Pulmonary Embolism Diagnosis

Pulmonary Embolism Diagnosis

Bismillahirahmanirahim , for today I want to continue the same topic regarding Pulmonary Embolism , here the info I want to share is about how to diagnosis the problem and what is the common procedure  to test and understand for prevention in this problem. To understand more you can read my previous topic regarding pulmonary embolism sign and symptom.

HISTORY AND PHYSICAL EXAMINATION

·         There always needs to be a high suspicion that PE may cause chest pain or SOB. Healthcare provider will take hx of the type of chest pain, including its onset and association symptoms that may direct diagnosis to PE. It may include asking about risk factors for developing DVT

·         Physical examination will concentrate on heart and lung, since chest pain and SOB may also be presenting complaints for heart attack, pneumonia, pneumothorax and aortic aneurysm, among others.

·         Chest examination often normal, but if there is some associated inflammation on the surface of the lung (pleura), a rub maybe heard during auscultation. When pleura become inflamed, as can occur in PE, a sharp pain can result that is worsened by breathing, so-called pleurisy or pleuritic chest pain

Physical examination may include looking for sign of DVT in extremity :

- warmth

- swelling

- redness

- tenderness

TESTS AND DIAGNOSIS

CHEST X-RAY

This noninvasive test shows images of heart and lungs on film. Although X-rays can't diagnose pulmonary embolism and may even appear normal when pulmonary embolism exists, they can rule out conditions that mimic the disease.

LUNG SCAN

This test, also called a ventilation-perfusion scan (V/Q scan), uses small amounts of radioactive tracers (radioisotopes) to study airflow (ventilation) and blood flow (perfusion) in lungs. The radioisotopes are attached to substances known as radiopharmaceuticals.

In the first part of the test, you inhale a small amount of radiopharmaceutical while a camera that's able to detect radioactive substances takes pictures of the movement of air in lungs. A small amount of a different radiopharmaceutical is then injected into a vein in arm, and pictures are taken of blood flow in the blood vessels of lungs. Comparing the results of the two studies helps provide a more accurate diagnosis of pulmonary embolism than does either study alone

CT SCAN

Contrast dye is injected into intravenous line in the arm while CT scan is being taken, and pulmonary arteries  can be visualized. There are risks with this test since some patients are allergic to the dye, and the contrast dye can be harsh on kidney function especially if pt’s kidney function is marginal.  It may be wise to limit exposure to pregnant pt. however, it still can be performed, preferably after the 3rd trimester. 

PULMONARY ANGIOGRAM

This test provides a clear picture of the blood flow in the arteries of lungs. It's the most accurate way to diagnose pulmonary embolism, but because it requires a high degree of skill to administer and carries potentially serious risks, it's usually performed when other tests fail to provide a definitive diagnosis

In a pulmonary angiogram, a flexible tube (catheter) is inserted into a large vein — usually in groin — and threaded through your heart into the pulmonary arteries. A special dye is then injected into the catheter, and X-rays are taken as the dye travels along the arteries in your lungs

TEST TO DETECT BLOOD CLOT

D-dimer blood test.

-Having high levels of the clot-dissolving substance D dimer in blood may suggest an increased likelihood of blood clots, although D-dimer levels may be elevated by other factors, including recent surgery. Drawing the blood takes just a few minutes, and the risks — which include slight bleeding or a small accumulation of blood at the puncture site — are minor.

Ultrasound.

- A noninvasive "sonar" test known as duplex venous ultrasonography uses high-frequency sound waves to check for blood clots in thigh veins. In this test, doctor uses a wand-shaped device called a transducer to direct the sound waves to the veins being tested. These waves are then reflected back to the transducer and translated into a moving image by a computer

Venography.

-A more complex and invasive procedure called venography can help reveal blockages caused by blood clots at any point in your arms or legs. During the test, a catheter is inserted into a vein in  foot or ankle. Because blood vessels aren't normally seen on X-rays, a contrast dye is injected into the vein to make it visible just before the X-rays are taken.

Magnetic resonance imaging (MRI).

-This test uses no X-rays. Instead, a computer creates tissue "slices" from data generated by a powerful magnetic field and radio waves. Because MRI is expensive, it's usually reserved for pregnant women and people whose kidneys may be harmed by dyes used in other tests.

Blood tests.

- If pt have a family history of blood clots, have had more than one episode of blood clots or have experienced clots for no known reason, doctor may order a series of blood tests to look for inherited defects in clotting system. If genetic abnormalities are found and you have a history of blood clots, doctor may recommend lifelong therapy with anticoagulants to prevent future clotting problems. Also, if genetic test results are abnormal, doctor may recommend that other members of family receive similar testing.

This info most of the method that practice by the Dr to detect and also to plan a best and suitable treatment base on the result of this test and diagnosis. wallahuaklam.