Dual source multislice computed tomography for pulmonary embolism: initial experience at AFIC/NIHD Rawalpindi

Observation of different computed tomography findings in patients suffering from pulmonary embolism. All patients who underwent computed tomography for pulmonary embolism and had positive findings of pulmonary embolism, were included in the study. Armed Forces Institute of Cardiology/ National Institute of Heart Disease, between April 2009 and October 2010. Patients on mechanical ventilation were excluded from the study. CT pulmonary angiograms were obtained with 64 slice dual source computed tomography [DSCT] machine [Somatom definition] from Siemens. Before scanning breath holding was taught. A craniocaudal acquisition was obtained with a collimation of 64 x 0.6 mm and a pitch of 1.2-1.4. Total number of patients included in the study were 34 with mean age 50 years. The mean of Score by Miller was 10 +/- 5.532 and the mean percentage obstruction by method of Miller was 62.5%. The mean of Score by Qanadli was 19.62 +/- 12.32 and the mean percentage obstruction by method of Qanadli was 49.04%. The mean of Score by Mastora was 54.53 +/- 33.27 and the mean percentage obstruction by method of Mastora was 35.18%. Calculated mean and SD of right ventricular [RV] diameters was 44 +/- 7.75mm, left ventricular [LV] diameter was 32 +/- 8.06mm, RV/LV ratio was 1.508 +/- 0.58 mm, main pulmonary artery [PA] luminal diameter was 29 +/- 4.16mm, ascending aorta size was 32.46 +/- 5.14mm, PA/Aorta ratio was 0.913 +/- 0.188mm, Azygos Vein diameter was 11.14 +/- 1.88mm and superior vena cava [SVC] diameter [at azygos arch] was 18.93 +/- 3.37 mm. Correlation between methods was generally significant. Reflux of contrast injection was noted in 24 out of 34 patients, leftward bowing of inter-ventricular septum was observed in 21 patients, pleural effusion was noted in 10 patients and pericardial effusion was seen in only 3 patients. CT pulmonary angiography has emerged as a reliable non invasive tool for not only confirmation of diagnosis of pulmonary embolism in short time but also gives valuable information about prognosis of these critically ill patients. Further it can provide accurate follow up of thrombolytic therapy and can help plan an interventional strategy