zaidsuror
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In Postoperative pulmonary embolism,once suspected from clinical and lab(blood gas)picture what is the next best step in establishing the diagnosis?
I read in Kaplan's medicine lecture notes that v/q scan is the next best step,however in surgery i came upon the statement"V/Q scan works only when the lungs are otherwise normal ,which is seldom the case in post op patients developing PE, CT is becoming the test of choice!!!!
Please clarify ,has CT become the Initial test ?
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| virgola82
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I didn't know the answer to your question so checked on UpToDate. According to what they say there the diagnostic algorithm depends on whether the institution is experienced or not in doing and reading helical ct for suspected PE.
In any case the diagnostic process starts with the clinical suspicion that should be raised by the modified Wells Criteria that include
- Clinical symptoms of DVT (3 points)
- Other diagnosis less likely than PE (3 points)
- Heart rate >100 (1.5 points)
- Immobilization or surgery in previous four weeks (1.5 points)
- Previous DVT/PE (1.5 points)
- Hemoptysis (1 point)
- Malignancy (1 point)
If score > 5 thean PE is likely so go ahead with imaging, if < 5 do Dimers and if negative rule out PE; if dimers + start imaging
Imaging should be done by helival ct if the center has good experience in it or V/Q scan if helical scan is not available or the center has no experience in that.
I attached the picture of the 2 algorithms
Attached Files:
CT-based_algorithm_for_PE.gif (6 KB, 26 downloads)
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| virgola82
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This is the other algorithm
Attached Files:
VQ-based_algorithm_for_PE.gif (10 KB, 22 downloads)
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| zaidsuror
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So i guess in such situations when something is not yet universal we go with the more traditional ,in this case V/q scan.
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