Imaging: Pulmonary Embolism

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Imaging: Pulmonary Embolism

  1. 1. Image of the week<br />Jagdish K<br />Prof. Dr. A Gowrishankar’s unit<br />m3<br />
  2. 2. 65 yr old male, who is a known smoker for the past 40yrs, presented with acute worsening of pre existing long standing breathlessness, 10 days prior to presentation<br />No h/o fever, cough or expectoration<br />h/O fracture neck of femur after trivial fall in bathroom 3years back and he was not ambulant since then.<br />
  3. 3. O/E<br />Pulse 110/min<br />BP 130/80 mm of hg<br />Conscious, oriented, afebrile<br />Conjunctiva suffused<br />CVS – S1 normal, P2 loud<br />RS :B/L Wheeze+, Right base BS↓<br />Other systems normal<br />
  4. 4. Chest X ray<br />
  5. 5. ECG<br />
  6. 6. exudative<br />60 lymphocytes/cumm<br />6 mesothelial cells/cumm<br />Ada – 16 iu/l<br />Pleural fluid analysis<br />
  7. 7. 700ng/ml<br /> D dimer<br />
  8. 8. CT Chest<br />
  9. 9. “ Few health care providers realise the case fatality rates for pulmonary embolism is 15%, exceeds that of acute MI”<br />Pulmonary embolism<br />
  10. 10. Risk factors<br />
  11. 11. Inherited <br />Acquired<br />Thrombophilias<br />
  12. 12. Endotelial injury <br />Stasis<br />Hypercoagulablility<br />Virchow’s Triad<br />
  13. 13.
  14. 14. Most common symptoms & signs<br />
  15. 15. Well’s clinical decision rule<br />
  16. 16. Mild <br />Moderate <br />Severe<br />Paradoxical<br />Pulmonary infarction syndrome<br />Nonthrombotic pulmonary embolism<br />Diverse clinical scenarios<br />
  17. 17.
  18. 18. Pulmonary infarction syndrome<br />
  19. 19. Oxygen saturation<br />Chest x ray<br />D dimer<br />Investigations <br />
  20. 20. ECG changes<br />
  21. 21. Echocardiographic changes<br />
  22. 22. Multidetector CT – The one stop shop<br />CT Angiography<br />
  23. 23. CT PULMONARY ANGIOGRAM<br />
  24. 24.
  25. 25. Lung scanning<br />Pulmonary angiography<br />Venous ultrasound<br />MRI<br />continued<br />
  26. 26. Clinical predictors of increased mortality<br />
  27. 27. Biomarkers & imaging predictors of increased mortality<br />
  28. 28. Approach to the patient<br />
  29. 29.
  30. 30. Lack of written diagnostic algorithm<br />Failure to use clinical probability scoring<br />Ruling out pulmonary embolism based on normal venous ultrasound of legs<br />Not evaluating after finding an abnormally elevated D- dimer test<br />Delay in seeking medical attention<br /> 5 common errors<br />
  31. 31. “Can also occur concomitantly with other illnesses , thereby confounding the diagnostic work up”<br />
  32. 32. “ The greatest challenges are to remember to consider the possible diagnosis of pulmonary embolism and realise that it can masquerade as many other illnesses” <br />
  33. 33. THANK YOU<br />

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