076 advances in pulmonary imaging
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076 advances in pulmonary imaging
- 1. Advances in Pulmonary Embolism Imaging Kelly MacLean; David Tso; Ferco Berger; Anja Reimann; Chris Davison; Joao Inacio; Ahmed Albuali; Savvas Nicolaou ASER 2010
- 11. Modified Wells Criteria Wells PS et al. Thromb Haemost 2000 Mar; 83(3):416-20. Clinical symptoms of DVT (leg swelling, pain with palpation) 3.0 Other diagnosis less likely than PE 3.0 Heart rate >100 1.5 Immobilization or surgery in previous 4 weeks 1.5 Previous DVT/PE 1.5 Hemoptysis 1.0 Malignancy 1.0 PE Likely >4 PE Unlikely </= 4
- 13. The Christopher Study – Workup Algorithm Writing Group for the Christopher Study Investigators JAMA. 2006; 295:172-179. Patient with clinically suspected pulmonary embolism Modified Wells Score PE Unlikely D-Dimer ELISA PE Likely MDCT-PA Indicated Normal Abnormal
- 28. MDCT Findings Large saddle thrombus with extensive clot burden. Arrows demonstrating tram-track sign (A), rim sign (B), complete filling defect (C), and a fully non-contrasted vessel (D) A B C D
- 29. Arrow indicating rim sign Arrow indicating tram-track sign
- 32. Patient with pneumonectomy Lingular subsegmental pulmonary embolism (arrow)
- 34. Contrast seen in IVC, indicating RV strain Bilateral mosaic attenuation
- 38. Diagnostic Imaging Algorithm Adapted from Agnelli G; Becattini C. N. Engl. J. Med. 2010;363:266-74. Elevated D-Dimer or High clinical probability MDCT-PA V/Q Scan if contraindication to contrast Negative PE confirmed May consider venous U/S but will be positive in less than 1% of patients Diagnostic Non-diagnostic PE confirmed PE ruled out Venous U/S
Notas del editor
- ASER limits to 40 slides per presentation. Suggest tightening intro to make more succint
- Discuss pathophysiology of tissue death, preload, RV strain
- Incorporate this into a table with Signs & Symptoms together
- Perhaps cut out this table and stick with summaries points
- Zoom into MDCT
- Using positive U/S as diagnosis of PE would mean: Sensitivity 29% Specificity 97% Benefits: Avoid 14% of lung scans and 9% of angiograms Drawbacks: Unnecessary treatment in false positives (13%)
- Flow chart
- David/Dr. Nicolaou – should I mention here anything about pros/cons of adding lower-limb CT venography?
- Incorporate PIOPED III Trial into limitations section next slide
- CT- PA: spell out acronym CT able to determine other causes
- Awaiting Charles Uh for protocols Need to get VGH protocols
- Need to make arrows more accentuated, use “Shapes” under drawing tools in Powerpoint Make image bigger,
- Increase afterload, can’t generate enough pressures Restate why contrast may end up in IVC
- Mosaic attenuation – should use lung window
- Is it okay we use these slides – technically is this presentation for educational purposes? Question: How do we score clot burden?
- Please have this in lung windows
- Where is CXR in this diagram. Also need to eliminate Venous U/S since it’s not done.