Volume 28, Issue 2 (Avicenna Journal of Clinical Medicine-Summer 2021)                   Avicenna J Clin Med 2021, 28(2): 71-78 | Back to browse issues page

XML Persian Abstract Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Hadei S K, Molani L, Kahramfar Z, Mohammadi Y. Relationship between Computed Tompgraphy Pulmonary Angiography Findings and Clinical Findings Based on Wells Score in Acute Pulmonary Thromboembolism. Avicenna J Clin Med 2021; 28 (2) :71-78
URL: http://sjh.umsha.ac.ir/article-1-2244-en.html
Relationship between Computed Tompgraphy Pulmonary Angiography Findings and Clinical Findings Based on Wells Score in Acute Pulmonary Thromboembolism
Seyed Kamaledin Hadei1 , Leila Molani 2, Zohreh Kahramfar3 , Younes Mohammadi4
1- Assistant Professor, Department of Radiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
2- Resident, Department of Radiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran , ni@gmail.com
3- Assistant Professor, Department of Internal Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
4- Associate Professor, Department of Epidemiology, School of Health, Hamadan University of Medical Sciences, Hamadan, Iran
Abstract:   (1873 Views)
Background and Objective: Acute pulmonary thromboembolism is an emergency disease that can lead to mortality if not diagnosed on time. Proper triage of patients based on clinical findings and the Wells Score will have a significant impact on the medical team's decision-making and patient management.
Materials and Methods: This descriptive cross-sectional study was conducted on 300 patients selected by the census sampling method. The patients were suspected of acute pulmonary thromboembolism referring to Farshchian Heart Hospital in Hamadan, Iran, within October 2017-March 2020. The cases considered a candidate for computed tomography (CT) pulmonary angiography were selected and compared regarding CT pulmonary angiography results and the risk of embolism based on Wells Score.
Results: According to the results of CT angiography, 91 (30.3%) patients had acute pulmonary thromboembolism, 16.5%, 45.1%, and 38.4% of which were in the low-risk, moderate-risk, and high-risk groups, respectively (P<0.001). Involvement of segmental and subsegmental branches, followed by the involvement of the pulmonary lobar branches, were the most common patterns of pulmonary artery involvement in acute pulmonary thromboembolism. Accompanying findings were significantly lower in patients with acute pulmonary thromboembolism than in patients with negative acute pulmonary thromboembolism (P<0.001(.
Conclusion: There was a significant relationship between the result of CT pulmonary angiography and clinical findings in patients suspected of acute pulmonary thromboembolism. The careful examination of the clinical symptoms of patients and determination of the level of risk in such patients according to the Wells Score can lead to the more efficient management of the process of diagnosis and treatment of patients.
Keywords: Angiography, Acute Pulmonary Thromboembolism, Wells Score
Full-Text [PDF 572 kb]   (929 Downloads)    
Type of Study: Original | Subject: Radiology
Extended Abstract [HTML 27 KB]  (77 Download)
References
1. . Jafarian AH, Kooshkiforooshani M, Rasoliostadi A, Roshan NM. Vascular mimicry expression in invasive ductal carcinoma; a new technique for prospect of aggressiveness. Iran J Pathol. 2019;14(3):232. PMID: 31583000 DOI: 10.30699/ijp.2019.94997.1939
2. . Tran DP, Spierings EL. Headache and insomnia: their relation reviewed. Cranio. 2013;31(3):165-70. PMID: 23971156 DOI: 10.1179/crn.2013.026
3. . Calder KK, Herbert M, Henderson SO. The mortality of untreated pulmonary embolism in emergency department patients. Ann Emerg Med. 2005;45(3):302-10. PMID: 15726055 DOI: 10.1016/j.annemergmed.2004.10.001
4. . Cushman M, Tsai AW, White RH, Heckbert SR, Rosamond WD, Enright P, et al. Deep vein thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology. Am J Med. 2004;117(1):19-25. PMID: 15210384 DOI: 10.1016/j.amjmed.2004.01.018
5. . Roy PM, Meyer G, Vielle B, Le Gall C, Verschuren F, Carpentier F, et al. Appropriateness of diagnostic management and outcomes of suspected pulmonary embolism. Ann Intern Med. 2006;144(3):157-64. PMID: 16461959 DOI: 10.7326/0003-4819-144-3-200602070-00003
6. . Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galie N, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2014;35(43):3033-69. PMID: 25173341 DOI: 10.1093/eurheartj/ehu283
7. . Remy-Jardin M, Pistolesi M, Goodman LR, Gefter WB, Gottschalk A, Mayo JR, et al. Management of suspected acute pulmonary embolism in the era of CT angiography: a statement from the Fleischner Society. Radiology. 2007;245(2):315-29. PMID: 17848685 DOI: 10.1148/radiol.2452070397
8. . Stojanovska J, Carlos RC, Kocher KE, Nagaraju A, Guy K, Kelly AM, et al. CT pulmonary angiography: using decision rules in the emergency department. J Am Coll Radiol. 2015;12(10):1023-9. PMID: 26435116 DOI: 10.1016/j.jacr.2015.06.002
9. . Mamlouk MD, vanSonnenberg E, Gosalia R, Drachman D, Gridley D, Zamora JG, et al. Pulmonary embolism at CT angiography: implications for appropriateness, cost, and radiation exposure in 2003 patients. Radiology. 2010;256(2):625-32. PMID: 20551182 DOI: 10.1148/radiol.10091624
10. . Costantino MM, Randall G, Gosselin M, Brandt M, Spinning K, Vegas CD, et al. CT angiography in the evaluation of acute pulmonary embolus. AJR Am J Roentgenol. 2008;191(2):471-4. PMID: 18647919 DOI: 10.2214/AJR.07.2552
11. . Righini M, Le Gal G, Aujesky D, Roy Pm, Sanchez O, Verschuren F, et al. Diagnosis of pulmonary embolism by multidetector CT alone or combined with venous ultrasonography of the leg: a randomised non-inferiority trial. Lancet. 2008;371(9621):1343-52. PMID: 18424324 DOI: 10.1016/S0140-6736(08)60594-2
12. . Bettmann MA, Baginski SG, White RD, Woodard PK, Abbara S, Atalay MK, et al. ACR Appropriateness Criteria(R) acute chest pain--suspected pulmonary embolism. J Thorac Imaging. 2012;27(2):W28-31. DOI: 10.1097/RTI.0b013e31823efeb6
13. . Carrier M, Righini M, Djurabi RK, Huisman MV, Perrier A, Wells PS, et al. VIDAS D-dimer in combination with clinical pre-test probability to rule out pulmonary embolism. A systematic review of management outcome studies. Thromb Haemost. 2009;101(5):886-92. PMID: 19404542
14. Pasha SM, Klok FA, Snoep JD, Mos ICM, Goekoop RJ, Rodger MA, et al. Safety of excluding acute pulmonary embolism based on an unlikely clinical probability by the Wells rule and normal D-dimer concentration: a meta-analysis. Thromb Res. 2010;125(4):e123-7. PMID: 19942258 DOI: 10.1016/j.thromres.2009.11.009
15. . Stein PD, Woodard PK, Weg JG, Wakefield TW, Tapson VF, Sostman HD, et al. Diagnostic pathways in acute pulmonary embolism: recommendations of the PIOPED II investigators. Am J Med. 2006;119(12):1048-55. PMID: 17145249 DOI: 10.1016/j.amjmed.2006.05.060
16. Chen C, Yu L, Tang X, Liu MZ, Sun LZ, Liu C, et al. Dynamic hip system blade versus cannulated compression screw for the treatment of femoral neck fractures: a retrospective study. Acta Orthop Traumatol Turc. 2017;51(5):381-7. PMID: 28844681 DOI: 10.1016/j.aott.2017.07.006
17. . Wicki J, Perneger TV, Junod AF, Bounameaux H, Perrier A. Assessing clinical probability of pulmonary embolism in the emergency ward: a simple score. Arch Intern Med. 2001;161(1):92-7. PMID: 11146703 DOI: 10.1001/archinte.161.1.92
18. . Wells PS, Anderson DR, Rodger M, Ginsberg JS, Kearon C, Gent M, et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the Simple RED D-dimer. Thromb Haemost. 2000;83(3):416-20. PMID: 10744147
19. . den Exter PL, van der Hulle T, Klok FA, Huisman MV. Advances in the diagnosis and management of acute pulmonary embolism. Thromb Res. 2014;133(Suppl 2):S10-6. PMID: 24862127 DOI: 10.1016/S0049-3848(14)50002-3
20. . Raji H, Javad Moosavi SA, Dastoorpoor M, Mohamadipour Z, Ghanavati SPM. Overuse and underuse of pulmonary CT angiography in patients with suspected pulmonary embolism. Med J Islam Repub Iran. 2018;32:3. PMID: 29977871 DOI: 10.14196/mjiri.32.3
21. . Wang J, Wu XY, Liang Y, Guo W. Predictive value of the Wells score combined with D-dimer level in identifying acute pulmonary embolism in patients with coronary heart disease with chest pain. Chinese Med J. 2020;133(18):2253-5. PMID: 32804728 DOI: 10.1097/CM9.0000000000000988
22. . Touhami O, Marzouk SB, Bennasr L, Touaibia M, Souli I, Felfel MA, et al. Are the wells score and the revised geneva score valuable for the diagnosis of pulmonary embolism in pregnancy? Eur J Obstet Gynecol Reprod Biol. 2018;221:166-71. PMID: 29310042 DOI: 10.1016/j.ejogrb.2017.12.049
23. . Vongchaiudomchoke T, Boonyasirinant T. Positive pulmonary computed tomography angiography in patients with suspected acute pulmonary embolism: clinical prediction rules, thromboembolic risk factors, and implications for appropriate use. J Med Assoc Thai. 2016;99(1):25-33. PMID: 27455821
24. . Molaee S, Ghanaati H, Safavi E, Foroumandi M, Peiman S. Computed tomography pulmonary angiography for evaluation of patients with suspected pulmonary embolism: use or overuse. Iran J Radiol. 2015;12(3):e22383. PMID: 26557282 DOI: 10.5812/iranjradiol.12(2)2015.22383
25. . Geeting GK, Beck M, Bruno MA, Mahraj RP, Caputo G, DeFlitch C, et al. Mandatory assignment of modified wells score before CT angiography for pulmonary embolism fails to improve utilization or percentage of positive cases. Am J Roentgenol. 2016;207(2):442-9. PMID: 27144311 DOI: 10.2214/AJR.15.15394.
Add your comments about this article : Your username or Email:
CAPTCHA
Send email to the article author

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2024 CC BY-NC 4.0 | Avicenna Journal of Clinical Medicine

Designed & Developed by : Yektaweb