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Old 02-04-2013
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Heart Doubts about pulmonary embolism and aortic dissection

1. If CT angiogram cannot be done in a patient of suspected pulmonary embolism then the next step would be Doppler of leg or V/Q scanning??
2. If aortic dissection is present, control BP then x ray after that ct scan or echo??
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Old 02-04-2013
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1. V/Q scan
2. CT scan or transesophageal echo or MR angio
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Old 02-05-2013
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Originally Posted by ts1234 View Post
1. If CT angiogram cannot be done in a patient of suspected pulmonary embolism then the next step would be Doppler of leg or V/Q scanning??
Remember, you start patient on Heparin with high pre-test probability of PE.

After starting Heparin, you do the test(s).
I cannot think of any condition in which CT Angio (aka Spiral CT) cannot be done and the patient will qualify for a V/Q Scan since a V/Q Scan requires a clear CxR.

Also, CT Angio is now the test of choice including pregnant patients.

Quote:
Originally Posted by ts1234 View Post
2. If aortic dissection is present, control BP then x ray after that ct scan or echo??
Hemodynamically unstable patient>>>>Transesophageal echo

Hemodynamically stable patient>>>>>> CT Angio
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Last edited by Novobiocin; 02-05-2013 at 07:26 AM.
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hi novobiocin what if the patient has renal insufficiency??can ct angiography still be done
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Quote:
Originally Posted by Novobiocin View Post
Remember, you start patient on Heparin with high pre-test probability of PE.

After starting Heparin, you do the test(s).
I cannot think of any condition in which CT Angio (aka Spiral CT) cannot be done and the patient will qualify for a V/Q Scan since a V/Q Scan requires a clear CxR.

Also, CT Angio is now the test of choice including pregnant patients.



Hemodynamically unstable patient>>>>Transesophageal echo

Hemodynamically stable patient>>>>>> CT Angio
Means for V/Q scan,patient must not have any pre-existing lung disease or any condition which cause haziness to lungs ????

UW says: Spiral CT,MRI and TEE are more than 90 % sensitive and specific for aortic dissection.But TEE preferred over MRI because MRI is time consuming.......??
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Originally Posted by ts1234 View Post
hi novobiocin what if the patient has renal insufficiency??can ct angiography still be done
The problem with V/Q Scan is that it is only useful in 50-70% of cases ( i.e. if it is normal with a normal CxR it virtually rules out PE). Also, it can only be interpreted correctly in the presence of calculated pre-test probability using Well's criteria.
For example: 85% of patients with High Probability scan has PE but it becomes 96 % with high pre-test probability using Well's criteria and only 6% with low pre-test probability using Well's criteria.

There are few remaining indications of a V/Q Scan:
1. Obese patient
2. Contrast allergy
3. Renal insufficiency
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Originally Posted by aknz View Post
Means for V/Q scan,patient must not have any pre-existing lung disease or any condition which cause haziness to lungs ????

UW says: Spiral CT,MRI and TEE are more than 90 % sensitive and specific for aortic dissection.But TEE preferred over MRI because MRI is time consuming.......??
You are correct.

You cannot do V/Q Scan in any patient with pre-existing cardiopulmonary diseases like COPD, ILD, pneumonia, CHF etc.

MRI is very time consuming as compared to TEE which can be done at the bedside.
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Originally Posted by Novobiocin View Post
You are correct.

You cannot do V/Q Scan in any patient with pre-existing cardiopulmonary diseases like COPD, ILD, pneumonia, CHF etc.

MRI is very time consuming as compared to TEE which can be done at the bedside.
So if the question gives us both choices CT angiogram and TEE,we will go for TEE ??
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Originally Posted by aknz View Post
So if the question gives us both choices CT angiogram and TEE,we will go for TEE ??
Depends on the information in the question stem. Check out UW ( use the search feature). It's explained quite well there.
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