Multislice computed tomographic pulmonary angiography for diagnosing pulmonary embolism in the emergency department: has the 'one-stop shop' arrived?
Current diagnostic pathways for pulmonary embolism are complex and involve multiple tests. Clinicians await a single diagnostic modality that accurately rules in or out pulmonary embolism and also provides additional diagnostic and prognostic information. Multislice computed tomographic pulmonary angiography (msCTPA) might be that test. msCTPA has good outcomes using current reference standards and can be used as a stand alone test in low risk patients. Additional leg vein imaging should still be performed for higher-risk patients. CT venography performed immediately after msCTPA has sufficient sensitivity and specificity for proximal deep venous thrombosis to allow a single scan to rule out venous thromboembolism in most patients. Up to 40% of patients have important alternative diagnoses seen on msCTPA. Right ventricular measurements may be calculated from msCTPA data and provide prognostic information for patients with severe PE. This may replace the need for echocardiography in the future. msCTPA provides a safe single radiological investigation for diagnosing PE for most patients, after risk stratification and D-dimer testing. A pathway is provided for msCTPA use in the management of PE in the ED.
Mountain
David
D
Emergency Department, Sir Charles Gairdner Hospital, and Faculty of Emergency Medicine, University of Western Australia, Perth, Western Australia, Australia. david.mountain@health.wa.gov.au
D000792:Angiography / Q000379:methods; D004636:Emergency Service, Hospital; D006801:Humans; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging*; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*