Role of spiral computed tomography in the diagnosis of pulmonary embolism in the emergency department

Citation
Jm. Holbert et al., Role of spiral computed tomography in the diagnosis of pulmonary embolism in the emergency department, ANN EMERG M, 33(5), 1999, pp. 520-528
Citations number
47
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Aneshtesia & Intensive Care
Journal title
ANNALS OF EMERGENCY MEDICINE
ISSN journal
0196-0644 → ACNP
Volume
33
Issue
5
Year of publication
1999
Pages
520 - 528
Database
ISI
SICI code
0196-0644(199905)33:5<520:ROSCTI>2.0.ZU;2-U
Abstract
Recently a debate has developed in the medical community as radiologists in some centers suggest the selective substitution of spiral computed tomogra phy (CT) for ventilation;perfusion (V/Q) nuclear medicine imaging as a scre ening test for the diagnosis of acute pulmonary embolism. Proponents of spi ral CT argue that it is more accurate than the usual practice of combining the (V/Q) scan and the physician's best clinical judgment. V/Q scans classi fy patients into groups according to the probability of pulmonary emboli, w hereas the thrombus is visible with spiral CT. Opponents point our that lar ge-scale patient outcome studies using spiral CT have not been completed, b ut such information is available for (V/Q) scans. Most clinicians are famil iar with the strengths and limitations of an assessment that relies primari ly on the (V/Q) scan, because this examination has been available for many years. Although spiral CT does Rot perform as well as pulmonary arteriograp hy in detecting subsegmental emboli, the importance of smaller peripheral e mboli is controversial. This review explores the advantages and disadvantag es of investigations currently available for the diagnosis of acute pulmona ry embolism from the perspective of the emergency physician, presenting the view that spiral CT is likely to have an increasingly important place in p atient evaluation.