|ECR 2018 / C-0629|
|Are we over imaging the obese patient with suspected pulmonary embolus?|
- 230 CTPAs were performed in our institution over a one year period in patients age 18-50, of which 221 were included.
- 129 were male and 92 were female.
- 69 (31%) patients were classified as obese by the fat/bone ratio criteria, 53 of which were female.
- The average age of the obese category was 41.
- 11 studies (16%) were positive for pulmonary embolus.
- 58 studies (84%) were negative for pulmonary embolus.
- Of the 11 positive studies, 8 (72%) were provoked and 3 (28%) were unprovoked.
- A provoked pulmonary embolism was defined as one that occurred in patients with an underlying clotting predisposition. Underlying conditions included antiphospholid syndrome, Crohn's disease, cocaine use, previous venous sinus thrombosis, and patients who were in the acute post-operative period.
- 28 (41%) had no significant findings or airways disease
- 59 patients had D dimers performed and of these, only seven patients had a D dimer within the normal range.
Non obese category:
- 24 studies (15%) were positive for pulmonary embolus.
- 128 studies (85%) were negative for pulmonary embolus.
- Of the 24 positive studies, 13 (54%) were provoked, and 11 (46%) were unprovoked. Underlying predisposing factors included use of the oral contraceptive pill, history of long haul travel, malignant hypertension, polytrauma and patients in the post partum period.
- 75 (49%) had no significant findings or airways disease.
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