0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Invited Commentary |

Computed Tomographic Pulmonary Angiography to Diagnose Acute Pulmonary Embolism: The Good, the Bad, and the Ugly:  Comment on “The Prevalence of Clinically Relevant Incidental Findings on Chest Computed Tomographic Angiograms Ordered to Diagnose Pulmonary Embolism”

Ami Schattner, MD
Arch Intern Med. 2009;169(21):1966-1968. doi:10.1001/archinternmed.2009.400.
Text Size: A A A
Published online

Extract

Pulmonary embolism (PE) remains a frequent and potentially fatal diagnosis that is easily missed. Its highly variable and nonspecific presentation mandates both a high index of suspicion and dependence on imaging techniques to confirm and treat PE or rule out the diagnosis.

With the advent of recent technological advances, multidetector computed tomographic pulmonary angiography (CTA) has rapidly become the sine qua non for the workup of PE. No wonder. The 1-minute test, ability to directly visualize clots within the pulmonary arteries, good sensitivity, and widespread availability 24 hours a day form indeed an impressive combination. When all of this is added to the allure of any new, sophisticated, and powerful technology, most suspected cases of acute PE are being currently referred for CTA soon after presentation.1 However, this decision may not be as straightforward as it seems.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Place holder to copy figure label and caption
Figure.

Suggested simple algorithm to substantially reduce the use of computed tomographic pulmonary angiography (CTA) in suspected cases of pulmonary embolism (PE). The numbered boxes indicate the sequence of actions by which subsets of patients can be sequentially ruled out or confirmed as having PE; DVT, deep vein thrombosis; V/Q, ventilation/perfusion. To convert D-dimer to nanomoles per liter, multiply by 5.476. *Patient numbers are approximate, based on large, high-quality studies cited; †technological improvement in scanning techniques are under way and results of trials might further improve diagnostic accuracy and reduce the number of indeterminate scans (none of 87 single photon emission computed tomographic [SPECT] V/Q scans was nondiagnostic)9,11; ‡unless contraindicated; §gadolinium-enhanced magnetic resonance angiography, digital subtraction angiography, SPECT V/Q scintigraphy, and others.

Graphic Jump Location

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 6

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();