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Clinical investigation of pulmonary vascular disease

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1B Barker, 1V Rao, 2R Rao, 1R Manns, 1K Srinivasan, 1H Moudgil. 1Shrewsbury and Telford Hospitals NHS Trust, Telford, UK, 2University of Birmingham, Birmingham, UK

Introduction and Objectives: Paralleling the increased use of computerised tomography pulmonary angiography (CTPA) in the investigation of pulmonary thromboembolsm (PTE) is anecdotal evidence that there has been an increased subsequent demand particularly on radiology resources as a result of incidental or co-lateral findings. Presently we set out to quantify and investigate the nature of these investigations with an evaluation of return on investment.

Methods: All 252 CTPA undertaken over a 12-month period to 31 December 2007 for primary exclusion of PTE were identified. The median age of patients was 69 years (range 18–98) with 148 (59%) women. Supporting data were gathered retrospectively from the hospital PACS radiology reporting system, from e-script electronic result reports and discharge summaries.

Results: Although 83/252 (33%) had confirmed PTE on CTPA, from the group as a whole (n  =  252), additional diagnoses other than PTE were also reported in 136 (54%) patients and in whom for 91/252 (36%) this was a new and significant finding. Comparatively, more of these additional outcomes were reported in the group with no PTE (103/169 (61%) vs 33/83 (40%), p = 0.002). Analysed together, these additional findings included consolidation (10%), emphysema (9%), primary lung carcinoma (4%), lung metastases (4%), mediastinal lymphadenopathy (4%), pleural thickening (4%), pleural effusions (4%) and lobar/segmental collapse (3%). Follow-up investigations, excluding plain chest radiology, were undertaken in 30/136 (22.1%) of those with reported abnormal CTPA, with further staging or high resolution computerised tomography (CT) (14%), fibreoptic bronchoscopy (9%), chest or abdominal ultrasound (3%) and cardiac echo (2%). Collectively, initial CTPA and subsequent investigations identified eight new diagnoses of primary lung carcinoma, nine of lung metastases, …

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