Source: Annual Congress 2006 - Pulmonary hypertension: thromo-embolic processes
Disease area: Pulmonary vascular diseases

Abstract

Acute Pulmonary Embolism ( PE) continues to pose a diagnostic challenge. The aim of our audit was to study our management of patients presenting with PE and to assess the usefulness of d-dimer in diagnosis of PE.
2668 patients were admitted to our unit between August & November 2005. 168 patients ( 85 females, mean age 49 yrs) were screened for a suspected PE.119 patients were white and the rest were asians& black afro-carribeans.
Presenting symptoms were chest pain( 58%),dyspnoea(26.5%),cough / haemoptysis(14%) and collapse(1.5%).49 patients had a pre-existing risk factor, commonest being recent surgery.33 patients had abnormal clinical signs (commonest: tachycardia).
Sinus tachycardia was the commonest finding on ECG (28 patients).Bi-Basal shadowing being the commonest radiological abnormality( 24 patients).
65 patients were found to have a raised d-dimer(NYCOCARD SUBTYPE) .The values ranged from 0.4 to 4.1 ( <0.3 was normal). 50 of these patients underwent further imaging to exclude a PE, the rest were excluded as they had co-morbidities which explained their symptoms.
23 patients had a VQ scan , 5 had a perfusion scan alone.17 patients had a low probability,8 had a high probability,3 patients had an intermediate probablity.
22 patients with an abnormal chest radiograph had a CT Pulmonary angiogram, PE was confirmed in 12 of these patients.
On diagnosis patients were treated with subcutaneous low molecular weight heparin and anticoagulated with warfarin.The incidence of PE with no co-morbidities and with a raised d-dimer was 35.4%. The prevalence of PE on our unit was 0.8%. All 23 patients with a confirmed PE had a pre-existing risk factor and were hypoxic at presentation ( PO2 <8.0 kPa.)

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Citations should be made in the following way:
A. Dwarakanath, A. Rana, D. Saralaya, P. McWhinney, B. Jacob, D. Newton (Bradford, United Kingdom). A prospective audit of acute pulmonary embolism in a medical admissions unit. Eur Respir J 2006; 28: Suppl. 50, 2362

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