Skip to main content
SpringerLink
Log in

Pulmonary Thromboembolic Disease

  • Chapter
  • First Online:
Clinically Oriented Pulmonary Imaging

Part of the book series: Respiratory Medicine ((RM))

  • 2178 Accesses

Abstract

Diagnostic imaging for acute pulmonary embolism has evolved; CT angiography of the chest is now considered the gold standard for diagnosis. The chest radiograph has limited utility, but can occasionally detect an alternative diagnosis. Although not frequently used, ventilation/perfusion scan can be diagnostic, particularly in the setting of a normal chest radiograph. Clinical features, including risk factors and presenting signs and symptoms, should be utilized to assess pre-test probability and guide diagnostic imaging choices. Unique situations, such as renal failure and pregnancy, will potentially alter the diagnostic decisions.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Anderson FA Jr, Wheeler HB, Goldberg RJ, et al. A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism: the Worcester DVT study. Arch Intern Med. 1991;151:933–8.

    Article  PubMed  Google Scholar 

  2. Silverstein MD, Heit JA, Mohr DN, Petterson TM, O’Fallon WM, Melton LJ 3rd. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med. 1998;158:585–93.

    Google Scholar 

  3. Dalen JE, Alpert JS. Natural history of pulmonary embolism. Prog Cardiovasc Dis. 1975;17(4):259–70.

    Article  PubMed  CAS  Google Scholar 

  4. Spencer FA, Emery C, Lessard D, et al. The Worcester venous thromboembolism study: a population-based study of the clinical epidemiology of venous thromboembolism. J Gen Intern Med. 2006;21:722–7.

    Article  PubMed  Google Scholar 

  5. Hirsh J, Hull RD, Raskob GE. Epidemiology and pathogenesis of venous thrombosis. J Am Coll Cardiol. 1986;8(6 Suppl B):104B–13B.

    Google Scholar 

  6. Alikhan R, Cohen AT, Combe S, et al. Risk factors for venous thromboembolism in hospitalized patients with acute medical illness: analysis of the MEDENOX Study. Arch Intern Med. 2004;164(9):963–8.

    Article  PubMed  Google Scholar 

  7. Anderson FA Jr, Spencer FA. Risk factors for venous thromboembolism. Circulation. 2003;107(23 Suppl 1):I9–26.

    Google Scholar 

  8. Stein PD, Beemath A, Matta F, et al. Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II. Am J Med. 2007;120(10):871–9.

    Article  PubMed  Google Scholar 

  9. West J, Goodacre S, Sampson F. The value of clinical features in the diagnosis of acute pulmonary embolism: systematic review and meta-analysis. QJM. 2007;100(12):763–9.

    Article  PubMed  CAS  Google Scholar 

  10. Stein PD, Henry JW. Clinical characteristics of patients with acute pulmonary embolism stratified according to their presenting syndromes. Chest. 1997;112(4):974–9.

    Article  PubMed  CAS  Google Scholar 

  11. Wells PS, Anderson DR, Rodger M, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med. 2001;135(2):98–107.

    PubMed  CAS  Google Scholar 

  12. Wolf SJ, McCubbin TR, Feldhaus KM, Faragher JP, Adcock DM. Prospective validation of Wells criteria in the evaluation of patients with suspected pulmonary embolism. Ann Emerg Med. 2004;44(5):503–10.

    Article  PubMed  Google Scholar 

  13. van Belle A, Büller HR, Huisman MV, et al. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA. 2006;295(2):172–9.

    Article  PubMed  Google Scholar 

  14. Pasha SM, Klok FA, Snoep JD, et al. Safety of excluding acute pulmonary embolism based on an unlikely clinical probability by the Wells rule and normal D-dimer concentration: a meta-analysis. Thrombosis Res. 2010;125:e123–7.

    Article  CAS  Google Scholar 

  15. Kline JA, Courtney DM, Kabrhel C, Moore CL, Smithline HA, Plewa MC, Richman PB, OÕNeil BJ, Nordenholz K. Prospective multicenter evaluation of the pulmonary embolism rule-out criteria. J Thromb Haemost. 2008;6:772–80.

    Article  PubMed  CAS  Google Scholar 

  16. Carrier M, Righini M, Djurabi RK, et al. VIDAS D-dimer in combination with clinical pre-test probability to rule out pulmonary embolism: a systematic review of management outcome studies. Thromb Haemost. 2009;101:886–92.

    PubMed  CAS  Google Scholar 

  17. Brotman DJ, Segal JB, Jani JT, Petty BG, Kickler TS. Limitations of D-dimer testing in unselected inpatients with suspected venous thromboembolism. Am J Med. 2003;114:276–82.

    Article  PubMed  Google Scholar 

  18. Hirai LK, Takahashi JM, Yoon HC. A prospective evaluation of a quantitative D-dimer assay in the evaluation of acute pulmonary embolism. J Vasc Interv Radiol. 2007;18:970–4.

    Article  PubMed  Google Scholar 

  19. Elliott CG, Goldhaber SZ, Visani L, DeRosa M. Chest radiographs in acute pulmonary embolism: results from the International Cooperative Pulmonary Embolism Registry. Chest. 2000;118:33–8.

    Article  PubMed  CAS  Google Scholar 

  20. The PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism: results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA. 1990;263(20):2753–59.

    Google Scholar 

  21. Sostman HD, Miniati M, Gottschalk A, Matta F, Stein PD, Pistolesi M. Sensitivity and specificity of perfusion scintigraphy combined with chest radiography for acute pulmonary embolism in PIOPED II. J Nucl Med. 2008;49:1741–8.

    Article  PubMed  Google Scholar 

  22. Stein PD, Freeman LM, Sostman HD, et al. SPECT in acute pulmonary embolism. J Nucl Med. 2009;50:1999–2007.

    Article  PubMed  Google Scholar 

  23. Coxson HO, Baile EM, King GG, Mayo JR. Diagnosis of subsegmental pulmonary emboli: a multi-center study using a porcine model. J Thorac Imaging. 2005;20:24–31.

    Article  PubMed  Google Scholar 

  24. Quinn MF, Lundell CJ, Klotz TA, et al. Reliability of selective pulmonary arteriography in the diagnosis of pulmonary embolism. AJR. 1987;149:469–71.

    PubMed  CAS  Google Scholar 

  25. Stein PD, Fowler SE, Goodman LR, et al. Multidetector comuted tomography for acute pulmonary embolism. N Engl J Med. 2006;354:2317–27.

    Article  PubMed  CAS  Google Scholar 

  26. Stein PD, Woodard PK, Weg JG, et al. Diagnostic pathways in acute pulmonary embolism: recommendations of the PIOPED II investigators. Am J Med. 2006;119:1048–55.

    Article  PubMed  Google Scholar 

  27. Kuriakose J, Patel S. Acute pulmonary embolism. Radiol Clin N Am. 2010;48:31–50.

    Article  PubMed  Google Scholar 

  28. Pesavento R, de Conti G, Minotto I, et al. The value of 64-detector row computed tomography for the exclusion of pulmonary embolism. Thromb Haemost. 2011;105(5):901–7.

    Google Scholar 

  29. Coche E, Verschuren F, Keyeux A, et al. Diagnosis of acute pulmonary embolism in outpatients: comparison of thin-collimation multi–detector row spiral CT and planar ventilation-perfusion scintigraphy. Radiology. 2003;229:757–65.

    Article  PubMed  Google Scholar 

  30. Brunot S, Corneloup O, Latrabe V, Montaudon M, Laurent F. Reproducibility of multidetector spiral computed tomography in detection of subsegmental acute pulmonary embolism. Euro Radiol. 2005;15:2057–63.

    Article  CAS  Google Scholar 

  31. Perrier A, Roy PM, Sanchez O, et al. Multidetector-row computed tomography in suspected pulmonary embolism. N Engl J Med. 2005;352:1760–8.

    Article  PubMed  CAS  Google Scholar 

  32. Eyer BA, Goodman LR, Washington L. Clinicians’ response to radiologists’ reports of isolated subsegmental pulmonary embolism or inconclusive interpretation of pulmonary embolism using MDCT. Am J Roentgenol. 2005;184:623–8.

    Google Scholar 

  33. Donato AA, Khoche S, Santora J, Wagner B. Clinical outcomes in patients with isolated subsegmental pulmonary emboli diagnosed by multidetector CT pulmonary angiography. Thrombosis Res. 2010;126:e266–70.

    Article  CAS  Google Scholar 

  34. van der Meer RW, Pattynama PM, van Strijen MJ, et al. Right ventricular dysfunction and pulmonary obstruction index at helical CT: prediction of clinical outcome during 3-month follow-up in patients with acute pulmonary embolism. Radiology. 2005;235(3):798–803.

    Article  PubMed  Google Scholar 

  35. Lim KE, Chan CY, Chu PH, Hsu YY, Hsu WC. Right ventricular dysfunction secondary to acute massive pulmonary embolism detected by helical computed tomography pulmonary angiography. Clin Imaging. 2005;29(1):16–21.

    Article  PubMed  Google Scholar 

  36. Stein PD, Chenevert TL, Fowler SE, et al. Gadolinium-enhanced magnetic resonance angiography for pulmonary embolism: a multicenter prospective study (PIOPED III). Ann Intern Med. 2010;152(7):434–43, W142–3.

    Google Scholar 

  37. Hadizadeh DR, Gieseke J, Lohmaier SH, et al. Peripheral MR angiography with blood pool contrast agent: prospective intraindividual comparative study of high-spatial-resolution steady-state MR angiography versus standard-resolution first-pass MR angiography and DSA. Radiology. 2008;249(2):701–11.

    Google Scholar 

  38. Meyer T, Binder L, Hruska N, Luthe H, Buchwald AB. Cardiac troponin I elevation in acute pulmonary embolism is associated with right ventricular dysfunction. J Am Coll Cardiol. 2000;36(5):1632–6.

    Article  PubMed  CAS  Google Scholar 

  39. Pruszczyk P, Bochowicz A, Torbicki A, et al. Cardiac troponin T monitoring identifies high-risk group of normotensive patients with acute pulmonary embolism. Chest. 2003;123(6):1947–52.

    Article  PubMed  CAS  Google Scholar 

  40. Giannitsis E, Müller-Bardorff M, Kurowski V, et al. Independent prognostic value of cardiac troponin T in patients with confirmed pulmonary embolism. Circulation. 2000;102(2):211–7.

    PubMed  CAS  Google Scholar 

  41. Ferrari E, et al. The ECG in pulmonary embolism. Chest. 1997;111:537–43.

    Article  PubMed  CAS  Google Scholar 

  42. Stein PD, et al. Clinical characteristics of patients with acute pulmonary embolism. Am J Cardio. 1991;68:1723–4.

    Google Scholar 

  43. Gibson NS, Sohne M, Buller HR. Prognostic value of echocardiography and spiral computed tomography in patients with pulmonary embolism. Curr Opin Pulm Med. 2005;11(5):380–4.

    PubMed  Google Scholar 

  44. Roy PM, Colombet I, Durieux P, Chatellier G, Sors H, Meyer G. Systematic review and meta-analysis of strategies for the diagnosis of suspected pulmonary embolism. BMJ. 2005;331(7511):259.

    Article  PubMed  Google Scholar 

  45. Gandara E, Wells PS. Diagnosis: use of clinical probability algorithms. Clin Chest Med. 2010;31(4):629–39.

    Article  PubMed  Google Scholar 

  46. Prevention of venous thrombosis and pulmonary embolism. NIH consensus development. JAMA. 1986;256:744–9.

    Article  Google Scholar 

  47. Hurwitz LM, Yoshizumi T, Reiman RE, et al. Radiation dose to the fetus from body MDCT during early gestation. Am J Roentgenol. 2006;186:871–6.

    Article  Google Scholar 

  48. Bourjeily G, Chalhoub M, Phornphutkul C, Alleyne TC, Woodfield CA, Chen KK. Neonatal thyroid function: effect of a single exposure to iodinated contrast medium in utero. Radiology. 2010;256(3):744–50.

    Google Scholar 

  49. Revel MP, Cohen S, Sanchez O, et al. Pulmonary embolism during pregnancy: diagnosis with lung scintigraphy or CT angiography? Radiology. 2011;258(2):590–8.

    Article  PubMed  Google Scholar 

  50. Pengo V, Lensing AW, Prins MH, et al. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med. 2004;350:2257–64.

    Article  PubMed  CAS  Google Scholar 

  51. Becattini C, Agnelli G, Pesavento R, et al. Incidence of chronic thromboembolic pulmonary hypertension after a first episode of pulmonary embolism. Chest. 2006;130:172–5.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pulmonary and Critical Care, Department of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, UHN 67, Portland, OR, 97239, USA

    Amie J. Tucker & Gopal Allada

  2. Department of Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, L340, Portland, OR, 97239, USA

    Steven L. Primack

Authors
  1. Amie J. Tucker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gopal Allada
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Steven L. Primack
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Steven L. Primack .

Editor information

Editors and Affiliations

  1. , Cardiothoracic Radiology, University of Wisconsin Hospital and Cli, 600 Highland Ave., Madison, 53792, USA

    Jeffrey P. Kanne

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Humana Press, a part of Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Tucker, A.J., Allada, G., Primack, S.L. (2012). Pulmonary Thromboembolic Disease. In: Kanne, J. (eds) Clinically Oriented Pulmonary Imaging. Respiratory Medicine. Humana Press. https://doi.org/10.1007/978-1-61779-542-8_7

Download citation

  • DOI: https://doi.org/10.1007/978-1-61779-542-8_7

  • Published:

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-61779-541-1

  • Online ISBN: 978-1-61779-542-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation