Research Article
An Analysis of Patients That Underwent Computed
Tomography Pulmonary Angiography with the Prediagnosis of
Pulmonary Embolism in the Emergency Department
Engin Ozakin,
1
Filiz Baloglu Kaya,
1
Nurdan Acar,
1
and Arif Alper Cevik
1,2
1
Department of Emergency Medicine, Eskisehir Osmangazi University Medical Center, Meselik 26480, Eskisehir, Turkey
2
Medical College and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
Correspondence should be addressed to Engin Ozakin; enginozakin@hotmail.com
Received 25 February 2014; Accepted 30 April 2014; Published 15 May 2014
Academic Editor: Ahmet Mentes ¸e
Copyright © 2014 Engin Ozakin et al. Tis is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Introduction. Te purpose of this study is to analyze the frequency of other diagnoses and fndings in patients that were diagnosed
with or not diagnosed with PE following the CTPA in the ED and to analyze the relationship between diagnosis and D-
dimer.Instrument and Method. Tis study involves all patients that presented to the ED that underwent CTPA with the prediagnosis
of PE. Te items considered in this study were their reason for presenting to the ED and pretest clinical risks for PE, D-dimer, and
CTPA results.Findings. Of the 696 cases, the most common cause was shortness of breath (59.3%). Te CTPA showed that 145
(20.83%) patients were sufering from PE. Among the remaining cases, 464 (66.66%) patients had pathological fndings other than
PE and 87 (12.5%) patients were reported as normal. Te most common pathological results other than PE found in CTPA were
atelectasis in 244 (39.9%) and ground glass in 165 (23.7%), as well as nonpulmonary results in 70 (10.05%) patients. Te diferences
in D-dimer results of patients diagnosed with PE, patients diagnosed with another pathology, and patients with normal CTPA
results were statistically signifcant ( < 0.001).Conclusion. CTPA scanning, performed on the basis of assessment scoring, helps
in discovering other fatal pathologies in addition to PE.
1. Introduction
PE is a frequently encountered disease that is difcult to
diagnose, and the disease may develop a fatal course [1].
Te disease mostly occurs when deep vein thrombosis blocks
the pulmonary artery completely or partially. Te diversity
of symptoms and fndings may mask the clinical evidence
and cause the disease to be unnoticed. In recent years, there
have been improvements in the diagnosis and treatment of
the disease. Early diagnosis and treatment are lifesaving.
Tat is why, in patients with suspected PE, risk factors as
well as clinical, laboratory and imaging results should be
examined carefully. In cases with suspicion, the frequency of
PE ranges between 8% and 39% [2, 3]. While the mortality
rate of PE is approximately 30% in noncured patients, the
rate reduces to 2–8% with treatment [4, 5]. Te symptoms
and fndings such as shortness of breath, chest pain, syncope,
hyperventilation, and unexplained tachycardia are not spe-
cifc to PE and may develop as well in case of pneumonia,
acute exacerbation of COPD, malignity, pleural efusion, or
cardiac diseases [6]. Tat is why the most signifcant phase
of PE diagnosis is clinically suspected. Because the specifcity
of clinical and physical examination in the diagnosis is low,
diagnostic tests should support the examination. Although
some algorithms and clinical risk rules have been defned
for the diagnosis of PE, there is no standard approach
concerning the tests or imaging methods that should be
requested. Te tests used for the diagnosis are arterial blood
gas, D-dimer test, electrocardiogram, chest radiography,
echocardiography, CTA, pulmonary angiography, magnetic
resonance imaging, and ventilation perfusion scintigraphy.
Although pulmonary angiography is the gold standard in the
diagnosis of PE, it has not been preferred very frequently
because it is an invasive method. Computerized tomography
Hindawi Publishing Corporation
e Scientific World Journal
Volume 2014, Article ID 470358, 5 pages
http://dx.doi.org/10.1155/2014/470358