QJM Advance Access published online on April 17, 2009
QJM, doi:10.1093/qjmed/hcp041
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Clinically suspected acute pulmonary embolism: a comparison of presentation, radiological features and outcome in patients with and without PE
From the 1Respiratory Medicine Unit, University of Edinburgh, Edinburgh, EH16 4SA, 2Public Health Sciences, University of Edinburgh Medical School, Teviot Place, Edinburgh, EH8 9AG, 3Department of Radiology, Borders General Hospital, Melrose, TD6 9BS and 4Department of Clinical Radiology, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SU, Scotland, UK
Address correspondence to Dr A.R. Akram, c/o Dr John Simpson, Respiratory Medicine Unit, New Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SU, Scotland, UK. email: ahsan.akram{at}hotmail.co.uk
Received 22 November 2008 and in revised form 16 March 2009
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Abstract |
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Background: Relatively little is known about prognosis in patients for whom suspected pulmonary embolism (PE) is refuted by imaging.
Aim: This prospective study of suspected PE therefore compared clinico-radiological features and outcome in patients with and without PE.
Design and Methods: Computed tomographic pulmonary angiography (CTPA) confirmed or refuted PE in consecutive patients. Clinical, laboratory and radiological features were recorded at baseline, and mortality at 1 year determined. Univariate and multivariate analyses identified variables associated with PE.
Results: PE was diagnosed in 45 patients and refuted in 141. The PE and ‘non-PE’ groups were similar with regard to extravascular radiology (though consolidation was significantly more common in the PE group [present in 24 (53%) of the PE group and 42 (30%) of the non-PE group, P < 0.01)], comorbidities (no significant differences), and baseline characteristics (only serum D-dimer concentrations were independently associated with PE by multivariate analysis, P = 0.001). Right ventricular dimensions were significantly higher in the PE group, [right ventricular to left ventricular ratio was 0.98 (range 0.64–2.48) in the PE group and 0.92 (range 0.66–1.95) in the non-PE group, P < 0.05]. In the PE group, right ventricular dimensions rose sharply when 10 or more segmental pulmonary arteries were occluded. One year all-cause mortality was 6.7% in the PE group and 13.5% in the non-PE group (no significant difference, P = 0.218).
Conclusion: Among a cohort of patients presenting with clinically suspected PE, clinical characteristics, co-morbidities and radiological features were similar when comparing groups with CTPA-proven or CTPA-refuted PE. However RV dimensions, radiological consolidation on imaging and D-dimer levels were significantly higher in the PE group. Patients with suspected PE have a poor prognosis irrespective of whether PE is confirmed. This appears accentuated in patients without PE, a finding possibly under-recognized in clinical practice.