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QJM. 2009 Jun;102(6):407-14. doi: 10.1093/qjmed/hcp041. Epub 2009 Apr 17.

Clinically suspected acute pulmonary embolism: a comparison of presentation, radiological features and outcome in patients with and without PE.

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1
Respiratory Medicine Unit, New Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, Scotland, UK. ahsan.akram@hotmail.co.uk

Abstract

BACKGROUND:

Relatively little is known about prognosis in patients for whom suspected pulmonary embolism (PE) is refuted by imaging.

AIM:

This prospective study of suspected PE therefore compared clinico-radiological features and outcome in patients with and without PE.

DESIGN AND METHODS:

Computed tomographic pulmonary angiography (CTPA) confirmed or refuted PE in consecutive patients. Clinical, laboratory and radiological features were recorded at baseline, and mortality at 1 year determined. Univariate and multivariate analyses identified variables associated with PE.

RESULTS:

PE was diagnosed in 45 patients and refuted in 141. The PE and 'non-PE' groups were similar with regard to extravascular radiology (though consolidation was significantly more common in the PE group [present in 24 (53%) of the PE group and 42 (30%) of the non-PE group, P < 0.01)], comorbidities (no significant differences), and baseline characteristics (only serum D-dimer concentrations were independently associated with PE by multivariate analysis, P = 0.001). Right ventricular dimensions were significantly higher in the PE group, [right ventricular to left ventricular ratio was 0.98 (range 0.64-2.48) in the PE group and 0.92 (range 0.66-1.95) in the non-PE group, P < 0.05]. In the PE group, right ventricular dimensions rose sharply when 10 or more segmental pulmonary arteries were occluded. One year all-cause mortality was 6.7% in the PE group and 13.5% in the non-PE group (no significant difference, P = 0.218).

CONCLUSION:

Among a cohort of patients presenting with clinically suspected PE, clinical characteristics, co-morbidities and radiological features were similar when comparing groups with CTPA-proven or CTPA-refuted PE. However RV dimensions, radiological consolidation on imaging and D-dimer levels were significantly higher in the PE group. Patients with suspected PE have a poor prognosis irrespective of whether PE is confirmed. This appears accentuated in patients without PE, a finding possibly under-recognized in clinical practice.

PMID:
19376792
DOI:
10.1093/qjmed/hcp041
[Indexed for MEDLINE]
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