imaging: pulmonary embolism

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  • 1. Image of the week
    Jagdish K
    Prof. Dr. A Gowrishankars unit
    m3

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
No h/o fever, cough or expectoration
h/O fracture neck of femur after trivial fall in bathroom 3years back and he was not ambulant since then.
3. O/E
Pulse 110/min
BP 130/80 mm of hg
Conscious, oriented, afebrile
Conjunctiva suffused
CVS S1 normal, P2 loud
RS :B/L Wheeze+, Right base BS
Other systems normal
4. Chest X ray
5. ECG
6. exudative
60 lymphocytes/cumm
6 mesothelial cells/cumm
Ada 16 iu/l
Pleural fluid analysis
7. 700ng/ml
D dimer
8. CT Chest
9. Few health care providers realise the case fatality rates for pulmonary embolism is 15%, exceeds that of acute MI
Pulmonary embolism
10. Risk factors
11. Inherited
Acquired
Thrombophilias
12. Endotelial injury
Stasis
Hypercoagulablility
Virchows Triad
13. 14. Most common symptoms & signs
15. Wells clinical decision rule
16. Mild
Moderate
Severe
Paradoxical
Pulmonary infarction syndrome
Nonthrombotic pulmonary embolism
Diverse clinical scenarios
17. 18. Pulmonary infarction syndrome
19. Oxygen saturation
Chest x ray
D dimer
Investigations
20. ECG changes
21. Echocardiographic changes
22. Multidetector CT The one stop shop
CT Angiography
23. CT PULMONARY ANGIOGRAM
24. 25. Lung scanning
Pulmonary angiography
Venous ultrasound
MRI
continued
26. Clinical predictors of increased mortality
27. Biomarkers & imaging predictors of increased mortality
28. Approach to the patient
29. 30. Lack of written diagnostic algorithm
Failure to use clinical probability scoring
Ruling out pulmonary embolism based onnormalvenous ultrasound of legs
Not evaluating after findingan abnormallyelevated D- dimer test
Delay in seeking medical attention
5 common errors
31. Can also occur concomitantlywith other illnesses , thereby confounding the diagnostic work up
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
33. THANK YOU