Chest
Clinical InvestigationsNatural Course of Treated Pulmonary Embolism: Evaluation by Perfusion Lung Scintigraphy, Gas Exchange, and Chest Roentgenogram
Section snippets
MATERIALS AND METHODS
Our study was performed in 33 nonconsecutive patients (17 men and 16 women; mean age, 57 ± 14 years) who were admitted to our ICU with a diagnosis of pulmonary embolism. In 21 of them (64 percent), the diagnosis of pulmonary embolism was initially made on the basis of the presence of multiple, large segmental defects on the perfusion lung scintigram.12, 13 According to McNeil,14 in patients who showed “multiple large (segmental or greater) perfusion defects, pulmonary embolism is very likely.”
RESULTS
Mean values (± 1 SD) of ULSs and of pulmonary gas exchange parameters in the acute phase of pulmonary embolism are reported in the following tabulation:
No. of ULSs 11.3 ± 2.6 pH 7.45 ± 0.03 PaO2, mm Hg 63 ± 10 PaO2st, mm Hg 52 ± 14 PaCO2, mm Hg 34 ± 5 P(A-a)O2, mm Hg 59 ± 15 P(a-A)CO2, mm Hg 10 ± 4 VE, L/min 12 ± 4 VD/VT% 45 ± 10
At this time, the mean number of ULSs was 11.3 ± 2.6, showing that the fraction of the pulmonary arterial tree obstructed by emboli was 63 percent on the average (18 segments
DISCUSSION
The recovery of pulmonary perfusion after embolism may be influenced by several factors, such as prompt and adequate treatment, recurrence of emboli, and underlying pulmonary pathologic abnormalities. Therefore, an accurate follow-up of patients, both in the early stages after embolization and later on, is clinically helpful.
Previous reports show that perfusion lung scintigraphy, owing to its simplicity and safety, still remains the most suitable technique to assess the severity of embolization
ACKNOWLEDGMENTS
We thank Dr. M. Miniati and Dr. G. Viegi for critical review of the manuscript, and Dr. C. Marini and G. Di Ricco for having performed the pneumoangiography. We also thank G. Maltinti (University of Pisa) and P. Pisani (CNR institute of Clinical Physiology) for their helpful technical assistance.
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2013, Thrombosis ResearchCitation Excerpt :After acute venous thromboembolism, thrombi either resolve completely or are replaced by chronic intravascular scars, which may have various clinical effects. In the case of acute pulmonary emboli, residual lung perfusion defects are common [1–6] and probably represent minor degrees of intravascular scarring. However, more extensive scars within the pulmonary arteries may result in chronic thromboembolic pulmonary hypertension (CTEPH), a life-threatening disease [7].
Supported in part with funds from CNR (National Research Council) Cardiorespiratory Group and Ministry of Public Education of Italy.
Manuscript received Decemher 14; revision accepted August 22.
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Dr. A. Giannella-Neto was partially supported by funds from the bilateral cooperation between CNR and CNPq (Conselho Nacional de Desenvolvimento Cientifico e Tecnologico) of Brazil.