Tuesday, February 3, 2015

Study group discussion: Diagnostic tests for pulmonary embolism

What is the commonest sign on ecg for PE?

Nonspecific ST changes?
Nope.

SQ3 T3 something like that?
Nope.

Most common sign is sinus tachycardia. Most specific is S1q3t3 pattern..Positive only in 20-30% cases.

Ohhh!! Nice question.

Ooh.. We tend to forget common ones when looking out for rare signs!

What is the screening test for PE?

Screening test is d-dimer. If d-dimer is negative you virtually exclude the diagnosis of PE.

Which is the most specific diagnostic test for pulmonary embolism?

Pulmonary angiography.

Depends if the person is low risk or high risk! CT angiography is done though.

Which is the most preferred test for PE?

Spiral CT is preferred next to know location, size and blah blah.

What about VQ scan?

That's done if the patient is allergic to contrast.
Or has kidney failure.
Or CT isn't available.
Or the patient is pregnant.

In our hospital setting angiography would key since most patients can't afford CT.

Oh. But its invasive..and can be very harmful. It's only preferred when you are planning for thrombectomy..Or as a last resort to diagnose PE if all the other test are negative but d-dimer is positive.

Well money for a CT can feed a peasants family for a year.

True.

Venous doppler is preferred when CT or V/Q are inconclusive.

Whats d-dimer?
The clot thingy. It interlocks fibrin strands.

It is released from the thrombus.

Fibrin is non specific for clots
Because it is elevated in some other conditions as well. So d dimer to the rescue!
*Fibrin degradation products are.

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