|ECR 2018 / C-0890||
|Assessment of severity and prognosis in patients with pulmonary embolism attending to clot load score on MDCT pulmonary angiography|
- Prevalence of acute PE and demographic characteristics.
From 400 adult patients who underwent acute PE-suspected pulmonary MDCT between 2010 - 2015, a total of 70 (17,5%) were included in our study with PE positive findings.
From the remaining 330 studies, 16 patients (4%) were excluded because of inadequate image quality to assess an accurate quantification of clot burden, and 314 patients (78,5%) were excluded because they were diagnostic for other conditions rather than acute PE, like chronic vascular disease (3,3%) or acute processes (75,2% of PE suspictions), such as congestive heart failure or pneumonia (Fig. 7).
Attending to the gender and age from patients with acute PE, the mean rate of hospitalizations was significantly higher among males than females (54,2% vs.45,7%). Additionally, patients aged ≥ 80 years exhibited significantly higher rates compared with those patients aged under 80 years (81,4% vs.18, 5%) (Fig. 8).
- MDCT angiographic findings.
The distribution of embolus along the pulmonary arterial tree is displayed in Fig. 9. The most proximally affected pulmonary artery branch was the trunk in 3 patients (4,2 %), followed by principal pulmonary arteries in 23 (32,8%) patients, lobar arteries in 32 (45%) patients, segmental pulmonary arteries in 59 (84,2%) patients, and subsegmental pulmonary arteries in 39 (55,7%) patients. Isolated PE in subsegmental arteries was only found in 8 (11,4%) patients.
According to our results of quantification of the clot burden (Fig.10), patients´ scoring groups were displayed as follows: Group 1, 35 patients (50%); group 2, 14 patients (20%) and group 3, 21 patients (30%).
The frequency of prognostic events in hospitalized patients according to the quantification of clot burden is shown in Fig. 11. Patients with the highest scores of clot burden (group 3) were related to have the highest incidence of recurrences (5%) and cardiopulmonary complications (14,2%) and patients of groups 2 and 3 were most related to have long-stay hospitalizations; however, rates of ICU incomes and mortality rates were similarly found in patients of the three groups.
Signs of right heart dysfunction on MDCT angiographic images are summarized in Fig. 12, where the most commonly found were pulmonary hypertension (34,2%), reflux of contrast medium into the IVC (27%) and dilatation of right ventricle (17%) of patients with acute PE. Their frequencies, attending to the clot burden scoring groups at MDCT, are displayed in Fig. 13, which shows the highest rates of RV dilatation (75%) and pulmonary hypertension (71%) in the highest clot burden scoring group (group 3).
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