#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

CT pulmonary angiography as a part of a diagnostic algorithm in a patient with a recurrent pulmonary embolism and a chronic renal failure


Authors: Otto Lang 1,2,3;  Ivana Kuníková 1
Authors place of work: Klinika nukleární medicíny, 3. LF UK a FNKV, Praha 10 1;  Oddělení nukleární medicíny, Oblastní nemocnice Příbram, a. s. 2;  Oddělení nukleární medicíny, PMCD s. r. o., Praha 6, ČR 3
Published in the journal: NuklMed 2019;8:29-33
Category: Casuistry

Summary

Introduction: The aim of our case report is to demonstrate overuse and potentially risky use of pulmonary CT angiography in patient with a recurrent pulmonary embolism and a chronic renal failure.

Material and methods: 56-y-old patient was sent to our department by his general practitioner to an emergency follow-up lung perfusion scintigraphy due to an exertional dyspnea which appeared after termination of anticoagulant therapy in April 2010. He had a bilateral pulmonary embolism on March 2008 with a massive recurrence in September 2008 also after termination of anticoagulation in his history. Recent pulmonary scintigraphy demonstrated again bilateral segmental to lobar embolism and the patient was sent to hospitalization to the internal department.

Results: Emergency CT pulmonary angiography was required immediately after the admission. It demonstrated emboli with a partial flow around in the lobar arteries for the upper and the lower lobe of the right lung and for the lower lobe of the left lung in accordance with pulmonary scintigraphy. The patient has a chronic hydronephrosis with afunction of the right kidney with a chronic renal failure in his history. Ultrasonography did not detect any thrombosis in the lower extremities veins, hematological investigation revealed only slight factor IX deficit, echocardiography was normal, oncological screening was negative. Patient was discharged after LMWH treatment, follow-up study was not required.

Conclusion: CT pulmonary angiography did not bring any new information comparing to lung perfusion scintigraphy. Moreover, the patient had a functionally solitary kidney with a chronic renal insufficiency. Therefore, we believe that the CT pulmonary angiography was redundant and potentially dangerous for the patient. We also believe, that the follow-up study after pulmonary embolism is important from the point of view of possible progression to CTEPH and should be required.

Keywords:

pulmonary embolism (PE) – CT pulmonary angiography (CTPA) – scintigraphy – chronic renal insuficiency


Zdroje
  1. Nikolaou K, Thieme S, Sommer W, et al. Diagnosing Pulmonary Embolism.New Computed Tomography Applications. J Thorac Imaging 2010;25:151–160
  2. Widimský J, Malý J, a kol. Akutní plicní embolie a žilní trombóza. Praha - 3. vydání, Triton, 2011, Praha, 420 p
  3. Leblanc M, Paul N. V/Q SPECT and Computed Tomographic Pulmonary Angiography. Semin Nucl Med 2010rok?;40:426-441
  4. Miniati M, Monti S. Should lung scan be abandoned for pulmonary embolism diagnosis in the age of multislice spiral CT? No. Intern Emerg Med 2009;4:193–194
  5. Lang O, Kuníková I. Změna kolektivní efektivní dávky pacientů vyšetřovaných pro podezření na embolii do plicnice po zavedení víceřadého CT – zkušenost jednoho pracoviště. NuklMed 2016;5(S1):17(A)
  6. Reid JH, Coche EE, Inoue T, et al. Is the lung scan alive and well? Facts and controversies in defining the role of lung scintigraphy for the diagnosis of pulmonary embolism in the era of MDCT. Eur J Nucl Med Mol Imaging 2009;36:505–521
  7. Suga K, Yasuhiko K, Iwanaga H, et al. Relation between lung perfusion defects and intravascular clots in acute pulmonary thromboembolism: Assessment with breath-hold SPECT–CT pulmonary angiography fusion images. Eur J Radiol 2008;67:472–480
Štítky
Nuclear medicine Radiodiagnostics Radiotherapy
Prihlásenie
Zabudnuté heslo

Zadajte e-mailovú adresu, s ktorou ste vytvárali účet. Budú Vám na ňu zasielané informácie k nastaveniu nového hesla.

Prihlásenie

Nemáte účet?  Registrujte sa

#ADS_BOTTOM_SCRIPTS#