Matheus TMC, Sandoval ZJ, Criales CJL, Martínez GML, Pulido T, Palomar LA, Gómez GA, Santos E, Barragán R, Fernández RA, Cardoso RM

Language: Spanish
References: 27
Page: 456-467
PDF size: 670.64 Kb.

ABSTRACT

We assessed the diagnostic usefulness of helical CT scan of the thorax in the setting of chronic thromboembolic pulmonary hypertension by prospectively comparing the results of helical CT scan to those of the pulmonary angiogram (gold standard). We studied 40 patients with diagnosis of pulmonary hypertension of diverse etiology (mean age: 40.7 ± 12 y.o.; mean systolic pulmonary artery pressure: 91 ± 33 mmHg)). Thirty of these patients fulfilled the diagnostic criteria of chronic thromboembolic pulmonary hypertension and the other ten were used as controls. Diagnosis in control patients included: primary pulmonary hypertension (4); patent ductus arteriosus (2); atrial septal defect (1); rheumatic valve disease (1); ischemic heart disease (1); and acute pulmonary embolism(1). Both helical CT scan and pulmonary angiogram were part of the routine diagnostic work up of these patients, and were, performed and interpreted almost simultaneously (within one week) by a different group of investigators in a blind manner. Only the diagnostic accuracy of the method regarding central (major arteries) vascular lesions was evaluated. Helical CT scan had an overall sensitivity of 100% (29/29), and a specificity of 91% (10/1l). Positive predictive and negative predictive values were 96.6% (29/30) and 100% (10/10), respectively. Overall diagnostic accuracy was 97.5% (39/40). We conclude that helical CT scan of the thorax is an excellent alternative approach for the diagnosis of major arteries lesions in the setting of chronic thromboembolic pulmonary hypertension.

REFERENCES

1. Moser KM, Fedullo PF, Auger WR: Results of pulmonary thromboendarterectomy for chronic, major vessel, thromboembolic pulmonary hypertension. In Weir EK, Archer SL, Reeves JT, eds. The diagnosis and treatment of pulmonary hypertension. Mount Kisko. N.Y. Futura Publishing Inc 1992: 311-329.

2. Moser KM, Auger WR, Fedullo PF, Jamieson SW: Chronic Thromboembolic pulmonary hypertension: clinical picture and surgical treatment. Eur Respir J 1992; 5: 334-342.

3. Moser KM, Auger WR, Fedullo PF: Chronic, major vessel, thromboembolic pulmonary hypertension. Circulation 1990; 81: 1735-1743.

4. Rich S, Levitsky S, Brundage BH: Pulmonary hypertension from chronic pulmonary thromboembolism. Ann Int Med 1985; 103: 844-850.

5. Jamieson SW, Auger WR, Fedullo PF, Channick RN, Kriett JM, Tarazi RY, et al: Experience and results with 150 pulmonary thromboendarterectomy operations over a 29-month period. J Throrac Cardiovasc Surg 1993; 106: 116-27.

6. Sandoval J, Amigo MC, Barragán R, Izaguirre R, Reyes PA, Martínez-Guerra ML, et al: Primary antiphospholipid syndrome presenting as chronic thromboembolic pulmonary hypertension. J Rheumatol 1996; 23: 772-5.

7. Barragán R, Palomar A, Gómez A, Martínez-Guerra ML, Salas J, Cueto G, et al: Tromboendarterectomía pulmonar como tratamiento de la hipertensión arterial pulmonar crónica secundaria a tromboembolia pulmonar no resuelta. Comunicación preliminar. Arch Inst Cardiol Méx 1991; 61: 413-423.

8. Gómez A, Santos E, Cueto G, Bauerle O, Palomar A, Martínez-Guerra ML, et al: Natural history of chronic thromboembolic pulmonary hypertension. Factors associated with mortality (Abstract). Chest 1994; 106 (Suppl): 121S.

9. Riedel M, Stanek V, Widimsky J, Prerovsky I: Long-term. Follow-up of patients with pulmonary thromboembolism. Late prognosis and evolution of hemodynamic and respiratory data. Chest 1982; 81: 151-158.

10. Auger WR, Moser KM: Pulmonary flow murmurs. A distinctive physical sign found in chronic thromboembolic disease (Abstract). Clin Res 1989; 37: 145A.

11. Ryan KL, Fedullo PF, Davis GR, Vasquez TE, Moser KM: Perfusion scands underestimate the severity of angiographic and hemodynamic compromise in chronic thromboembolic pulmonary hypertension. Chest 1988; 93: 1180-1185.

12. Auger WR, Fedullo PF, Moser KM, Buchbinder M, Peterson KL: Chronic major vessel thromboembolic pulmonary artery obstruction: appearance at angiography. Radiology 1992; 182: 393-398.

13. Remy-Jardin M, Remy J, Wattinne L, Giraud F: Central pulmonary thromboembolism: Diagnosis with spiral volumetric CT with the Single-Breath-hold technique. Comparison, with pulmonary angiography. Radiology 1992; 185: 381-387.

14. Greaves SM, Hart EM, Brown K, Young DA, Batra P, Aberle DR: Pulmonary thromboembolism: Spectrum of findings on CT. AJR 1995; 165: 1359-1363.

15. Teigen CL, Maus TP, Sheedy II PF, Johnson CM, Stanson AW, Welch TJ: Pulmonary embolism: Diagnosis with contrast-enhanced electron-beam CT and comparison with pulmonary angiograpy. Radiology 1995; 194: 313-319.

16. Remy-Jardin M, Remy J, Deschildre F, Petyt L, Duhamel A: Diagnosis of pulmonary embolism with spiral CT: Comparison with pulmonary angiography and scintigraphy. Radiology 1996; 200: 699-706.

17. Remy-Jardin M, Louvegny S, Remy J, Deschildre F, Bauchart JJ, Thery C, et al: Acute central thromboembolic disease: Posttherapeutic follow-up with CT angiography. Radiology 1997; 203: 173-180.

18. Goodman LR, Lipchick RJ. Kuzo RS: Acute pulmonary embolism: the role of compute tomographic imagim. J Thorac Imaging 1997; 12: 83-102.

19. Bergin CJ, Rios G, King MA, Belezzuoli E, Luna J, Auger WR: Accuracy of high resolution CT in identifying chronic pulmonary thromboembolic disease. AJR 1996; 166: 1371-1377.

20. King MA, Bergin CJ, Yeung DWC: Chronic pulmonary thromboembolism: Detection of regional hypoperfusion with CT. Radiology 1994; 191: 359-363.

21. King MA, Ysrael M, Bergin CJ: Chronic thromboembolic pulmonary hypertension: CT findings. AJR 1998; 170: 955-960.

22. Bergin CJ, Sirlin CB, Hauschildt JP, Huynh TV, Auger WR, Fedullo PF, et al: Chronic thromboembolism: Diagnosis with helical CT and MR imaging with angiopraphic and surgical correlation. Radiology 1997; 204: 695-702.

23. Sandoval J, Bauerle O, Palomar A, Gómez A, Martínez-Guerra ML, Beltrán M, et al: Survival in primary pulmonary hypertension. Validation of a prognostic equation. Circulation 1994; 89: 1733-1744.

24. Shure D, Gregoratos G, Moser KM: Fiberoptic angioscopy, Role in the diagnosis of chronic pulmonary arterial obstruction. Ann Int Med 1985; 103: 844-850.

25. Bergin CJ, Hauschildt J, Rios G, Belezzuoli EV, Huynh T, Channick RN: Accuracy of MR angiography compared with radionuclide scanning in identifying the cause of pulmonary arterial hypertension. AJR 1977; 168: 1549-1555.

26. Kauczor HU, Schwickert HC, Mayer E, Schweden F, Schild HH, Thelen M: Spiral CT of bronchial arteries in chronic thromboembolism. J Comput Assist Tomogr 1994; 18: 855-861.

27. Moser KM, Bloor CM: Pulmonary vascular lesions occuring in patients with chronic major vessel thromboembolic pulmonary hypertension. Chest 1993; 103: 685-692.