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Outcomes of Negative Multidetector Computed Tomography with Pulmonary Angiography in Pregnant Women Suspected of Pulmonary Embolism

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Abstract

Study Objectives

Validated clinical pretest probability tools are lacking in the diagnosis of pulmonary embolism (PE) in pregnancy, and the negative predictive value of D-dimers in this population has not been appropriately tested. The goal of this study was to evaluate outcomes of negative multidetector computed tomography with pulmonary angiography (MDCT-PA) for the diagnosis of PE in pregnancy in the absence of such measures.

Methods

Imaging and medical record data, including clinical presentation, risk factors, and all imaging studies performed for the diagnosis of venous thromboembolism (VTE), of 343 pregnant women with PE were reviewed retrospectively. The imaging was performed at a large tertiary-care women’s hospital between 2004 and 2008 using the same-generation MDCT scanner. Primary outcome measure was the occurrence of VTE events 3 months following MDCT-PA or 6 weeks postpartum (whichever came later).

Results

Dyspnea (75.6%) and chest pain (45.6%) were the most common complaints. Fifty-seven percent of patients had at least one additional risk factor other than pregnancy. Body mass index >30 was the most common risk factor (49%). Eight scans were positive for PE and one patient with a negative MDCT-PA had a positive upper-extremity ultrasound, yielding a diagnosis of VTE in 2.9%. Negative scans were technically adequate in 79.1%, technically limited in 20%, and inconclusive in 0.9%. Follow-up showed no symptomatic VTE events after index imaging.

Conclusion

This study showed that MDCT-PA may safely exclude clinically significant PE in pregnancy.

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Acknowledgments

We thank Gina Ankner, RN, MSN, Beth Hott, and Gwen LaRiviere for their assistance with manuscript preparation. This study was partially funded by the Department of Risk Management at Women and Infants Hospital of Rhode Island (project No. 07-0024, approved March 1, 2007).

Conflict of interest

The authors have no financial ties or conflicts of interest to disclose.

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Authors and Affiliations

  1. Women’s Medicine Collaborative of Lifespan, Pulmonary and Critical Care Medicine, Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA

    Ghada Bourjeily

  2. Women’s Medicine Collaborative at Lifespan, Pulmonary and Critical Care Medicine, Department of Medicine, Warren Alpert Medical School of Brown University, 146 West River Street, Providence, RI, 02904, USA

    Ghada Bourjeily

  3. Rhode Island Medical Imaging, Division of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, RI, 02905, USA

    Hanan Khalil

  4. Division of Research, Women and Infants Hospital of Rhode Island, Providence, RI, 02905, USA

    Christina Raker

  5. Department of Medicine, Women’s Medicine Collaborative, Providence, RI, 02904, USA

    Susan Martin

  6. New Haven, CT, USA

    Pauline Auger

  7. Pulmonary and Critical Care Medicine, Staten Island University Hospital, Staten Island, NY, 10305, USA

    Michel Chalhoub

  8. Women’s Medicine Collaborative of Lifespan, Division of Obstetric Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, 02904, USA

    Lucia Larson

  9. The Miriam Hospital, Women’s Medicine Collaborative of Lifespan, Division of Obstetric Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, 02904, USA

    Margaret Miller

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  1. Ghada Bourjeily
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  2. Hanan Khalil
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Correspondence to Ghada Bourjeily.

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Bourjeily, G., Khalil, H., Raker, C. et al. Outcomes of Negative Multidetector Computed Tomography with Pulmonary Angiography in Pregnant Women Suspected of Pulmonary Embolism. Lung 190, 105–111 (2012). https://doi.org/10.1007/s00408-011-9329-9

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  • DOI: https://doi.org/10.1007/s00408-011-9329-9

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