The pattern of findings on multidetector computed tomographic pulmonary angiography for suspected pulmonary embolism in Nairobi.

Abstract

Introduction:

Pulmonary embolism is a common condition with considerable morbidity and mortality. Prompt and accurate diagnosis is important because the mortality of untreated PE is high and complications can occur with its treatment of long-term anticoagulation. As there are no specific signs or symptoms of this condition, the diagnosis relies heavily on imaging tests. Since the introduction of MDCT technology with high spatial and temporal resolution, MDCT-PA has become the current imaging method of choice for imaging pulmonary vessels when PE is suspected.

Objective:

The main objective of this study was to assess the clinical utility of MDCTPA for suspected PE and determine the pattern of imaging findings. Additionally to identify shortcomings in PE services at KNH and MP Shah hospital in Nairobi Kenya with recommendations.

Methods:

This was a cross-sectional descriptive study carried out at the Radiology departments over a period of 7 months between April and October 2011 for 110 consecutive patients referred by clinicians with clinically suspected PE for MDCT-PA. The patients were included in the study once ascertained they did not have history of allergy to iodinated contrast media and after signing an informed consent. The study was performed on 16 slice MDCT. Each CTPA was reviewed by the researcher and a consultant radiologist. The findings were recorded in the data collection form. Data entry preceded analysis using SPSS 17.0. The results were presented in form of tables, graphs and charts followed by a discussion of the results.

Results:

A total of 110 consecutive patients were recruited into the study. The age distribution ranged between 20 and 92 years with a mean age of 52.6 and a median age of 55years. The male to female ratio of patients with clinically suspected PE was 1:2.1. Dyspnea [100%](n=110) was the commonest presenting complaint. There was radiologic evidence of PE in 30 patients (27.3%). There was no evidence of PE in 80 patients (72.7%). PE male to female ratio was 1:2. PE was

also found to be more common with increasing age greater than 60 years comprising 16 patients (53.3%). Anatomically PE was found more commonly in the sub-segmental arteries followed by segmental, lobar and finally MPA. Additional diagnosis was found in 21 out of 30 patients with PE (70%) whereas alternative diagnosis was made in 37 out of 80 patients (46.3%) found to have no evidence of PE.

Conclusion:

MDCT-PA was found to be a useful diagnostic tool in the work-up of patients suspected of having PE. In patients without a contraindication for iodinated intravenous contrast medium, this readily available, rapid and minimally invasive study is well tolerated. It allows direct demonstration of endoluminal clots in the thorax and also reveals significant additional diagnosis which is imperative for appropriate patient management.

The patient selection in Kenya for CTPA demonstrated comparable yield for a positive diagnosis of PE (27.3%) to that published in literature [8,44].

The management of patients with suspected PE requires a multidisciplinary approach which will ensure that only relevant examinations are performed and reduce unnecessary medical radiation exposure.