-5.
Chaosuwannakit N, Makarawate P. Prognostic value of right ventricular dysfunction and pulmonary obstruction index by commuted tomographic pulmonary angiography in patients with acute pulmonary embolism. J Med Assoc Thai 2012;95:1457-65.
Dahnert W. Radiology Review Manual. 7th ed. Philadelphia : Lippincott Williams &Winkins, 2011.
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;176:1415-20.
Hefeda MM, Elmasry MM. Prediction of short term outcome of pulmonary embolism: Parameters at 16 multi-detector CT pulmonary angiography. The Egyptian Journal of Radiology and Nuclear Medicine 2014;45:1089-98.
Groves AM, Win T, Charman SC, Wisbey C, Pepke-Zaba J, CouldenRA.Semi-quantitative assessment of tricuspidregurgitation on contrast-enhancedmultidetector CT. ClinRadiol 2004; 59: 715–9.
Collomb D, Paramelle PJ, Calaque O, Bosson JL, Vanzetto G, Barnoud D, et al. Severity assessment of acute pulmonary embolism: evaluation using helical CT. EurRadiol 2003; 13:1508-14.
Aviram G, Rogowski O, Gotler Y, Bendler A, Steinvil A, GoldinY,et al. Real-time risk stratification of patients with acute pulmonary embolism by grading the reflux of contrast intothe inferior vena cava on computerized tomographic pulmonary angiography. J ThrombHaemost 2008;6:1488-93.
van der Meer RW, Pattynama PM, van Strijen MJ, van den Berg-Huijsmans AA, Hartmann IJ, Putter H, et al. Right ventricular dysfunction and pulmonary obstruction index at helical CT: prediction of clinical outcome during 3-months follow up in patient with acute pulmonary embolism . Radiology 2005;235:798-803.
Araoz PA, Gotway MB, Harrington JR, Harmsen WS, Mandrekar JN. Pulmonary embolism :prognosis CT findings. Radiology 2007;242:889-97.
Hama Y, Yakushiji T, Iwasaki Y, Kaji T, Isomura N, Kusano S. Small left atrium:anadjunctive sign of hemodynamically compromised massive pulmonary embolism. Yonsei Med J 2005; 46:733-6.
Aviram G, Soikher E, Bendet A, Shmueli H, Ziv-Baran T, Amitai Y, et al. Prediction of mortality in pulmonary embolism based on left atrial volumemeasured on CT pulmonary angiography.Chest 2016;149:667-75.
Kirsch J, Kirby A, Williamson EE. Venous anatomy of the thorax. In: Ho VB, Reddy GP, Editors. Cardiovascular imaging. St Louis: Elsevier, 2011; p 1001.
Dillman JR, Yarram SG, Hernandez RJ. Imaging of pulmonary venous developmental anomalies. AJR Am J Roentgenol2009;192:1272–85.
Sompradeekul S, Ittimakin S. Clinical Characteristics and Outcome of Thai Patients with Acute Pulmonary Embolism. J Med Asso Thai 2007;90(Suppl 2):67-72.
ConcattoNH,DowichV,Soldatelli MD, Pelepenko Teixeira SL, Da Conceição TMB, da SilveiraArruda B, et al.Measuring cardiac chambers in non-ECG-gated thoracic CT: what the radiologist needs to know. European society of Radiology [Internet].2018 [cited 2019 Mar 8];1-18. Available from: https://posterng.netkey.at/esr/viewing/index.php?module=viewing_posteraction&task=downloadpdf&pi=142700
Miller RL, Das S, Anandarangam T, Leibowitz DW, Alderson PO, Thomashow B, et al. Association between right ventricular function and perfusion abnormalities in hemodynamically stable patients with acute pulmonary embolism. Chest 1998;113:665-70.
Maceira AM, Cosín-Sales J, Roughton M, Prasad SK, Pennell DJ. Reference right atrial dimensions and volume estimation by steady state free precession cardiovascular magnetic resonance. J CardiovascMagnReason[Internet]. 2013[cited 2019 Mar 8] ;15:29. Available From: https://jcmr-online.biomedcentral.com/track/pdf/10.1186/1532-429X-15-29
Lobo JL, Zorrilla V, Nieto JA, Gomez V, García-Bragado F, Bueso T, et al. Right atrial size and 30-day mortality in normotensive patients with pulmonary embolism.JPulmRespir Med [Internet]. 2014[cited 2019 Mar 8];4:6. Available from: https://www.omicsonline.org/open-access/right-atrial-size-and-day-mortality-in-normotensive-patients-with-pulmonary-embolism-2161-105X.1000218.pdf