title: The prevalence and radiological findings of pulmonary embolism in HIV-positive patients referred for computed tomography pulmonary angiography in the Western Cape of South Africa.
abstract: OBJECTIVE
  To provide imaging data and report associations between human immunodeficiency virus (HIV), tuberculosis (TB) and pulmonary embolism (PE) in a South African population that underwent computed tomography pulmonary angiography (CTPA) for suspected PE.
  
  
  METHODS
  A validated Qanadli severity scoring system for PE was used for 164 CTPA scans, and parenchymal, pleural and cardiovascular complications were reported. Serological confirmation of HIV testing and microbiological confirmation of TB were recorded.
  
  
  RESULTS
  Prevalence of PE in the CTPA population was 26% (95% CI: 19.67-33.65%). HIV-positive prevalence in patients with PE was 67% (95% CI: 48.17-82.04%), however it was not statistically significantly different when compared with the patients without PE (p = 1). HIV-positive patients had more extensive partial thrombus in the right middle lobe (p = 0.045), but no other differences when compared with HIV-negative patients. TB prevalence in patients with PE was 57% (95% CI: 34.49-76.81%). This was statistically significantly different when compared with the patients without PE (p = 0.073 at the 10% level). Prevalence of TB co-morbidity in the HIV-positive group with proven PE was 71% (95% CI: 41.90- 91.61%), however there was no statistically significant difference in comparison with the HIV-negative patients with TB and PE (p= 0.305).
  
  
  CONCLUSIONS
  The high number of patients presenting for CTPA who were HIV infected (and also infected with TB) highlights that PE evaluation should include severity/extent of the disease, as these patients may have more severe disease in specific lung lobes. The use of a validated scoring system, such as the Qanadli score, when reporting PE may have a profound effect on patient risk stratification, management and prognosis and would also provide a system for collecting larger volumes of data for analysis.
authors.affiliation: Department of Radiology, Groote Schuur Hospital and University of Cape Town, South Africa. Email: docrakshar@gmail.com.
authors.forename: Raksha
authors.initials: R
authors.lastname: Ramlakhan
authors.affiliation: Department of Paediatric Radiology, University of Bristol and the Bristol Royal Hospital for Children, Bristol, United Kingdom and Department of Radiology, University of Cape Town, South Africa.
authors.forename: Savvas
authors.initials: S
authors.lastname: Andronikou
authors.affiliation: Department of Radiology, Mitchell's Plain Hospital, Mitchells Plain, Cape Town, South Africa.
authors.forename: Ashmitha
authors.initials: A
authors.lastname: Rajkumar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity / Q000639:trends; D000072226:Computed Tomography Angiography / Q000379:methods*; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000453:epidemiology*; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult