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Query: UMLS:C0034065 (pulmonary embolism)
 14,979 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Nuclear medicine plays a major role in the diagnosis of pulmonary embolism as well as in other lung diseases. Important innovations have concerned in recent years the equipment and radiopharmaceuticals. In ventilation studies the use of technegas, a monodisperse aerosol able to supply images of the same quality or even superior to gas images, is widespread in the clinical practice. Significant clinical results in the evaluation of acute thromboembolism have been achieved with antifibrin monoclonal antibodies and radioactive peptides specific for activated platelet receptors. Primary lung cancer and its metastases can now be visualized with tracers used for the study of myocardial perfusion (sestaMIBI, tetrofosmin) or labeled ocreotide, a molecule able to recognize lung tumors with somatostatin receptors. 99mTc-NR-LU-10 Fab immunoscintigraphy was shown to be very sensitive for tumors, while the major role of PET in the differential diagnosis of solitary pulmonary nodule, in the initial staging and in the response assessment to lung cancer therapy, is confirmed. SPECT is widespread in the clinical field with the use of 2-3 head gamma cameras and the possible combined imaging with CT or MRI. The use of PET with common gamma cameras with appropriate collimation systems or coincident recording without collimation is being studied. PET is used in the study of tumor metabolism as well as in the evaluation of intra-and extravascular lung water, regional blood flow and pulmonary vascular permeability. PET studies of vascular lung physiology as well as of receptor physiology, amine accumulation and clearance and drug transport to the areas of healthy or impaired lung, were also shown to be fundamental.
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PMID:Advances in pulmonary nuclear medicine. 914 15

The authors report about a patient with thrombosis of the transverse and sigmoid sinus who also suffered from multiple pulmonary embolism and deep leg vein thrombosis. The etiologic factor was a deficiency of the free (unbounded) and total protein S. The cerebral sinus thrombosis was diagnosed by MRI and angio-MRI. The first 4 weeks the patient was treated with heparin and later with phen-procoumon. The plasma protein S serves as a cofactor for protein C and plays an important role in the anticoagulation. Deficiencies of these proteins are either hereditary with an autosomal dominant trait or acquired in patients with severe hepatic diseases and coagulation disorders.
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PMID:[Cerebral thrombophlebitis, sural phlebitis, pulmonary embolisms and protein S deficiencies]. 920 1

This study was to evaluate the accuracy of MR angiography (MRA) using a Gd-DTPA-polyethylene glycol polymer (Gd-DTPA-PEG) with a 3D fast gradient echo (3D fgre) technique in diagnosing pulmonary embolism in a canine model. Pulmonary emboli were created in six mongrel dogs (20-30 kg) by injecting tantalum oxide-doped autologous blood clots into the femoral veins via cutdowns. MRI was performed with a 1.5 T GE Signa imager using a 3D fgre sequence (11.9/2.3/15 degrees) following intravenous injection of 0.06 mmol Gd/kg of Gd-DTPA-PEG. The dogs were euthanized and spiral CT of the lungs were then obtained on the deceased dogs. The MRI images were reviewed independently and receiver-operating-characteristic (ROC) curves were used for statistical analysis using spiral CT results as the gold standard. The pulmonary emboli were well visualized on spiral CT. Out of 108 pulmonary segments in the six dogs, 24 contained emboli >2 mm and 27 contained emboli < or = 2 mm. With unblinded review, MRI detected 79% of emboli >2 mm and only 48% of emboli < or = 2 mm. The blinded review results were significantly worse. Gd-DTPA-PEG enhanced 3D fgre MRI is potentially able to demonstrate pulmonary embolism with fairly high degree of accuracy, but specialized training for the interpretations will be required.
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PMID:MRI of pulmonary embolism using Gd-DTPA-polyethylene glycol polymer enhanced 3D fast gradient echo technique in a canine model. 925 98

Acute pulmonary embolism (PE) is an increasing and underdiagnosed cause of mortality and morbidity in hospitalised patients: pulmonary hypertension based on chronic pulmonary embolism is an uncommon, but severe and surgically curable complication. Since clinical signs might be silent or unspecific, both acute and chronic PE require imaging methods for diagnosis and treatment planning. Chest radiographic findings are usually non-specific. Scintigraphy provides a high sensitivity for PE, but lacks anatomic resolution and sufficient specificity. Pulmonary angiography, albeit accurate, is an invasive procedure associated with low but still not negligible morbidity and mortality. Hence, non-invasive methods offer advantages. Spiral CT, for example, is most reliable in the diagnosis of acute and chronic PE: Such fast CT techniques provide a non-invasive means to detect and differentiate acute emboli and organised thrombi, as well as perfusion abnormalities and other concomitant findings. MRI offers both morphological and functional information on lung perfusion and right heart function, but its image quality still needs improvement to be comparable with CT. Thus, while MRI must still be tested in clinical studies. CT is recommended as a screening method in acute and chronic pulmonary embolism.
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PMID:[The algorithm of imaging diagnostics of pulmonary embolism: is it time for a new definition?]. 951 59

Accurate diagnosis of deep venous thrombosis (DVT) and pulmonary embolism (PE) is required because treatment can be life-saving, while inappropriate anticoagulation exposes the mother and fetus to haemorrhage and other hazards. Clinicians must be aware of which patients are at risk because DVT is frequently asymptomatic. Clinical diagnosis is unreliable for DVT and PE so objective tests are required. Venography is the gold standard test for DVT but is invasive and has been superseded by less invasive tests such as duplex ultrasound which is now the first-line investigation in pregnancy. However, where doubt remains, venography, CT and MRI have a role. Ventilation-perfusion scanning is the pivotal test for PE in pregnancy, and need not expose the fetus to excess radiation. If the result is unclear deep venous ultrasound can guide management of suspected PE, thus avoiding pulmonary angiography, the invasive gold standard test.
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PMID:Diagnosis of deep venous thrombosis and pulmonary embolism. 948 86

The case of a 14-year-old girl with Behcet syndrome is described. Besides painful and recurrent oral ulcerations, the patient had a cough and intermittent hemoptysis. The initial chest roentgenogram revealed bilateral parahilar opacities. CT and MRI scans of the thorax showed bilateral thrombosing aneurysms of the pulmonary arteries. Pulmonary blood flow imaging was performed after technegas ventilation lung scanning and Tc-99m MAA injection using a first-pass radionuclide angiography procedure. Altered blood flow in the left pulmonary artery was shown. Bilateral and well-defined ventilation/perfusion mismatched areas suggested a high probability of pulmonary embolism. Little additional information was obtained on subsequent contrast pulmonary angiography. The high incidence of pulmonary artery hypertension and associated vascular injury risk makes pulmonary angiography an unsafe procedure in patients with pulmonary Behcet syndrome. The need for pulmonary angiography could be obviated in such cases with the use of high-precision MRI and ventilation/perfusion lung scanning, including radionuclide pulmonary angiography.
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PMID:Bilateral pulmonary artery aneurysms in a patient with Behcet syndrome: evaluation with radionuclide angiography and V/Q lung scanning. 981 58

The incidence of puerperal ovarian vein thrombosis is estimated to range between 1 in 600 and 1 in 2000 deliveries. The cardinal signs of puerperal ovarian vein thrombosis include fever, leukocytosis, and right lower quadrant abdominal pain, most often in a recently delivered female patient. These patients are classically described as failing to improve with intravenous antibiotic therapy alone; resolution of symptoms and presumptive diagnosis is made on defervescence with the addition of intravenous heparin therapy. Objective diagnostic modalities include venography, ultrasound, laparoscopy, and MRI, although CT remains the gold standard for the identification of this under-diagnosed entity. We present a case report of a 20-year-old female treated at our facility for puerperal ovarian vein thrombosis. She was transferred to our vascular surgery service after developing the classic signs of puerperal ovarian vein thrombosis and undergoing CT demonstrating ovarian vein thrombosis with extension of free-floating thrombus into her inferior vena cava (IVC). This degree of thrombosis was particularly concerning when one considers the 3 to 33 per cent rate of pulmonary embolism reported in patients with puerperal ovarian vein thrombosis. Treatment modalities for such extensive degrees of thrombosis are described in the literature and range from hysterectomy and thrombectomy to ligation of the IVC. In our case, we prophylactically placed a suprarenal IVC Greenfield filter to protect against pulmonary embolism and proceeded with the standard regimen of anticoagulation and antibiotics. This treatment approach has been reported only twice previously in the literature, to our knowledge.
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PMID:Puerperal ovarian vein thrombosis with extension into the inferior vena cava. 992 50

Among radiological diagnostical procedures, the conventional chest X-ray has retained its significance as a screening investigation up to the present. Digital imaging does not reveal any advantages. Due to its higher resolution the CT scan, particularly the spiral CT scan, has markedly increased radiological possibilities, thus influencing surgical oncology significantly. Tumor invasion of the mediastinum, heart, and thoracic wall has become detectable, as well as enlarged lymph nodes and metastases. CT angiography permits a better assessment of large vessels by aortic rupture or dissection and pulmonary embolism, to name a few. MRI is inferior to CT scan in this respect, displaying a slight advantage in terms of detecting tumor infiltration of the nerval plexus, i.e. pancoast syndrome.
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PMID:[Progress in diagnostic imaging of the thorax (CT, MRI, intervention)--significance and value for the surgeon]. 993 21

This study attempted to assess the accuracy and potential of lung magnetic resonance (MR) perfusion imaging compared with perfusion scintigraphy in the evaluation of patients with suspected lung perfusion defects. The technique, which uses an inversion recovery turbo-FLASH sequence with ultra-short TE (1.4 msec), was tested in 24 patients suspected clinically of having acute pulmonary embolism (n = 19) and in patients with severe pulmonary emphysema (n = 5). Perfusion lung scintigraphy was performed within 48 hours prior to the MRI examination in both groups of patients. The dynamic study was acquired in the coronal plane and consisted of 10 images of 6 slices (a total of 60 images per series). Gadopentetate dimeglumine (0.1 mmol/kg) was manually injected as a compact bolus during the acquisition of the first image. Three senior radiologists reviewed all unprocessed two-dimensional coronal sections. They were blinded to clinical data and other imaging modalities. For the three observers, the average sensitivity and specificity of MR were 69% and 91%, respectively. The overall agreement between MR and scintigraphy appears to be good, with a good correlation between the two modalities (kappa = 0.63). However, the data showed variability depending on the location of the perfusion defect, with higher accuracy in the upper lobes. The agreement between MR perfusion and scintigraphy appears to be moderate in the left inferior lobe (kappa = 0.48). The data showed an overall good interobserver agreement (kappa = 0.66). MR perfusion of the lung is a promising technique in detecting lung perfusion defects.
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PMID:Prospective comparison of MR lung perfusion and lung scintigraphy. 1003 Jun 51

Acute pulmonary embolism is a frequent disease with non-specific findings, high mortality, and multiple therapeutic options. A definitive diagnosis must be established by accurate, non-invasive, easily performed, cost-effective, and widely available imaging modalities. Conventional diagnostic strategies have relied on ventilation-perfusion scintigraphy complemented by venous imaging. If the results are inconclusive, pulmonary angiography, which is regarded as the gold standard, is to be performed. Recently, marked improvements in CT and MRI and shortcomings of scintigraphy led to an update of the diagnostic strategy. Spiral CT is successfully employed as a second-line procedure to clarify indeterminate scintigraphic results avoiding pulmonary angiography. It can also be used as a first-line screening tool if service and expertise is provided. Venous imaging is indicated if CT is inconclusive. The MRI technique can be applied as an alternative second-line test if spiral CT is not available or is contraindicated. It has the greatest potential for further developments and refinements. Echocardiography should be used as a first-line bedside examination in critical patients. If inconclusive stabilized patients undergo spiral CT, unstable patients should be referred for pulmonary angiography. Chronic thromboembolic pulmonary hypertension is a rare sequela of acute pulmonary embolism which can be cured surgically. Morphology, complications, and differential diagnoses are better illustrated by spiral CT and MRA, whereas invasive acquisition of hemodynamic data is the sole advantage of angiography.
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PMID:Update on diagnostic strategies of pulmonary embolism. 1010 49


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