title: Negative Computed Tomography for Acute Pulmonary Embolism: Important Differential Diagnosis Considerations for Acute Dyspnea.
abstract: Computed tomography pulmonary angiography (CTPA) is the principal means of evaluating dyspnea in the emergency department. As its use has increased, the number of studies positive for pulmonary embolism (PE) has decreased to less than 20%. Many of the negative PE studies provide an alternative explanation for dyspnea, most commonly pneumonia, pulmonary edema, pleural effusion, or atelectasis. Nonthrombotic emboli may also be suggested. Airway and obstructive lung disease may be detected on CTPA. Pleural and pericardial disease may also explain the dyspnea, but more detailed evaluation of the serosal surfaces may be limited on the arterial phase of a CTPA.
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway, St Louis, MO 63110, USA.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Green
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway, St Louis, MO 63110, USA.
authors.forename: Constantine A
authors.initials: CA
authors.lastname: Raptis
authors.affiliation: Department of Radiology, Catholic University, Marcoleta 367, 2º piso, Santiago, Chile.
authors.forename: Isidro
authors.initials: I
authors.lastname: Alvaro Huete Garin
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway, St Louis, MO 63110, USA. Electronic address: bhallas@mir.wustl.edu.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Bhalla
mesh_terms: D000208:Acute Disease; D000792:Angiography / Q000379:methods; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D010996:Pleural Effusion / Q000150:complications / Q000000981:diagnostic imaging*; D011014:Pneumonia / Q000150:complications / Q000000981:diagnostic imaging*; D001261:Pulmonary Atelectasis / Q000150:complications / Q000000981:diagnostic imaging*; D011654:Pulmonary Edema / Q000150:complications / Q000000981:diagnostic imaging*; D011655:Pulmonary Embolism / Q000150:complications / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Alternative diagnosis; CT pulmonary angiography (CTPA); Dyspnea; Emergency department (ED); Indication creep; Pulmonary embolism (PE)