Incidental findings on Computed Tomographic Pulmonary Angiography in patients with suspected Pulmonary Embolism and normal chest radiograph
Keywords:Pulmonary embolism, Computed Tomographic Pulmonary Angiography (CTPA), Incidental findings
AbstractBackground: Certain signs and symptoms (even non specific ones) unexplained by other pathology should raise the possibility of pulmonary embolism (PE) and trigger a workup. Computed Tomographic Pulmonary Angiography (CTPA) is the recommended primary imaging tool in patients with suspected pulmonary embolism. This diagnostic tool (CTPA) is far more sensitive than plain chest X-ray in detecting various abnormalities which may easily be missed by plain chest X-ray film.Objective: The purpose of this sturdy was to assess the detection rate for PE for all patients who underwent CTPA between January 2014 and December 2015 and describe other radiological abnormalities in addition to PE, with particular reference to those not observed on contemporaneous plain CXR.Methodology: This is a retrospective study. Two hundred and eighty (280) patients who had CTPA (and Chest X-ray) performed during two years period as a part of their workup for suspected pulmonary embolism were included. Radiological diagnoses were cross checked with medical notes, electronic discharge summaries and pathology reports where appropriate.Results: Two hundred and eighty (280) patients underwent CTPA for suspected PE (Female 57%). Overall, 56 (20%) patients had evidence of PE. Initial CXR was normal in 176 (63%). Of these, 40 (23%) had evidence of PE. Additional diagnostic findings were seen in 20 (11%) patients with a PE and 49 (28 %) with no evidence of PE, accounting for 69 (39%) of all patients with a normal CXR.Conclusion: One in five CTPA (20%) confirmed the diagnosis of PE. CTPA is far superior to plain chest radiography at providing a diagnosis in patients investigated for PE. It may help find other explanation for the symptoms even when no PE is present. Incidental findings are commonly identified by CTPA despite a normal CXR. Many of these findings are may be clinically relevant and may lead to further investigations including repeat imaging with associated cost implications.