Chest
Clinical Investigations: Pulmonary EmbolismPrevalence of Acute Pulmonary Embolism in Central and Subsegmental Pulmonary Arteries and Relation to Probability Interpretation of Ventilation/Perfusion Lung Scans
Section snippets
MATERIALS AND METHODS
Patients in this investigation participated in either of two arms of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED): (1) the arm of patients who consented to obligatory angiography if their ventilation/perfusion ( ) lung scan was abnormal as described in the original PIOPED report6 and (2) the arm of patients who were referred for pulmonary angiography. In the obligatory angiography arm of PIOPED, 251 patients showed PE by pulmonary7 angiography.6 In the
RESULTS
The prevalence of PE according to the largest pulmonary artery involved is shown for patients with high-, intermediate-, and low-probability interpretations of the scans (Table 1). These data are further analyzed in patients according to the presence or absence of prior cardiopulmonary disease (Table 2).
Among all patients with PE, 6% (95% CI, 4 to 9%) had PE limited to subsegmental branches of the pulmonary artery (Table 1). Patients with a low-probability interpretation of the
DISCUSSION
Angiography showed PE limited to subsegmental pulmonary arteries in 6% of patients with PE in PIOPED. Only 1% of patients with high-probability interpretations of the scans had PE limited to subsegmental pulmonary arteries, whereas 17% of patients with low-probability interpretations of the scans had PE limited to subsegmental pulmonary arteries. Among patients with low-probability interpretations of the scans who had no prior cardiopulmonary disease, 30% had PE
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Management of Low-Risk Pulmonary Embolism
2018, Clinics in Chest MedicineCitation Excerpt :The increased usage of CT pulmonary angiography has led to a 5.4% increase in the diagnosis for subsegmental PE (SSPE).48 The investigators showed the increase from the single-detector CT was 4.7%, 7.1% with the 4 detectors, 6.9% with 16 detectors, and 15.0% with the MDCT 64 detector,49 in contrast to a high probability from a V/Q scan; 1% are SSPEs.50 The investigators of PIOPED I showed that 6% of patients had SSPEs with pulmonary angiography,50,51 whereas a low-probability read on the V/Q scan had 17% of patients with PEs in the subsegmental arteries.
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