Clinical rules reduce need for CTPA during pregnancy

Using a set of clinical rules, researchers from the Netherlands and France...Read more on AuntMinnie.comRelated Reading: Which test is best for excluding PE during pregnancy? MRA tops CTA for pulmonary embolism evaluation French find no need for CT to rule out PE CT use for pulmonary embolism rises despite low yield Doctors who order fewer CTPA scans detect more PE
Source: AuntMinnie.com Headlines - Category: Radiology Source Type: news

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(Abstracted from N Engl J Med 2019;380:1139–1149) Acute pulmonary embolism is one of the leading causes of maternal death, with the overall incidence reported to be 1.72 cases per 1000 deliveries, accounting for approximately 1 death in every 100,000 deliveries. Since the D-dimer test has low specificity and sensitivity, it is common for pregnant women with suspected pulmonary embolism to undergo computed tomography (CT) pulmonary angiography or ventilation-perfusion (V/Q) scanning, both of which involve radiation exposure to the mother and fetus.
Source: Obstetrical and Gynecological Survey - Category: OBGYN Tags: OBSTETRICS: MEDICAL COMPLICATIONS OF PREGNANCY Source Type: research
AbstractPurpose of ReviewThe purpose of this article is to review the imaging findings and current imaging techniques of acute pulmonary embolism (PE) and chronic thromboembolic disease. Special considerations are also discussed, including pregnancy, congenital heart disease, lower extremity computed tomography (CT), and the isolated subsegmental PE.Recent FindingsCT pulmonary angiography and planar ventilation/perfusion (V/Q) lung scintigraphy are the primary means of evaluating pulmonary embolic disease. Magnetic resonance angiography avoids ionizing radiation and iodinated contrast in select patients. V/Q SPECT/CT provi...
Source: Current Respiratory Care Reports - Category: Respiratory Medicine Source Type: research
Authors: Kruger PC, Eikelboom JW, Douketis JD, Hankey GJ Abstract Pulmonary embolism (PE) is a potentially life-threatening condition, mandating urgent diagnosis and treatment. The symptoms of PE may be non-specific; diagnosis therefore relies on a clinical assessment and objective diagnostic testing. A clinical decision rule can determine the pre-test probability of PE. If PE is "unlikely", refer for a D-dimer test. If the D-dimer result is normal, PE can be excluded. If D-dimer levels are increased, refer for chest imaging. If PE is "likely", refer for chest imaging. Imaging with computed tomo...
Source: Medical Journal of Australia - Category: General Medicine Tags: Med J Aust Source Type: research
In conclusion, pulmonary embolism is an important complication of pregnancy. Understanding the recommendations from various specialty groups allows us to be better consultants and assist in the management of these patients. References 1. Righini M, Robert-Ebadi H, Elias A, et al. Diagnosis of pulmonary embolism during pregnancy. Ann Intern Med. 2018; 169:766-773 2. Kirsch J, Brown RKJ, Henry TS, et al. ACR Appropriateness Criteria ® Suspected Pulmonary Embolism. Available at https://acsearch.acr.org/docs/69404/Narrative/. American College of Radiology. Accessed January 2019. 3. Parker JA, Coleman RE, Grady E, et al. SN...
Source: Journal of Nuclear Medicine - Category: Nuclear Medicine Authors: Tags: Educational Exhibit Posters Source Type: research
As much as 37% of CT pulmonary angiography exams for patients with a pulmonary...Read more on AuntMinnie.comRelated Reading: Clinical rules reduce need for CTPA during pregnancy MRA tops CTA for pulmonary embolism evaluation French find no need for CT to rule out PE CT use for pulmonary embolism rises despite low yield Doctors who order fewer CTPA scans detect more PE
Source: AuntMinnie.com Headlines - Category: Radiology Source Type: news
Conclusion: High-pitch dual-source CT with free-breathing yields better image quality, reduces image acquisition time and radiation doses. PMID: 30834417 [PubMed - in process]
Source: Saudi Medical Journal - Category: Middle East Health Tags: Saudi Med J Source Type: research
CONCLUSION: Careful CTPA scan protocol selection and additional optimization of scan length may result in significant radiation dose reduction for a pregnant patient and her fetus, whilst maintaining diagnostic confidence. PMID: 30672171 [PubMed - in process]
Source: Korean J Radiol - Category: Radiology Authors: Tags: Korean J Radiol Source Type: research
ConclusionA differential diagnosis of digestive system neoplasm should be considered when a pregnant patient presents with gestational diabetes mellitus and disseminated intravascular coagulation, where the disseminated intravascular coagulation has no specific cause and cannot be readily resolved.
Source: Journal of Medical Case Reports - Category: General Medicine Source Type: research
​BY FREDDIE IRIZARRY-DELGADO; VAROON KAKAIYA; &AHMED RAZIUDDIN, MDAn 86-year-old African-American woman was brought to the ED by her daughter after two days of nutritional neglect, abdominal pain, and altered mental status. Her daughter said her mother felt lightheaded, appeared dehydrated, and vomited nonbilious watery fluid once. The patient had a history of diabetes mellitus type 2, DVT/PE, dementia, and early signs of parkinsonism.Her vital signs were remarkable only for tachypnea (24 bpm). Her troponin I was markedly elevated at 1.7 ng/mL. A D-dimer was ordered because of her history of unprovoked DVT/PE, and it...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research
BackgroundAcute pulmonary embolism (PE) is the leading cause of maternal mortality in Western countries, accounting for 20 to 30% of all maternal deaths. Therefore, the threshold to test for PE during pregnancy is low. Because evidence regarding the safety of ruling out PE with clinical decision rules and D-dimer tests in pregnant women is unavailable, all women with a suspected PE need to undergo an imaging test, with potential harm to patient and fetus by exposure to ionizing radiation. In the present international, multicenter, prospective management study, we evaluated the safety and efficiency of the YEARS diagnostic ...
Source: Blood - Category: Hematology Authors: Tags: 331. Pathophysiology of Thrombosis: Risk Factors and Thromboembolism Source Type: research
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