Clinical follow-up of patients after a negative digital subtraction pulmonary arteriogram in the evaluation of pulmonary embolism.
OBJECTIVE
This study was designed to examine the clinical course of patients following digital subtraction pulmonary arteriography (DSPA) interpreted as negative for pulmonary emboli (PE).


METHODS
Sixty-three patients underwent DSPA interpreted as negative for PE over a 27-month period. Follow-up data were collected by means of medical and diagnostic radiology record review, interviews of referring physicians, and patient telephone interviews.


RESULTS
Of 63 patients, two were excluded and seven were lost to follow-up, leaving a study population of 54 patients. Mean follow-up was 12.1 months (range, 0-28.5 months). Thirty-one reported no symptoms of PE. Of 13 patients reporting intermittent chest pain and/or dyspnea during their mean follow-up of 13.6 months, 10 had a history of cardiac, nonthrombotic pulmonary, or gastroesophageal reflux disease. There were no subsequent positive angiograms or ventilation/perfusion scans. Comorbid conditions in the 10 patients who died included cardiac events (n = 4), advanced cancer (n = 2), sepsis/pneumonia (n = 2), sarcoidosis (n = 1), and cerebrovascular accident (n = 1). No documented PE was identified.


CONCLUSIONS
The technique of DSPA is sufficiently sensitive to exclude clinically significant PE. The advantages of image post-processing, in addition to the savings in cost, time, and contrast media, support its use in the angiographic diagnosis of PE.
Forauer
A R
AR
Department of Radiology, Western Pennsylvania Hospital, Pittsburgh, USA.
McLean
G K
GK
Wallace
L P
LP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D001943:Breast Neoplasms / Q000150:complications; D002423:Cause of Death; D002561:Cerebrovascular Disorders / Q000150:complications; D002637:Chest Pain / Q000209:etiology; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000150:complications; D006331:Heart Diseases / Q000150:complications; D006801:Humans; D007407:Interviews as Topic; D008168:Lung / Q000098:blood supply*; D008171:Lung Diseases / Q000150:complications; D008175:Lung Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D011014:Pneumonia / Q000150:complications; D011655:Pulmonary Embolism / Q000150:complications / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D012507:Sarcoidosis / Q000150:complications; D014692:Ventilation-Perfusion Ratio