SESSION TYPE: DVT/PE/Pulmonary Hypertension Posters II
PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM
PURPOSE: CTPA is the procedure of choice in the diagnosis of PE . It has a high sensitivity and specificity and diagnoses other diseases. However CTPA is contraindicated in patients with renal failure, allergy to iodinated contrast and in pregnancy. In such patients diagnosis is solely made on V/Q .PIOPED study noted that most patients with ultimate diagnosis of PE had non- high probability lung scan (Intermediate+ Low probability) and many needed additional studies to confirm/exclude PE. We report our experience in such patients with underlying cardiopulmonary diseases, which clinically confounds the diagnosis of PE.
METHODS: Retrospective review of all patients who were suspected to have PE and underwent V/Q as the initial diagnostic procedure.
RESULTS: Over a 5 month period from 8/11 to 12/11, 150 patients, had VQ; Males/Females, 50/100.with a median/range age, 65/(20-100) years. Chronic comorbidities: heart disease, 96; Lung, 58; Renal, 20, hematological, 10. Revised Geneva score(RGS) was calculated to assign Pretest clinical probability and this was related to V/Q lung probability as defined in PIOPED study to arrive at the final diagnosis of PE. High V/Q scan diagnosed PE in 19 and excluded PE in 59 patients with Normal V/Q. Among 72 with non-high V/Q scan, CTPA/Duplex US excluded PE in 33 and diagnosed DVT/PE in 8 patients. Of other 31 patients with non-high V/Q scan, 8 patients had a combination of low RGS and low V/Q and the DVT/PE was excluded. 9 patients were diagnosed with other pulmonary causes (asthma/COPD exacerbation/pneumonia/atelactasis), 14 patients had cardiac causes (NSTEMI/A fib/CHF exacerbation), to explain the symptoms, which resolved with specific therapy.
CONCLUSIONS: A combination of low clinical probability RGS and a low probability V/Q lung scan is sensitive in excluding PE. Identification of alternative diagnosis to explain patient’s symptoms and response to specific therapy helped exclude DVT/PE in others. In patients with underlying cardiopulmonary diseases, a combination of Non-high probability lung scan and Intermediate/High clinical probability RGS has a low specificity in diagnosing PE. In patients who could not undergo CTPA, V/Q lung scan is inconclusive in many.further diagnostic studies were not pursued because of alternative diagnoses.
CLINICAL IMPLICATIONS: V/Q is conclusive in a minority of patients with chronic co-morbid cardiopulmonary diseases, A Non-high probabilityV/Q has limited utility in excluding PE in the context of Intermediate/High RGS.
DISCLOSURE: The following authors have nothing to disclose: Vijay Vanam, Viswanath Vasudevan, Praveen Jinnur, Rana Ali, Farhad Arjomand, In Suk Seo, Pooja Vasudevan, Ou Yang
No Product/Research Disclosure InformationThe Brooklyn Hospital Centre, Brooklyn, NY