Spiral CT for PE
                      ================

>Do you espouse this [spiral CT] or not? (That is, for PE dx.)
>
>Just wondering...
>
>James Li

Several other people from emed-l asked me this same question, so I'm
posting this (and another longer message to follow) to the list.

Yes, if the lesion is large enough to cause hemodynamic compromise then it
should be equally well visualized on spiral CT and on angiography.

Neither spiral CT nor angio are reliable beyond the 3rd branching of
vessels -- when compared head to head (small studies so far) basically
every patient who had PE seen by angio also had PE seen by spiral CT.

The interesting thing was that while the majority of emboli were visualized
both by angio and by CT, many individual emboli were seen by spiral CT that
were not seen on angio, and vice versa. The fact that these patients all
had multiple emboli caused the tests to come out with the same result in
nearly all patients. None of the disagreements went to autopsy, so it's
hard to know which was really right in those few cases.

--Craig Feied, MD

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Date sent:              Wed, 11 Mar 1998 21:35:00 +1000
Send reply to:          "EMED-L -- a list for emergency medicine."
                <EMED-L@ITSSRV1.UCSF.EDU>
From:                   Ramin Geoff <RaminG@SCRHA.HEALTH.QLD.GOV.AU>
Subject:                Re: CT Scan for PE diagnosis New Dogma?
To:                     EMED-L@ITSSRV1.UCSF.EDU

<<Do you mean that you consider distal pulmonary emboli that CT is
likely to
miss (maybe except in very few institutions) are meaningless? >>>

Not at all. However we feel confident of helical CTA in evaluating the
presence of PE to at least 7th generation vessels. We have used this
technique exclusively for two years and around 1000 patients with full
agreement between our emergency physicians, general physicians,
intensivists, cardiologists and radiologists ( a feat in itself). We have
completely abandoned V/Q scanning. The data is being prepared for
publication and I believe will speak for itself. I do agree however that
the use of CTA is very operator and equipment dependant.

<<Are distal emboli not thromboembolism ? If not, all right, let us not
treat then patient, but if they do represent thromboembolism we've got to
treat the patient, so we must not overlook them.>>

I agree and I don't think we are

___________________________________________________________________
Dr Geoff Ramin FACEM
Medical Director CareFlight Queensland
Director Emergency Medicine John Flynn Hospital
Specialist Emergency Medicine Gold Coast Hospital
Regional Medical Officer Queensland Ambulance Service

raming@scrha.health.qld.gov.au  (work)
ketamine@ozemail.com.au         (home)

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