Format

Send to

Choose Destination
Arch Surg. 2001 May;136(5):505-11.

Spiral computed tomography for the diagnosis of pulmonary embolism in critically ill surgical patients: a comparison with pulmonary angiography.

Author information

1
LAC+USC Medical Center, 1200 N State St, Room 9900, Los Angeles, CA 90033, USA. velmahos@hsc.usc.edu

Abstract

HYPOTHESIS:

Spiral computed tomographic pulmonary angiography (CTPA) is sensitive and specific in diagnosing pulmonary embolism (PE) in critically ill surgical patients.

DESIGN:

Prospective study comparing CTPA with the criterion standard, pulmonary angiography (PA).

SETTING:

Surgical intensive care unit of an academic hospital.

PATIENTS:

Twenty-two critically ill surgical patients with clinical suspicion of PE. The CTPAs and PAs were independently read by 4 radiologists (2 for each test) blinded to each other's interpretation. Clinical suspicion was classified as high, intermediate, or low according to predetermined criteria. All but 2 patients had marked pulmonary parenchymal disease at the time of the event that triggered evaluation for PE.

INTERVENTIONS:

Computed tomographic pulmonary angiography and PA in 22 patients, venous duplex scan in 19.

RESULTS:

Eleven patients (50%) had evidence of PE on PA, 5 in central and 6 in peripheral pulmonary arteries. The sensitivity and specificity of CTPA was, respectively, 45% and 82% for all PEs, 60% and 100% for central PEs, and 33% and 82% for peripheral PEs. Duplex scanning was 40% sensitive and 100% specific in diagnosing PE. The independent reviewers disagreed only in 14% of CTPA and 14% of PA interpretations. There were no differences in risk factors or clinical characteristics between patients with and without PE. The level of clinical suspicion was identical in the 2 groups.

CONCLUSIONS:

Pulmonary angiography remains the gold standard for the diagnosis of PE in critically ill surgical patients. Computed tomographic pulmonary angiography needs further evaluation in this population.

Comment in

PMID:
11343539
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Silverchair Information Systems
Loading ...
Support Center