Clinical impact of findings supporting an alternative diagnosis on computed tomography pulmonary angiography in patients with suspected pulmonary embolism.
Chest. 2013 Aug 29;
Authors: van Es J, Douma RA, Schreuder SM, Middeldorp S, Kamphuisen PW, Gerdes VE, Beenen LF
ABSTRACT BACKGROUND Computed tomography pulmonary angiography (CTPA) is commonly used as the first imaging test in the diagnostic work-up of patients with suspected pulmonary embolism (PE). Other CTPA findings may provide an alternative explanation for the signs and symptoms in these patients however, the clinical impact here of is not clear. METHODS In 203 consecutive patients with suspected PE, we prospectively evaluated the clinical implication of abnormalities on CTPA. Alternative diagnoses were defined on clinical grounds prior to CTPA and afterwards. Subsequent, diagnostic tests and therapeutic consequences were assessed using a priori defined criteria. RESULTS Of the 203 patients, 61 (30%) had no abnormality on CTPA. Thirty-nine (19%) patients were diagnosed with PE. Before CTPA, alternative diagnoses were suspected in 97 (48%) patients. Findings supporting an alternative diagnosis were detected in 88 (43%) patients. In 28 patients this was a new finding; in 18 patients, a conclusive and previously unknown alternative diagnosis for the complaints was made based on the outcome of the CTPA. Overall, findings supporting alternative diagnoses had therapeutic consequences in 10 (4.9%) patients. Incidental findings (nodules/lymph nodes) requiring diagnostic procedures were present in 17 (8.4%) patients, of which one (0.5%) had a therapeutic consequence. CONCLUSION In patients undergoing CTPA for suspected PE, findings supporting an alternative diagnosis were found in almost half of the patients. However, in only a few patients this had therapeutic consequences. Hence, CTPA should principally be used to confirm or exclude PE in high probability patients, but not to establish an alternative diagnosis.
PMID: 23989896 [PubMed - as supplied by publisher]