Risk of acute pulmonary embolism in COVID-19 pneumonia compared to community-acquired pneumonia: a retrospective case-control study. El-Sayed M S,Jones T A Clinical radiology AIM:To compare the incidence of pulmonary embolism (PE) in COVID-19 pneumonia and non-COVID-19-related community-acquired pneumonia (CAP) in hospitalised patients. MATERIALS AND METHODS:A retrospective case-control study was conducted. This included patients hospitalised with pneumonia and investigated for suspected PE with computed tomography pulmonary angiogram (CTPA). Cases were defined as patients with COVID-19 pneumonia from 1 March 2020 to 17 May 2020; controls were patients with CAP from 5 July 2019 to 31 January 2020. The primary outcome was to determine the risk of developing PE in both groups. Multivariable logistic regression was used to calculate the adjusted odds ratio for PE. RESULTS:One hundred and forty-four patients were included; 72 cases (47% male; mean age 59 (±15) years), and 72 controls (56% male; mean age 58 (±20) years). PE was diagnosed in 23.6% of the cases versus 6.9% of the controls. The adjusted odds ratio for PE in hospitalised patients with COVID-19 pneumonia compared with those with CAP was 3.23 (95% confidence interval [CI] 1.04-10.04, p=0.04). CONCLUSION:The odds of developing PE in hospitalised patients with COVID-19 pneumonia are three-times higher than in those with CAP. The results provide a quantitative assessment of the risk of PE in COVID-19 pneumonia, a condition new to healthcare, compared to other forms of pneumonia with a well-established scientific basis. 10.1016/j.crad.2021.03.014

Pulmonary Embolism in Pneumonia: Still a Diagnostic Challenge? Results of a Case-Control Study in 100 Patients. Paparoupa Maria,Spineli Loukia,Framke Theodor,Ho Huy,Schuppert Frank,Gillissen Adrian Disease markers This study evaluated the diagnostic value of D-dimer, CRP, and leucocytes count to detect an underlying pulmonary embolism (PE) in patients with pneumonia. A predictive model of an underlying PE, based on laboratory markers and clinical symptoms, was our ultimate objective. Overall 100 patients underwent a computed tomography angiography (CTA) of the lung: 54 with coexistence of PE and pneumonia (cases) and 46 with pneumonia without PE (controls). Cases and controls were matched 1 : 1. Symptoms and paraclinical findings were registered on admission. Receiver operating characteristic (ROC) curves, search for an optimal threshold, and conditional logistic regression analysis were conducted. D-dimer has a moderate ability to detect PE in pneumonia. Sensitivity of D-dimer was estimated at 97.78% and specificity at 11.11%. No optimal cut-point has acceptable diagnostic ability. After excluding patients with sepsis, sensitivity was reduced to 96.97%, whereas specificity increased to 16.13%. Consolidation in chest X-ray and positive D-dimer predict better an underlying PE as D-dimer itself. Thus, discriminatory power of the prediction model (AUC of 0.740) is not much greater than D-dimer (AUC of 0.703). No threshold that could increase the diagnostic value of D-dimer or a prediction model which is significantly better than D-dimer itself was identified. 10.1155/2016/8682506

Evaluation of pulmonary embolism in a pediatric population with high clinical suspicion. Victoria Teresa,Mong Andrew,Altes Talissa,Jawad Abbas F,Hernandez Andrea,Gonzalez Leonardo,Raffini Leslie,Kramer Sandra S Pediatric radiology BACKGROUND:Pulmonary embolism (PE) is an underdiagnosed entity in the pediatric population in part because of the low level of suspicion and awareness in the clinical world. OBJECTIVE:To examine its relative prevalence, associated risk factors and imaging features in our pediatric population. MATERIALS AND METHODS:A total of 92 patients age 21 years and younger with a high clinical suspicion of PE and who had available radiographic studies were identified from January 2003 to September 2006. Patients with a positive CT scan or a high probability ventilation/perfusion scan formed the case group; patients with a high clinical suspicion of PE and no radiographic evidence of PE or deep venous thrombosis (DVT), randomly matched in age and sex, became the matched control group. We reviewed the charts of both groups and analyzed the imaging studies. RESULTS:In our hospital, the prevalence of PE in patients with a strong suspicion of PE was 14%. The overall prevalence of thromboembolic disease (PE and/or DVT) was 25%. Recent surgery or orthopedic procedure, blood dyscrasias and contraceptive use were more common in patients with PE. No child died of PE in our study. The youngest child with PE in our study was 13 years. Girls were twice as likely to develop PE as boys. CONCLUSION:PE is a relatively common diagnosis in our tertiary care pediatric population when the clinical suspicion is high. We suggest increased awareness and index of suspicion in order to initiate prompt diagnostic imaging and treatment. 10.1007/s00247-008-1037-0

The challenges of identifying pulmonary embolism in patients hospitalized for exacerbations of COPD. Respiratory medicine and research BACKGROUND:Chronic obstructive pulmonary disease (COPD) is associated with airflow obstruction that threatens global health. During the hospitalization of patients with acute exacerbations of COPD (AECOPD), the high prevalence of pulmonary embolism (PE) seriously affects the prognosis of disease. This study aims to assess the differences in clinical data between patients with AECOPD and patients with AECOPD-PE, and to identify the relevant factors of PE. METHODS:We performed a retrospective case-control study in AECOPD patients between January 2018 and December 2021. Due to suspected PE, all patients underwent radiological examination. Patients without PE were included as controls. Clinical data and laboratory tests were recorded. Univariate analysis and multivariate logistic regression analysis were used to investigate the independent predictors of PE. Receiver operating characteristics (ROC) curves was performed to evaluate the effect of risk factors on PE prediction. RESULTS:A total of 191 patients were included for analysis, divided into the AECOPD group (96 cases) and AECOPD-PE group (95 cases). No statistic differences were detected in demographic characteristics between patients with AECOPD and patients with AECOPD and PE. Average PO and PCO levels, lung function, and Echocardiographic indicator were not associated with PE. The concentration of D-dimer, the proportion of simplified wells score ≥ 2, and the incidence rate of lower extremity deep vein thrombosis (DVT) remarkably increased in AECOPD-PE group than AECOPD individuals. At multivariate analysis, the above three indicators were closely relevant to the occurrence of PE. The AUC value for D-dimer combined with lower extremity DVT and Simplified Wells Score was 0.729. CONCLUSIONS:D-dimer, lower extremity DVT, and simplified wells score ≥ 2 were relevant to higher risks of PE, which will help to improve clinicians' understanding of PE secondary to AECOPD. 10.1016/j.resmer.2024.101122