Imaging |

Ancillary Findings and Alternative Diagnoses in Patients Evaluated With CT-Pulmonary Angiography: Prevalence and Clinical Significance FREE TO VIEW

Apostolos Perelas, MD; Anastasios Dimou, MD; Augustina Saenz, MD; Ji Hyun Rhee, MD; Krittika Teerapuncharoen, MD; Adam Rowden, DO; Glenn Eiger, MD
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Internal Medicine, Einstein Medical Center Philadelphia, Philadelphia, PA

Chest. 2014;146(4_MeetingAbstracts):581A. doi:10.1378/chest.1964958
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SESSION TITLE: Ultrasound and Other Imaging Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: 1) To investigate the prevalence and clinical significance of ancillary findings in CT-pulmonary angiographic studies (CT-PA) of patients evaluated for pulmonary embolism (PE) at the Emergency Department 2) To identify the value of CT-PA in providing alternative diagnoses compared to standard chest X- ray (CXR).

METHODS: All adult patients investigated with CT-PA over a two year period were included in the initial analysis. 641 records were reviewed. Studies negative for PE were stratified into 3 categories according to clinical significance: type I studies prompted immediate action, type II studies had findings requiring follow up and type III studies had findings of limited or questionable clinical significance. We also reviewed CXR and CT-PA to determine whether they could provide alternative diagnoses in the non-PE patients.

RESULTS: 62 cases of pulmonary embolism were detected and excluded from further analysis. 115 of the remaining 579 studies were normal. Among the remaining 464 non-PE studies, 87 were characterized as type I, 98 type II and 279 type III. Pneumonia was the most common finding in type I, lung nodules in type II and atelectasis in type III studies. CT-PA identified alternative diagnoses in 14.33% of non-PE cases. When comparing CT-PA and CXR, CT could explain the patient’s presentation in 14.03% of non-PE cases and CXR in 9.88%.

CONCLUSIONS: Incidental findings are common in CT-PAs, and often can affect acute management. CT-PA is able to identify alternative diagnoses in a significant proportion of patients presenting with symptoms suspicious for PE, however its value is marginally higher compared to that of CXR. In conclusion, our data do not support the routine use of CT-PA for reasons other than the investigation of PE.

CLINICAL IMPLICATIONS: Although CT-PA can reveal ancillary findings in the majority of patients undergoing imaging for the exclusion of PE,its ability to provide alternative explanations for patients' symptoms is only marginally higher than that of CXR and should not be used routinely for that purpose.

DISCLOSURE: The following authors have nothing to disclose: Apostolos Perelas, Anastasios Dimou, Augustina Saenz, Ji Hyun Rhee, Krittika Teerapuncharoen, Adam Rowden, Glenn Eiger

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