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Pulmonary Vascular Disease |

Utility of Chest Computed Tomography Angiogram to Diagnose Pulmonary Embolus in Cancer Patients Who Presented in the Emergency Department FREE TO VIEW

Zubin Mukadam, MD; Chetan Kammari, MD; Pierre Tannous, MD; Ayman Soubani, MD
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Wayne State University/Detroit Receiving Hospital, Detroit, MI


Chest. 2014;146(4_MeetingAbstracts):827A. doi:10.1378/chest.1968705
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Abstract

SESSION TITLE: DVT/PE/Pulmonary Hypertension Posters II

SESSION TYPE: Original Investigation Poster

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

PURPOSE: Chest computed tomography angiograms (CTAs) are frequently ordered in emergency department (ED) to rule out pulmonary embolism (PE) in cancer patients presenting with respiratory symptoms. The aim of this study is to assess the yield of chest CTA under these circumstances.

METHODS: Records of 99 consecutive patients with cancer who presented to ED and received a CTA were reviewed between Jan 2012 to Dec 2012. The review included demographics, type and status of cancer, presentation, chest CT results, management based on CT findings and outcome of patients.

RESULTS: Out of the 99 patients, 73% were women and 27% were men with the mean age of 57 (std 14.4). African Americans comprised 62%, Caucasians 32%, with 6% other ethnicities. Diagnosis of PE was confirmed in four patients who all had active metastatic disease. All four patients with PE presented with dyspnea. Two out of the four patients with PE also reported hemoptysis. One patient had associated lower extremity edema, and another reported chest pain. Of the 99 patients, six patients had a Wells score greater than 4. Of these six patients, three had an acute PE. Only one patient with a Wells score of less than 4 was found to have a PE that was chronic in nature. Thirty six patients had a Wells score less than or equal to 1.5 and none of them were diagnosed with a PE. D-dimer was obtained in 33% of the patients and was positive in each case. Management was modified in 27 cases post CTA with the most frequent alteration being the initiation of antibiotic (13 cases) for pneumonia, COPD exacerbation, and lower extremity cellulitis. Diuresis was initiated in six cases for pulmonary edema, and surgery was consulted in four cases for thoracentesis (2), pericardial effusion (1), and pneumothorax (1). Anticoagulation was discontinued in one patient once PE was ruled out and treatment for NSTEMI was initiated in another patient. Of the four cases with positive PE, management was altered in two cases with the initiation of anticoagulation, while the other two cases had anticoagulation initiated prior to the CTA given the high likelihood of PE. Six cases had contrast induced nephropathy.

CONCLUSIONS: The use of CTA to rule out PE in patients with cancer is overused in our ED. Of the 99 CTA obtained, 36 could have been avoided by utilizing Wells criteria. D-dimer was found to be elevated in every case and did not aid in stratifying moderate risk patients.

CLINICAL IMPLICATIONS: Using Wells criteria in patients suspected for PE can decrease the number of CTA performed.

DISCLOSURE: The following authors have nothing to disclose: Zubin Mukadam, Chetan Kammari, Pierre Tannous, Ayman Soubani

No Product/Research Disclosure Information


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