Pulmonary CT Angiography as First-Line Imaging for PE: Image Quality and Radiation Dose Considerations.

AJR Am J Roentgenol. 2013 Mar;200(3):522-8

Authors: Mayo J, Thakur Y

Abstract
OBJECTIVE: This article reviews dose reduction techniques in pulmonary CT angiography (CTA) for imaging pulmonary embolism (PE). Dose reduction technologies covered include tube current modulation, kilovoltage modulation, scanning length modification, dynamic z-axis collimation, iterative reconstruction, and dual-energy CT. Age- and weight-specific imaging techniques are suggested. CONCLUSION: Pulmonary CTA plays a vital role in imaging PE. Using dose reduction technologies can provide high-quality diagnostic imaging with a significant reduction in patient dose.

PMID: 23436840 [PubMed - in process]

[Diagnosis approach of pulmonary embolism].

Tunis Med. 2012 Nov;90(11):759-63

Authors: Louzir B, Mehiri N, Cherif J, Zakhama H, Toujani S, Ben Salah N, Daghfous J, Beji M

Abstract
BACKGROUND: Pulmonary embolism (PE) is a fairly common condition that can be fatal. The variability of presentation sets clinician up for potentially missing the diagnosis. Routine laboratory findings are nonspecific and are not helpful in diagnosis of PE.Diagnosis is based on clinical prediction rule in combination with laboratory tests such as the D-dimers test leading to the realization ofa confirming examination.
AIM: To precise the confirming examinations of PE and propose analgorithm based on clinical prediction rules in combination with D-Dimers.
METHODS: A Pub Med search was conducted using the following keywords: pulmonary embolism,computed tomogramphy pulmonary angiography, scintigraphy and D Dimer. The study was based on are view of 18 studies including meta analysis, reviews and original articles referring recent strategy diagnosis of pulmonary embolism.
RESULTS: Ventilation/perfusion scan is a type of examination that is used less often because it is not a widespread technology. However,it may be useful in patients who have an allergy to iodinated contrast.Ultrasonography of the legs, also known as leg doppler, in search of deep venous thrombosis (DVT) may help the diagnosis approach particularly when other exams are not available or contraindicated.This may be a valid approach in pregnancy. The gold standard for diagnosing PE is pulmonary angiography. It is used less often due to wider acceptance of multi detector CT scans, which are non-invasive.A normal ventilation/perfusion scan rules out the diagnosis of PE with negative predictive value of 97%. There is no consensus in pregnancy. Finally, the MRI has a low and insufficient sensibility to diagnose PE.Conclusion: D Dimers, multidetector CT, ventilation/ perfusion scintigraphy and ultrasonography of the legs are the most useful examinations to diagnose PE. Many algorithms were established depends on medical experience and examination availability

PMID: 23330217 [PubMed - indexed for MEDLINE]

Non-tuberculous mycobacterial pulmonary infection in the immunocompetent host.

QJM. 2013 Jan 29;

Authors: Zheng C, Fanta CH

Abstract
Throughout much of the world, the incidence of non-tuberculous mycobacterial pulmonary infections in immunocompetent hosts is on the rise. These organisms are widespread in the natural environment; the explanation for what appears to be an increased susceptibility among human hosts is uncertain. Among more than 120 known species, the most common pathogenic isolate in the USA is Mycobacterium avium complex. The diagnosis of pulmonary disease caused by M. avium complex requires a compatible history, suggestive radiographic findings (on chest computed tomography) and microbiologic confirmation on culture of respiratory samples (sputum or direct lung sampling). Treatment options have improved with inclusion of macrolide antibiotics in a multi-drug regimen, but failure rates remain high (20-40%) even after a prolonged course of therapy. Newer, less toxic and more effective anti-mycobacterial agents are greatly needed for treatment of this increasingly common respiratory disease.

PMID: 23365141 [PubMed - as supplied by publisher]

Related Articles

Mechanisms of physical activity limitation in chronic lung diseases.

Pulm Med. 2012;2012:634761

Authors: Vogiatzis I, Zakynthinos G, Andrianopoulos V

Abstract
In chronic lung diseases physical activity limitation is multifactorial involving respiratory, hemodynamic, and peripheral muscle abnormalities. The mechanisms of limitation discussed in this paper relate to (i) the imbalance between ventilatory capacity and demand, (ii) the imbalance between energy demand and supply to working respiratory and peripheral muscles, and (iii) the factors that induce peripheral muscle dysfunction. In practice, intolerable exertional symptoms (i.e., dyspnea) and/or leg discomfort are the main symptoms that limit physical performance in patients with chronic lung diseases. Furthermore, the reduced capacity for physical work and the adoption of a sedentary lifestyle, in an attempt to avoid breathlessness upon physical exertion, cause profound muscle deconditioning which in turn leads to disability and loss of functional independence. Accordingly, physical inactivity is an important component of worsening the patients' quality of life and contributes importantly to poor prognosis. Identifying the factors which prevent a patient with lung disease to easily carry out activities of daily living provides a unique as well as important perspective for the choice of the appropriate therapeutic strategy.

PMID: 23365738 [PubMed]