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TEP agudo em paciente do sexo feminino, 49 anos. Imagem de TC em multidetector evidencia falhas de enchimento na artéria pulmonar direita, artéria interlobar direita e artéria interlobar esquerda com extensão para a artéria lingular (setas).
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O diagnóstico do tromboembolismo pulmonar agudo é baseado na probabilidade clínica, uso do dímero D (quando disponível) e na avaliação por imagem. Os principais métodos de imagem utilizados no diagnóstico são representados por cintilografia ventilação-perfusão, angiografia pulmonar e tomografia computadorizada (TC). Na última década vários estudos...
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Context 1
... salientar que embora a TC espiral tenha uma elevada sensibilidade para detectar trombos nas artérias pulmonares centrais (Figura 4), lobares e segmentares, ela tem valor limitado no diagnóstico de trombo subsegmentar. Todavia, o significado clínico de trombo subsegmentar isolado é controverso. ...
Citations
... Angiotomography for the diagnosis of pulmonary thromboembolism (TEP) has replaced, in most cases, angiography of pulmonary vessels and pulmonary ventilation and perfusion scintigraphy, mainly because it is less invasive and cheaper, in addition to having a diagnostic capacity similar to others methods [3,4]. ...
Pulmonary thromboembolism is the third cause of morbimortality between acute cardiovascular diseases and for your diagnosis, Angiotomography is the most used exam in the current. When performing analyzes by gender and age group of the population participating in a study, that they submitted an angiotomography for pulmonary thromboembolism, it was observed that the female gender comprised 65.48% of the population studied with an average age group (55.86 ± 16,88) years and the male 34.52% with an age average of (56.86 ± 16.87) years. Thus, the contrast ratio by age groups between genders was studied, where statistical studies did not show significant differences.
... Computed tomography angiography (CTA) for the diagnosis of pulmonary thromboembolism (TEP) has been replacing in most cases, angiography of pulmonary vessels and pulmonary ventilation and perfusion scintigraphy, mainly because it is less invasive and low costly, besides presenting diagnostic capacity similar to the others methods [3,4]. ...
With the development of computed tomography, tomography examinations have been replacing other modalities of imaging tests. Computed tomography angiography to pulmonary thromboembolism, for example, has been replacing pulmonary scintigraphy of ventilation/perfusion and angiography of pulmonary vessels. But angiotomography to the pulmonary thromboembolism is a complex examination, where factors such as scanning time, contrast injection flow, venous access caliber, venous access puncture site, use of the contrast injector, auto-trigger parameters, among others, interfere in the outcome of exam in the studied population. In this study, we performed the contrast ratio (RZC), relative the opacification of contrast in the trunk of the pulmonary artery and the descending aorta, which may vary according to the injection protocol used, determined by the flow of contrast injection (ml/s) associated with the auto-trigger (HU) parameters of the density reading in automatic mode of the equipment. For the injection of manual contrast, and its mean and standard deviation of RZC (2.66±3.56), for the flow (ml/s) and automatics reading (HU) protocols the means and standard deviations RZC consecutively are: 3.5 ml/s and 90 HU (3.68±2.79); 3.5 ml/s and 70 HU (1.90±0.72); 4.0 ml/s and 70 HU (1.98±0.56); 3.0 ml/s and 80 HU (2.15±0.89); 3.5 ml/s and 80 HU (1.50±0.36); 4.0 ml/s and 80 HU (3.91±3.22); 4.5 ml/s and 80 HU (4.69±4.82); 5.0 ml/s and 80 HU (4.27±3.78). The technique with the best result in the average level of RZC was the one that used a flow of 4.5 ml/s and auto-trigger in 80 HU.
... A cintilografia pulmonar em seres humanos é amplamente utilizada para o diagnóstico de embolia pulmonar. O exame cintilográfico é realizado em duas etapas, denominadas de ventilação e perfusão pulmonar (SILVA; MULLER, 2004;CARVALHO et al., 2005). ...
Nuclear medicine is a medical practice used to diagnose or treat some diseases. Pulmonary scintigraphy is one of the most common nuclear medicine exams in humans and domestic animals (dogs, cats and horses). Due to their differences, this work proposed to describe the performance of lung scintigraphy in human and veterinary medicine through the literature and present the main differences in the procedures performed in each species. For the preparation of this review were used books, periodicals, sites with online publications found in Google Scholar, Scielo, Bireme and Pubmed. Through the descriptions of pulmonary scintigraphy presented in this review, it was possible to identify the main differences among the analyzed species, such as dose utilization, use of chemical containment, the stages of the examination, isolation and adaptations present in the equipment used.
... Esse fato, somado ao grau de suspeita clínica de TEP, fez com que o resultado fosse considerado definitivo, sem necessidade de complementação. Pacientes com exames de TC de má qualidade e negativos para TEP, mas com elevada suspeita clínica, devem ser submetidos à angiografia pulmonar (31) . O protocolo incluindo cortes tomográficos até os joelhos também foi muito útil nesses casos, pois o afastamento da hipótese de TVP falava a favor de um diagnóstico negativo, enquanto a constatação de um trombo venoso no abdome ou membro inferior tornava o diag-nóstico automaticamente positivo, independente de a visualização de trombos pulmonares ter sido prejudicada ou não. ...
OBJECTIVE: To evaluate the occurrence and the correlation between pulmonary embolism (PE) and deep venous thrombosis (DVT) using a single CT angiography protocol. MATERIALS AND METHODS: This was a prospective study performed at Hospital Copa D'Or, Rio de Janeiro, Brazil from July 2003 to June 2004. We analyzed 116 CT angiography examinations of patients with clinical suspicion of PE. After an interval of approximately three minutes, venous phase images from the diaphragm to the knees were acquired without additional contrast injection in order to determine the presence of DVT. RESULTS: From the 116 patients studied, 23 (19.8%) had PE, 24 (20.7%) had DVT, 15 (12.9%) had both PE and DVT and 9 (7.8%) had DVT alone. Among the 23 cases of PE, 15 (65.2%) had concomitant DVT whereas 8 (34.8%) had only PE. Among the 24 cases of DVT, 15 (62.5%) had associated PE and 9 (37.5%) had DVT alone. CONCLUSION: The results showed a strong relationship between PE and DVT, as well as the importance of investigating DVT in cases with suspected PE and the benefits of performing indirect CT venography after pulmonary CT angiography as a single examination alternative method for simultaneous investigation of PE and DVT.
... Silva et al (5) apresentam uma revisão concisa sobre o diagnóstico por imagens da TEP aguda, com ênfase no papel da angiotomografia helicoidal. Desde o artigo inicial de Remy-Jardim et al, (6) foi rápida e fulminante a ascensão desta técnica, para posicionar-se, inicialmente, como de confirmação e logo como de exclusão da TEP aguda. ...
OBJETIVO: Avaliar a ocorrência e a correlação de tromboembolismo pulmonar (TEP) e trombose venosa profunda (TVP) por meio de um protocolo único de angiotomografia computadorizada. MATERIAIS E MÉTODOS: Estudo prospectivo realizado de julho de 2003 a junho de 2004 no Hospital Copa D'Or, Rio de Janeiro, RJ. Foram analisadas 116 angiotomografias de pacientes com suspeita clínica de TEP. Após o estudo do tórax, com um intervalo de três minutos e sem injeção adicional de contraste, foram obtidos cortes do diafragma até os joelhos, a fim de pesquisar TVP. RESULTADOS: De 116 pacientes, 23 (19,8%) cursaram com TEP, 24 com TVP (20,7%), 15 (12,9%) apresentaram tanto TEP quanto TVP e 9 (7,8%) apresentaram TVP na ausência de TEP. Dos 23 casos positivos de TEP, 15 apresentaram concomitantemente TVP (65,2%), enquanto em 8 (34,8%) foi visto apenas TEP. Dos 24 casos positivos de TVP, 15 (62,5%) apresentaram TEP associado, enquanto em 9 (37,5%) foi encontrada TVP isolada. CONCLUSÃO: Os resultados demonstraram a forte relação entre TEP e TVP, a importância de pesquisar TVP nos casos com suspeita de TEP e a utilidade do uso combinado da angiotomografia de tórax e da venotomografia como alternativa de único exame de investigação de TEP e TVP simultaneamente.
