CT Angiography for Pulmonary Embolism

Why is CT angiography the preferred imaging modality for suspected PE in patients with high clinical probability?

A negative CT angiography result always requires further diagnostic testing to rule out PE.

In patients with kidney disease or an allergic reaction to contrast dye, what is a more suitable imaging modality than CT angiography for suspected PE?

Echocardiography can detect thrombi in the right atrium, right ventricle, or pulmonary artery, or demonstrate right ventricular dysfunction, signifying presence of hemodynamically significant ________.

Match the following imaging modalities with their primary role in PE diagnosis:

What is the primary indication for thrombolytic therapy (rt-PA) in PE patients?

In cases of submassive PE (right ventricular enlargement or dysfunction without hypotension), thrombolytic therapy is generally preferred over anticoagulation alone.

What class of oral anticoagulants is generally preferred over warfarin for PE treatment due to a lower risk of intracranial bleeding and increased ease of use?

Surgical or percutaneous removal of emboli should be considered in patients with massive PE who have ________ for thrombolytic therapy.

Match the following treatment approaches with the associated risk level in PE patients:

How long should warfarin be administered to patients with VTE and a history of trauma or surgery?

In patients with cancer and VTE, warfarin is more effective than subcutaneous fixed-dose LMWH in preventing recurrent thromboembolism.

In patients with unprovoked PE and a low risk of bleeding, for how long should oral anticoagulation be continued?

Beyond 3 months, ________ is an alternative to long-term warfarin and should be considered for patients who have contraindication for anticoagulation or high bleeding risk.

Match the following clinical scenarios with the recommended duration of anticoagulation:

Which of the following is the primary advantage of using DOACs over warfarin in the treatment of PE?

A completely normal V/Q scan effectively excludes the diagnosis of PE without further testing.

In patients with a moderate or high clinical probability of PE, what is the diagnostic accuracy of a high-probability V/Q scan?

If warfarin therapy is chosen instead of DOACs, ________ anticoagulation should be administered until a therapeutic INR of 2 to 3 is reached.

Match the following imaging findings with their diagnostic significance in PE:

In the described algorithm for PE work-up, what is the role of clinical probability assessment?

Patients with low-risk PE always require inpatient admission for monitoring and treatment.

What initial anticoagulant is typically used in high-risk PE patients before transitioning to DOACs?

The presence of reversible ________ factors for recurrent VTE influences the duration of anticoagulation after an acute PE or DVT episode.

Match the following risk factors with their influence on the duration of anticoagulation:

The CT scan permits detection of other pathologic conditions, such as:

PE patients with moderate to high risk features for cardiovascular decompensation should not be admitted and monitored closely.

In PE patients with right ventricular enlargement or dysfunction alone without hypotension, what is the preferred treatment approach?

In PE patients with cancer and VTE, preliminary studies indicated that ________ are as effective as LMWH in preventing thromboembolic events, though the bleeding risk is higher with DOACs.

Match what happens when the following imaging modalities for PE are used:

Why are patients with cancer and VTE treated initially with subcutaneous fixed-dose LMWH for 3 to 6 months?

Patients with unprovoked PE with high bleeding risk should be treated with oral anticoagulation for more than 3 months.

What parameters should be assessed in PE patients to guide the treatment approach once a diagnosis of PE is made?

For PE patients with moderate to high-risk features for cardiovascular decompensation, ______ parenteral therapy is preferred.

Match the conditions with the imaging modality you would choose:

What is one advantage of the newer generation of scanners like CT angiography?

A low or intermediate probability scan is more helpful than a coin flip for determining PE.

What can restrict the applicability of CT scans?

PE patients with moderate to high risk features for cardiovascular decompensation (Table 12.4) should be admitted and monitored closely (PESI class III-V, or simplified PESI of at least ________).