Computed tomography pulmonary angiography findings in clinically suspected pulmonary embolism patients at Muhimbili National Hospital Tanzania

Abstract

Background: Pulmonary embolism is a blockage in the pulmonary artery, the blood vessel that carries blood from the heart to the lungs. The blockage is commonlycaused by a blood clot, and is potentially life threatening because it can prevent blood from reaching the lungs. Diagnosing or excluding pulmonary embolism on clinical signs and symptoms is difficult since most of these clinical manifestations are nonspecific. Therefore, the need for accurate diagnostic tests to exclude or confirm pulmonary embolism is apparent. As a matter of fact, Computed tomography pulmonary angiography (CTPA) is becoming the Gold standard of care at many institutions for the evaluation of patients with suspected pulmonary embolism. The study assesses the imaging findings on Computed tomography pulmonary angiography (CTPA) in patients clinically suspected of PE in relation to demographics, risk factors and clinical presentation.

BROAD OBJECTIVE: To assess CT Pulmonary Angiography (CTPA) findings among patients clinically suspected of pulmonary embolism attended CT UNIT at MNH Tanzania from August to March 2018.

METHODOLOGY: A cross-sectional hospital based descriptive study conducted at the Radiology Department, Muhimbili National Hospital Daresalaam Tanzania from August 2017 to March 2018. The study includedpatients who were referred by clinicians with a clinical suspicion of pulmonary embolism (PE)and presented to Radiology department for Computed tomography pulmonary angiography (CTPA). Structured questionnaires were used for recording patient’s demographics, clinical information, and imaging findings. The study was performed on 128 slices (64 slices each), images interpreted by the researcher and a consultant radiologist. Data analysis conducted using Statistical Package for Social Sciences (SPSS) version 20. Statistical Association was done by using cross tabulation, and Chi-square test used to compare proportions. P value of < 0.05 was considered statistically significant.

RESULTS A total of seventy four patients participated in this study, of which 27(36.5%) were male and 47(63.5%) female. The patients' mean (SD) age was 51.2(±15.8) years old, ranges from 15-80 years old. Majority of the patients were in the age group of 61 years old and above 25(33.8%). Hemoptysis was found to be highly related with PE, 12(85.7%, P=0.0001). Although dyspnea was not statistically significance, this parameter showed high magnitude, and it was found in all 25 patients diagnosed with PE through CTPA. There was no statistical significant relationship between PE risk factors; immobilization 24 (33.8%, P=0.987), deep venous thrombosis 1 (33.3%, P=0.987), pregnancy 1 (33.3%, P=0.987), and pulmonary embolism (PE). The Multi detector computed tomography pulmonary angiography (DCT-PA) radiological findings in acute pulmonary embolism patients which were strongly significantincluded, central filling defect which was 6 (100%, P=0.0001), and acute angle intraluminal filling defect 5(100%, P=0.0001). Another finding was complete occlusion 3(100%, P=0.001). In addition, there was strong significant relationship between chronic PE with linear filling defect 15 (93.8%, P = 0.001) and eccentric filling defect 13 (100%, P = 0.0001). Conclusion. Twenty five (33.8%) out of 74 patients were found to have PE in this study. CTPA revealed significant radiological findings in both acute and chronic pulmonary embolisms. MDCT-PA was found to be a useful diagnostictool in the work – up of patients suspected of having PE hence ensures a proper diagnosis and appropriate management to patients, thus saving many patients lives. Recommendations. CTPA is the gold standard of care for evaluation of patients with suspected pulmonary embolism. I recommend CTPA to be requested to all patients suspected with PE, as CTPA significantly shows radiological finding in acute and chronic PE. Since there are limited documentations about CTPA in diagnosing PE in developing countries including Tanzania, it is therefore vital to understand this study to assess the diagnostic role of CTPA in the management of patients with suspected PE. Moreover we urge that findings from this research be able to provide baseline database for Researchers wishing to conduct a similar study in developing countries, particularly sub-Saharan Africa.