Frequency of plain film abnormalities and some clinical findings of acute pulmonary embolism – correlation with severity of pulmonary arterial obstruction

• Main Authors: Igor Požek, Igor Drinovec, Rok Cesar
• Format: Article
• Language: English
• Published: Slovenian Medical Association 2005-07-01
• Series: Zdravniški Vestnik
• Subjects: pulmonary embolism; CT angiography; chest plain film; ECG
• Online Access: http://vestnik.szd.si/index.php/ZdravVest/article/view/2124

<p><strong>Background:</strong> The aim of the study was to find out if chest x-ray abnormalities and some clinical signs and findings in patients with acute pulmonary embolism (PE) correlate with the degree of pulmonary arterial obstruction (CT obstruction index – CTOI) determined with scoring system on spiral CT angiograms (SCTA).</p><p><strong>Material and methods:</strong> In 41 pts (16 men, 25 women; age range 20–89 years, mean 65 years) with SCTA proven acute PE, plain chest films were retrospectively reviewed for signs of acute PE. A scoring system based on site and degree of arterial obstruction enabled measurement of severity of obstruction on SCT angiograms. Some clinical signs (sudden onset dispnea, chest pain, syncope), ECG, pH and pCO2 of arterial blood were evaluated and compared between group with major PE (10 pts with CTOI &gt; 40%) and the rest (31 pts with CTOI &lt; 40%).</p><p><strong>Results:</strong> Mean CTOI for whole group (41 pts) was 22.7% ± 18.7%. CTOI was significantly higher in pts with oligemia on chest x-ray films than without it (43.3% ± 16.8% vs. 14.1% ± 11.6%; p value &lt; 0.05). Other x-ray signs (increase in the size of the main pulmonary arteries, elevation of the hemidiaphragm, discoid atelectases, consolidation, pleural effusion) did not correlate with CTOI. ECG signs of right ventricular strain were significantly more frequent in patients with CTOI &gt; 40% (60% vs. 22.5%; p value &lt; 0.05). There was no difference in frequency of clinical signs, pH and pCO2 of arterial blood between patients with major and minor PE.</p><p><strong>Conclusions:</strong> In pts with CT proven acute PE, oligemia on chest x-ray and ECG signs of right ventricular strain correlate with severity of pulmonary arterial obstruction. Clinical simptoms, pH and pCO2 of arterial blood show no correlation with degree of pulmonary arterial obstruction.</p>