• 27
    Feb
  • Clinical Validity of a Normal Perfusion Lung Scan in Patients: RESULTS

Patients

The 515 consecutive patients with clinically sus­pected pulmonary embolism and normal perfusion scans ranged in age from 14 to 93 years (mean, 45 years); 154 (30 percent) were men and 361 (70 percent) were women. Their clinical characteristics are shown in Table 1. Of the 515 patients, 361 patients (70 percent) were outpatients at the time of presentation and 154 (30 percent) were inpatients.

Findings by Impedance Plethysmography at Presentation

Impedance plethysmography was performed suc­cessfully in 493 of the 515 patients (it could not be performed in 22 patients due to leg casts, leg ampu­tation or other reasons). Proximal-vein thrombosis was detected by impedance plethysmography in only five of the 493 patients (1 percent). Of the five patients, venography confirmed proximal-vein thrombosis in three patients, was unsuccessful in one patient and could not be performed in the remaining patient who could not be moved from intensive care.

Alternative Diagnoses

In 367 of the 515 patients (71 percent) the clinical manifestations were consistent with an alternative diagnosis. In 148 patients (29 percent), an alternative diagnosis could not be made. The alternative diagnoses are shown in Table 2. Long-Term Follow-up
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All 515 patients were followed up successfully for three months. Three of the 515 patients (0.6 percent) had objectively documented venous thromboembo­lism on follow-up (95 percent confidence limits, 0.12 to 1.69 percent).

Table 1—Clinical Characteristics in 515 Consecutive Patients with Suspected Pulmonary Embolism and Normal Perfusion Lung Scans

No. of

Patients (%)

Characteristics

(n = 515)

Symptoms on presentation

Pleuritic chest pain

252 (49)

Central chest pain

148(29)

Dyspnea at rest

201 (39)

Dyspnea on mild or moderate exertion

249(48)

Hemoptysis

26(5)

Syncope

23(5)

Signs on presentation

Pleural friction rub

24(5)

Elevated jugular venous pulse

33(6)

Central cyanosis

7(1)

Respiratory rate>20 breaths per minute

302(59)

Chest wall tenderness

64(12)

Left parasternal heave

0

Abnormal physical examination of chest

124 (24)

History of

Pulmonary embolism

27(5)

Deep-vein thrombosis

33(6)

Surgery in past 6 months

107 (21)

Ischemic heart disease

78 (15)

Congestive heart failure

31(6)

Chronic obstructive lung disease

19(4)

Carcinoma

28(5)

One of these three patients had symptomatic pul­monary embolism (confirmed by angiography) during the eighth week. Thus, the frequency of symptomatic pulmonary embolism on follow-up was one of 515 patients (0.2 percent [95 percent confidence limits, 0.01 to 1.08 percent]).

The other two patients with venous thromboembo­lism on follow-up had deep-vein thrombosis. One of these patients, at the time of entry into the study, had a history of adenocarcinoma and had had proximal- vein thrombosis six weeks earlier; this patient had symptomatic recurrent proximal-vein thrombosis (con­firmed by venography) during the third week. The other patient entered the study two days postopera­tively after elective hip replacement, and proximal- vein thrombosis was detected by routine venography during the second week. canadian pharmacy cialis

The two patients with deep-vein thrombosis on follow-up were inpatients at the time of entry into the study. The patient with pulmonary embolism on follow-up was an outpatient at the time of entry. Thus, the frequency of symptomatic venous thromboembo­lism on follow-up in the outpatients with normal lung scans was one of 361 patients (0.3 percent [95 percent confidence limits, 0.01 to 1.53 percent]), and in the inpatients was two of 154 patients (1.3 percent [95 percent confidence limits, 0.16 to 4.61 percent]).

Deaths

Seventeen patients died during the study. One patient, in whom proximal-vein thrombosis was de­tected at presentation, died within 24 h of entry. At entry, this patient had syncope, central cyanosis and hypotension (blood pressure reading, 70/40 mm Hg) and a normal chest x-ray film. The patient was severely hypoxic and died a few hours later in acute respiratory distress. An autopsy was not performed.

Table 2—The Alternative Diagnoses in 515 Consecutive Patients with Normal Perfusion Scans

No. of

Patients (%)

Diagnosis

(n = 515)

Musculoskeletal disorder

133(26)

Other specific conditions involving chest wall*

34(7)

Cardiac disordert

85(16)

Pleuritis

Viral

26(5)

Due to other documented condition^

11(2)

Pneumonia

22(4)

Esophagitis

14(3)

Asthma

8(1)

Chronic obstructive pulmonary disease

7(1)

Carcinoma of lung

4(1)

Miscellaneous§

23(4)

Unknown

Pleuritic disorder

72 (14)

Other

76 (15)

The causes of death in the remaining patients were disseminated carcinoma (six patients), myocardial in­farction (five patients), septicemia (two patients), bron­chopneumonia (two patients) and cardiomyopathy (one patient). buy generic cialis

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