Right ventricular dysfunction secondary to acute massive pulmonary embolism detected by helical computed tomography pulmonary angiography.
OBJECTIVE
Acute massive pulmonary embolism causes abrupt pulmonary arterial hypertension and right ventricular dysfunction (RVD). Patients with RVD have a worse prognosis than those with normal right ventricular function. Consequently, recognizing the RVD at the time of pulmonary embolism is useful for risk stratification and enables more aggressive therapy. The study compared the accuracy of helical computed tomographic (CT) scans with echocardiography in the detecting of RVD in patients with acute massive pulmonary embolism.


METHODS
Specifically, this work reviewed the CT pulmonary angiograms of 14 patients who were positive for acute massive pulmonary embolism during a 52-month period. CT scans were reviewed for findings indicating RVD. Scans were considered positive for RVD if the right ventricle was dilated or there was leftward shift of the interventricular septum. Echocardiographic reports serving as the reference standard for the diagnosis of RVD were also reviewed. CT study results were then correlated with echocardiography results.


RESULTS
Among 14 patients with massive pulmonary embolism, echocardiography identified 12 patients having RVD, whereas the remaining two patients were negative for RVD. Meanwhile, CT correctly identified 11 of 12 patients as having RVD, and was negative for RVD in the remaining 3 patients. Correlated with echocardiography, CT scan for RVD detection had a sensitivity of 91.6% and a specificity of 100%.


CONCLUSIONS
CT can accurately detect RVD in patients with acute massive pulmonary embolism. However, this result requires confirmation using a larger prospective cohort study.
Lim
Kun-Eng
KE
Department of Radiology, Chang Gung Memorial Hospital, Linkou, Taiwan, ROC. ikethm@adm.cgmh.org.tw
Chan
Chen-Yi
CY
Chu
Pao-Hsien
PH
Hsu
Yuan-Yu
YY
Hsu
Wen-Chin
WC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D011655:Pulmonary Embolism / Q000150:complications*; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000209:etiology*