الفهرس 
Introduction
Pathophysiology Of Pulmonary EmbolismOnly 14 pages are availabe for public view
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Abstract
Pulmonary embolism (PE) is life threatening condition requiring adequate diagnosis and treatment. CTPA is the first choice diagnostic imaging technique in patients suspected of having acute PE.
Aim:
Evaluate the clinical dependent diagnosis by uses of CT angiography
This study was conducted on 70 patients who was divided into 2 groups :
group I included 50 patients with proved pulmonary embolism and subdivided
according to systolic blood pressure group Ia : non high-risk and group Ib : high risk group ,according to heart rate into tachycardic group and normal heart rate group and according to RV/LV ratio measured on CTPA with RVD and no RVD.
group II included 20 patients ( no pulmonary embolism)
patients were subjected to history, general ,local chest examinations, laboratory investigations including mean platelet volume ,platelet distribution width ,D-Dimer and Arterial blood gases
Clinical probability scores for pulmonary embolism as wells score , revised Geneva score and PERC rules .
CTPA with calculation of PAOI
group I the most frequent co morbidity was hypertension and group II was diabetes and COPD and dyspnea was the most presenting symptom in both groups.
• Regarding clinical scores wells score has Sensitivity 90.00% and Specificity 50% while Revised geneva score Sensitivity 80.00% and Specificity 45%.
• In group II 37.5 % of cases according to Wells scoring system (patient was confirmed to be –ve according to PERC rules and 25% according to revised Geneva score .
• groups I had higher MPV and PDW
• In group I there was significant correlation between PAOI and clinical probability scores, hospital length of stay, laboratory data and sPAP while it was significant negative correlation with systolic blood pressure
• high risk group (Ib) had lower blood pressure and more length of hospital stay and higher both sPAP ,PAOI and RV/LV
• The MPV cut-off value for the prediction of RV dysfunction was >9.4 fL
• There was correlation between MPV and Modified Wells score , Revised Geneva score , Hospital length of stay, RV/LV
• The Tachycardic group was higher in both PAOI and RV/LV ratio patients with RVD had higher MPV , sPAP and lower Systolic BP
conclusion
• Wells criteria and revised Geneva score have been found to be the useful methods for patient selection.
• Serum D-dimer levels in combination with clinical scores could determine patients in whom CTA should be performed.
• PERC-negative patients may reduce the costs of ED visits as it will safely reduce the volume of D-dimer and CTPA testing and, therefore, irradiation, adverse events, length of ED stay and overcrowding.
• There was a link between clinical presentation and platlet indices with both extent of thrombus and signs of RV dysfunction on CTPA.
• MPV and PDW as potential markers of platelet activation can be used in the determination of disease severity, hospital length of stay and the therapeutic options for PE patients.
• The assessment of pulmonary clot burden throught PAOI calculation has a considerable clinical and imaging impact, enabling accurate diagnosis, risk stratification and the selection of patients for more aggressive treatment.