Fast Five Quiz: Venous Thromboembolism

Zab Mosenifar, MD

Disclosures

September 11, 2019

CT pulmonary angiography is generally the preferred imaging method for the diagnosis of acute PE in patients with a high clinical probability or low/intermediate probability and elevated D-dimer levels. 

Chest radiographic findings most often are normal. Radiographs may, however, reveal an enlarged right descending pulmonary artery, decreased pulmonary vascularity (Westermark sign), a wedge-shaped infiltrate, or elevation of the hemidiaphragm (Hampton hump). If infarction occurs, a pleural effusion may be present.

Impedance plethysmography is a noninvasive method of assessment. Sensitivity and specificity have been reported to be between 92% and 95%. However, it is of limited value when DVT is asymptomatic or distal or when findings are inconclusive.

Ventilation-perfusion scanning is a common screening technique. This modality provides a probability estimate for PE by evaluation of the size and number of defects in the perfusion of the lung compared with the areas of ventilation. The diagnosis of PE is easily made with this modality when the probability estimate is high for PE. With a normal scan finding, the possibility of PE is excluded. However, the test results are nondiagnostic in about 66% of cases.

For more on the use of imaging studies in VTE, read here.

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