Pulmonary embolism (PE) remains one of the most underrecognized medical diagnoses. Clinical presentation, D-dimer and imaging studies combined, remain the cornerstone of the PE diagnosis. Currently used imaging studies (CT-PA and VP scan) are similar in sensitivity and specificity of. The availability and the relative rapidity of the CTPA make it the first diagnostic tool in the inpatient settings. There is a large number of disorders incidentally discovered during the CTPA especially in elderly population with multiple morbidities. The aim of our study is to quantify the frequency of such findings in this group of population.
We retrospectively analyzed 47 charts of elderly patients (more than 65 years of age) who underwent CTPA for diagnosis of pulmonary embolism. All the patients had a moderate to high pretest probability for PE. CT findings, clinical presentation and the past medical history were analyzed in detail.
Out of 47 elderly patients (mean age 74,5) included in the study, 10 of them were found to have PE, 3 bilateral central and 7 cases with segmental/subsegmental filling defects. Interestingly, alternative findings were seen in more than 50% of CTPA results: bilateral atelectasis (4), consolidations (8), unilateral/bilateral effusions (11), pericardial effusion (1), SVC thrombus (1), IVC thrombus (1), brachiocephalic vein thrombus (1), aortic aneurysm with mural thrombus (1), aspergilloma (1), loculatedpneumothorax (1), thymic/mediastinal mass (3), large substernalgoitre (1), lung mass (2). All the alternative findings were not part of the clinical presentation or the past medical history of the patients.
CTPA allows assessment of not only pulmonary thromboembolism, but also the evaluation of the bronchi, lung parenchyma, mediastinum and heart. Unknown disorders can be incidentally identified during the CTPA especially in the elderly population with multiple comorbidities.
CTPA is increasingly used for the detection of pulmonary embolism. The availability and the relative rapidity of the CTPA and the possibility to identify other pathologies makes it the preferred procedure compared to other modalities, especially in elderly population.
Seema Naik, None.