Page 1 of 2: medicine: standard test for pulmonary embolism?

quincy · Credits: 3567 My Scrapbook

what is the standard test for pulmonary embolism?
is it isotope studies/ ct thorax /d dimer?

skjeev · Credits: 8210 My Scrapbook

ventilation perfusion scan,ie the first one??

simv · Credits: 3490 My Scrapbook

yes its the perfusion scan..twisted Q.

and the best one for diagnosis is angiography

tini · Credits: 1183 My Scrapbook

perfusion scan..??

grandmaster · Credits: 4266 My Scrapbook

Spiral CT is the FIRST investigation of choice..

Ref??? Bailey and Love 24 !!

Harrison and CMDT and Cecil are not so clear on this

Of course arteriography is the gold standard

quincy · Credits: 3567 My Scrapbook

so is angio gold standard or perfusion studies?

artydoc · Credits: 294 My Scrapbook

Guys ...Iam working currently in the UK as a senior SHO and with my little practical experience I can say that diagnosing Pulmonary embolism in the hospital can be really difficult..The reasons being :

1.So far CT Pulmonary angiography ( CTPA ) is considered to be the gold standard for investigating PE.But it depends on the scanner that's being used..I mean in the hospital where I work its just a single slice , meaning that it can only exclude central PE ( thrombi in main pulmonary arteries )

2.D-dimer only has a negative predictive value , it means that a negative d-dimer safely exludes PE but positive d-dimer only means we need further imaging

3.V/Q scan is good provided the CXR is normal and patient doesnt have a lung disease like asthma and COPD as they can give false positive results...and VQ scan can only say if the probability is low / intermediate or high.People with intermediate or high probability are treated with warfarin....

So the diagnosis of PE should be based on clinical scoring first and appropriate imaging.Well's score is the post frequently used which has been studied in US......

All the current information is based on PIOPED ( prospective investigation for pulmonary embolic disease ) study......

I hope this information was useful...

fredie · Credits: 309 My Scrapbook

gold standard means the most specefic test that is ANGIOGRAPHY
YA INITIAL SENSITIVE INVESTIGATION IS V/Q scan
after V/Q scan stands normal we go for D DIMER which if negative WE DO PULMONARY ANGIOGRAPHY . which stands out as gold standard
V/Q scan is not gold standard it is good sensitive test true positives are high that is even if positive we cannot excude that the v/q mismatch is due to embolism

drlouis · Credits: 5374 My Scrapbook

clinical suspicion of whether or not a patient has a pulmonary embolism is crucial in making the diagnosis!!

Prospective Investigation of Pulmonary Embolism Diagnosis II (PIOPED II) trial found that multidetector computed tomographic angiography (CTA) had excellent specificity and good sensitivity for the detection of pulmonary embolism.

The PIOPED II trial also replicates the findings of the PIOPED I trial (which used ventilation–perfusion scanning as the imaging technique) that the a priori — that is, before imaging — clinical suspicion of whether or not a patient has a pulmonary embolism is crucial in making the diagnosis

In patients with suspected pulmonary embolism, multidetector CTA–CTV(multidetector computed tomographic angiography (CTA) combined with venous-phase imaging (CTA–CTV) has a higher diagnostic sensitivity than does CTA alone, with similar specificity

nejm 2006

butcher · Credits: 616 My Scrapbook

can some 1 x plain this

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