title: Computed tomography pulmonary angiography: more than a screening tool for pulmonary embolus.
abstract: BACKGROUND
  Traumatically injured patients have multiple causes for acute respiratory decompensation. We reviewed the use of computed tomography pulmonary angiography (CTPA) in critically injured patients to evaluate the results and impact on patient care.
  
  
  METHODS
  The charts of trauma patients (age >16 years) admitted to our intensive care unit for greater than 48 hours, who underwent CTPA for acute respiratory decompensation, were reviewed to determine the results of these studies and the effect on patient care.
  
  
  RESULTS
  We identified 188 patients who underwent CTPA for acute physiologic changes. Pertinent clinical finding were identified in 95% of studies and included atelectasis/collapse (56%), pleural effusion (18%), pneumonia (15%), and pulmonary embolus (18%). These results prompted interventions designed to improve patient outcome. The most frequent interventions were modifications of ventilator therapy (52%), antibiotic therapy (28%), mini-bronchoalveolar lavage (15%), or bronchoscopy (15%). Diagnostic agreement between chest x-ray and CTPA was poor to moderate (κ = 0.013-0.512).
  
  
  CONCLUSIONS
  Computed tomography pulmonary angiography is valuable in the evaluation of cardiopulmonary deterioration in critically ill traumatically injured patients. Computed tomography pulmonary angiography offers the ability to identify causes of acute physiologic changes not detected using standard chest x-ray. The results of these studies provide insight into the underlying pathophysiology and offer an opportunity to direct subsequent patient care.
authors.affiliation: Department of Surgery, University of Texas Southwestern/Parkland Memorial Hospital, Dallas, TX, USA. Electronic address: christian.minshall@utsouthwestern.edu.
authors.forename: Christian T
authors.initials: CT
authors.lastname: Minshall
authors.affiliation: Department of Surgery, Baystate Medical Center, Springfield, MA, USA. Electronic address: andrew.doben@baystatehealth.org.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Doben
authors.affiliation: Department of Surgery, Medical University of South Carolina, Charleston, SC, USA. Electronic address: leon@musc.edu.
authors.forename: Stuart M
authors.initials: SM
authors.lastname: Leon
authors.affiliation: Department of Surgery, Medical University of South Carolina, Charleston, SC, USA. Electronic address: fakhry@musc.edu.
authors.forename: Samir M
authors.initials: SM
authors.lastname: Fakhry
authors.affiliation: Department of Surgery, Medical University of South Carolina, Charleston, SC, USA. Electronic address: evsurgery@gmail.com.
authors.forename: Evert A
authors.initials: EA
authors.lastname: Eriksson
mesh_terms: D000328:Adult; D000368:Aged; D016638:Critical Illness; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D015601:Injury Severity Score; D055370:Lung Injury / Q000000981:diagnostic imaging / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications*; D010996:Pleural Effusion / Q000000981:diagnostic imaging* / Q000209:etiology; D011014:Pneumonia / Q000000981:diagnostic imaging* / Q000209:etiology; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D001261:Pulmonary Atelectasis / Q000000981:diagnostic imaging* / Q000209:etiology; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000209:etiology; D011667:Pulmonary Veins / Q000000981:diagnostic imaging; D013902:Radiography, Thoracic / Q000379:methods; D012131:Respiratory Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D013610:Tachycardia / Q000209:etiology; D013898:Thoracic Injuries / Q000150:complications; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Computed tomography pulmonary angiography; Critical care; Intensive care unit; Pneumonia; Pulmonary embolus; Trauma