Computed tomography pulmonary angiography: a sample of experience at a District General Hospital

Our plain-English summary of Computed tomography pulmonary angiography: a sample of experience at a District General Hospital, by J.A. Soye, C.B. Loughrey, P.D. Hanley (The Ulster Medical Journal, 2008).

The study

• Authors: J.A. Soye, C.B. Loughrey, P.D. Hanley
• Journal: The Ulster Medical Journal
• Published: 2008;77(3):175-80
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Free full text

Abstract

Purpose: Pulmonary embolism (PE) has a significant associated morbidity and mortality. The role of diagnostic imaging in PE is being increasingly undertaken by computed tomography pulmonary angiography (CTPA). An advantage of CTPA is its ability to simultaneously provide information on the lung parenchyma, mediastinum, pleural spaces, and chest wall. A sample of CTPAs was therefore reviewed to identify the types of additional pathology demonstrated.

Materials And Methods: One hundred and ninety-eight CTPA examinations were retrospectively reviewed. A record was made of the presence of PE and any additional pathology, with particular interest given to "incidental" pathology, or pathology that was unsuspected but which was significant enough to change the patient's management. A note was also made as to the adequacy of the study. D-Dimer values were recorded when available.

Results: PE was demonstrated in 56 studies (28.3%). Additional pathology was seen in 112 studies (56.6%), of which 17 were categorised as incidental. These included multiple pulmonary nodules, solitary lung lesions, destructive bony lesions, pancreatitis, a solid renal mass, mesothelioma, reactivated pulmonary tuberculosis, recurrent bronchial carcinoma, pulmonary fibrosis, an SVC filling defect, and a compression fracture of T10.

Conclusion: The prevalence of PE in our sample was 28.3%, compared with a reported prevalence, mainly by pulmonary angiography, of between 19% and 79%. Secondary findings were found in 56.6% of scans, with completely incidental findings demonstrated in 17 patients (9%). This emphasizes the usefulness of CTPA in providing additional diagnostic information and alternative diagnoses in patients with suspected PE.

In plain English

This retrospective study reviewed 198 computed tomography pulmonary angiography (CTPA) scans. CTPA is a chest scan for blood clots in the lungs (pulmonary embolism, PE). The scans were done between January and November 2006 at the Ulster Hospital, a district general hospital near Belfast, Northern Ireland. The article does not mention asbestos. PE was seen in 56 scans (28.3%). Other abnormalities were seen in 112 scans (56.6%), most often consolidation (45) and pleural effusion (35). Seventeen findings were classed as incidental, meaning unsuspected but significant enough to change care. One was nodular pleural thickening in one patient, with a presumptive diagnosis of mesothelioma. Others included lung lesions presumed to be cancers or metastases, and a solid kidney mass. None of the 7 patients with a D-Dimer below 250 nanograms per millilitre had PE shown on CTPA. PE was shown in 31 of 72 patients with values above 1000. The authors said their numbers were too small to assign significance to a negative D-Dimer. They concluded that CTPA was useful in providing additional diagnostic information and alternative diagnoses.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: retrospective review of CTPA scan examinations and their reports
• Who was studied: 198 CTPA examinations for suspected pulmonary embolism, performed January to November 2006 at the Ulster Hospital, a district general hospital on the outskirts of Belfast, Northern Ireland
• Main results:
  • Pulmonary embolism was shown in 56 of the 198 studies (28.3%).
  • Additional pathology was seen in 112 studies (56.6%). The most common were consolidation (n=45) and pleural effusion (n=35).
  • 17 findings were categorised as incidental: unsuspected but significant enough to change management. The results section gives this as 8.6% and the conclusions as 9%.
  • Table II gives presumptive diagnoses for the incidental findings. Multiple pulmonary nodules in 4 patients were presumed to be multiple metastases (n=3) or inflammatory nodules (n=1). Solitary lung lesions in 4 patients were presumed to be bronchial carcinoma. A solid renal mass in 1 patient was presumed to be renal cell carcinoma.
  • One incidental finding was nodular pleural thickening in one patient. It was listed with a presumptive diagnosis of mesothelioma.
  • None of the 7 patients with a D-Dimer below 250 (the normal range was less than 250 nanograms per millilitre) had PE demonstrated on CTPA.
  • PE was shown on CTPA in 31 of the 72 patients with a D-Dimer greater than 1000 (43.1%).
  • 49 scans (24.7%) were reported as at least technically adequate. 36 scans (18.2%) were reported as suboptimal or inadequate. Technical adequacy was not commented on in 112 (56%).
• The authors' conclusion: The authors concluded that the 56.6% rate of secondary findings, including completely incidental findings in 17 patients, showed CTPA's usefulness in providing additional diagnostic information and alternative diagnoses in patients with suspected PE.
• Limitations the authors state:
  • The numbers were too small to assign significance to a negative D-Dimer result.
  • Most scan reports made no mention of the adequacy of the examination. The authors said this figure could be significantly improved upon.

Topics

Medical terms in this study, explained in our Lexicon: Parenchyma, Mediastinum, Pathology, Mesothelioma, Carcinoma, Pulmonary Fibrosis.

Related studies

• Day Case Local Anaesthetic Thoracoscopy: Experience from 2 District General Hospitals in the United Kingdom — M. Turner, F. Craighead, et al. (2023)
• Computer tomography in the evaluation of pulmonary asbestosis. Preliminary experiences with the EMI general purpose scanner — L. Kreel (1976)
• In Situ Pulmonary Artery Thrombosis: Unrecognized Complication of Radiation Therapy — J. Ahuja, G.S. Shroff, et al. (2020)
• A review of the outcomes of rigid medical thoracoscopy in a large UK district general hospital — A. Aujayeb, K. Jackson (2020)
• The usefulness of computed tomography in detecting asbestos-related pleural abnormalities in people who had indeterminate chest radiographs: the Libby, MT, experience — O.I. Muravov, W.E. Kaye, et al. (2005)
• Computed tomography in pulmonary asbestosis — D. Katz, L. Kreel (1979)

Browse more research in The Ulster Medical Journal, or return to medical research.