Case Study (2): CT-PA
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Ms. K.M., a 39-year-old HIV-positive woman, presented with a week of hemoptysis and shortness of breath following a deep vein thrombosis in her right leg. Imaging investigations such as chest X-ray and venous duplex ultrasound can be normal or non-diagnostic in pulmonary embolism cases. CT pulmonary angiography has a high sensitivity of over 90% for detecting clots as small as 2mm, making it the gold standard for diagnosis. Indications for CT-PA include when the diagnosis needs to be confirmed to determine options for anticoagulation, IVC filter placement, or surgical embolectomy.
Case Study (2): CT-PA
- 2. Case Summary Ms K.M, a 39 year old female, HIV +ve on ATRIPLA with a 1 week history of haemoptysis and SOB following a right leg DVT Diagnosis: ? Recurrent Pulmonary Embolism
- 3. Imaging Investigations CXR usually normal Atelectasis or pleural effusion may be present Classic signs such as hamptons hump or westermarks sign are very rare Duplex u/s of the leg Half of cases are negative
- 6. CT-PA CT-Pulmonary Angiography has a sensetivity of > 90% Visualise clots as small as 2mm It is a Gold Standard
- 11. Indications For CT-Angiography Pulmonary Embolism Left ventricular stress/failure Aortic Dissection Teratology of Fallot Aortic overloading
- 12. Invasive and costs so.. Usually reserved for patients in whom more information or certainty of the diagnosis of PE are necessary.
- 13. Indications for CT-PA Indications are the need to confirm the diagnosis of PE in the presence of contraindications to anticoagulation or if IVC filter placement or surgical embolectomy are contemplated
- 14. In addition, patients with a high index of clinical suspicion but non-diagnostic non-invasive studies and patients with pulmonary hypertension of unknown cause
- 15. Contraindication for CT- Angio Renal failure Allergies to contrast Pregnancy Severe DM
- 16. Life threatening complications are typically secondary to acute cor pulmonale in patients with pre-existing severe pulmonary hypertension and failing right ventricle.