Re: pulmonary embolism
mohhaider - 10-12-08 12:18

Actually I never heard that before ,can you please tell us what does this triad about ?
I know that there is Virchos triad for thrombosis ,is that what you asked ?

Re: pulmonary embolism
sackatdoc - 10-12-08 13:52

i expected you to answer any 3 things that help you diagnose PE,triad is hemoptysis,pleuritic chest pain and cough,how about the diagnostic methods and treatment???

Re: pulmonary embolism
mohhaider - 10-13-08 00:20

These are symptoms and hemoptesis only when there is infarction .For diagnosis,after chest Xray although most commonly normal,CT scan ,ABGs and arteriogram which is more diagnostic although more complications.
Treatment :Heparin then antiplatelet like asprin or other like clopidogril.

Re: pulmonary embolism
sackatdoc - 10-13-08 03:22

swanson mention it as tyical triad of PE, yes sure infarction will give hemoptysis
PE can be a stable patient or unstable, stable can go the battery of test you are mentioning,ut unstable has to be diagnosed fast-spiral CT,you didnt mention the place of V/Q scan in management of PE.Arteriogram is the definitive test.treatment is oxygen, heparin,warfarin,IVC filter,thrombolytics

Re: pulmonary embolism
mohhaider - 10-13-08 11:17

Yes ,by mentioning V/Q ,I would like to add some thing ,Abnormal V/Q can be seen in patients with preexisting COPD making this test less helpful BUT normal V/Q rules out Pulmonary thromboembolism .

Re: pulmonary embolism
sackatdoc - 10-14-08 05:45

right you pointed out,so when will be done, can it be done as 1st initial test,when is it really indicated??

Re: pulmonary embolism
mohhaider - 10-14-08 08:26

I know that it's not used as first test because of low specifity of V/Q ,the first one should be spiral CT after the routine chest X-ray .

Re: pulmonary embolism
sackatdoc - 10-14-08 14:49

it is just done to rule out PE, if you are suspecting it in a patient with no prominent/confusing clinical findings, as you pointed out, normal scan will rule out the presence of PE.

Re: pulmonary embolism
niusha - 10-24-08 02:46

Angiography and V/P scan are major means for Dx, although angiography is the most accurate test but it won't be done in first step because it's invasive..the first one will be v/P scan..

Re: pulmonary embolism
mohhaider - 10-24-08 04:45

No Niusha,we discussed this case above and said that V/P is not specific( abnormal V/P can occur in patients with COPD ) .So spiral CT is considered as first diagnostic measure after chest X-Ray.

Re: pulmonary embolism
niusha - 10-24-08 10:50

I never heard about spiral CT in PE,,is it in KAPLAN?

Re: pulmonary embolism
mohhaider - 10-24-08 11:49

Yes Kaplan lecture notes for CK .As we said above V/P is used only to rule out pulmonary embolism as negative result excludes that diagnosis while positive one DOES not confirms a diagnosis of PE .

Re: pulmonary embolism
sackatdoc - 10-25-08 10:29



You have to see whether the patient is stable or unstable, if unstable you want fast yet acurate test so SPIRAL CT but in a stable and well pt. in which you are only suspecting, then V/P SCAN is better test than spiral CT, angio is gold standard and is done to confirm stable cases undetected by spiral CT and with confusing results on V/P scan, hope that clears the confusion