Correspondence: Dr. D. Jiménez. Servicio de Neumología. Hospital Ramón y Cajal. Departamento de Medicina. Universidad de Alcalá de Henares. Ctra. de Colmenar, km 9.100. 28034 Madrid. España
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Jiménez. Servicio de Neumología. Hospital Ramón y Cajal. Departamento de Medicina. Universidad de Alcalá de Henares. Ctra. de Colmenar, km 9.100. 28034 Madrid. España" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2005-07-07" "fechaAceptado" => "2005-11-22" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec154439" "palabras" => array:3 [ 0 => "Pulmonary thromboembolism" 1 => "Diagnosis" 2 => "Computed tomography" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec154438" "palabras" => array:3 [ 0 => "Tromboembolia pulmonary" 1 => "Diagnóstico" 2 => "Tomografía computarizada" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">To determine the value of computed tomography (CT) angiography of the chest as a diagnostic test to exclude pulmonary embolism and to assess compliance with diagnostic protocols for thromboembolic disease.</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStyleSimplePara elsevierViewall">We retrospectively studied patients who underwent CT angiography of the chest because of suspected pulmonary embolism in 2004. All the patients were followed for 3 months. The percentage of patients diagnosed with a thromboembolic event based on an objective test during the follow-up period was determined. We analyzed the percentage of patients with a negative CT angiogram on whom additional diagnostic tests (ultrasound of the lower limbs and/or ventilation-perfusion lung scintigraphy) were performed.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">One hundred sixty-five patients underwent CT angiography of the chest because of suspected pulmonary embolism in 2004. Four of the patients were excluded from the study because they were on chronic anticoagulation therapy and a further 2 were excluded because they had a life expectancy of under 3 months. Of the remaining 159 patients, 60 had CT angiograms that were interpreted as high probability for pulmonary embolism (prevalence of 38%). Thirty-five of the 99 patients with a negative CT angiogram experienced an objectively confirmed thromboembolic event (63% sensitivity; 95% confidence interval, 53%–73%). Other diagnostic tests were not performed in 46% of the cases.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">In our setting, a negative single-detector helical CT angiogram was not sensitive enough to exclude the diagnosis of pulmonary embolism. Furthermore, compliance with internationally accepted diagnostic protocols was far from optimal.</p>" ] "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">Determinar el rendimiento de la angiotomografía axial computarizada (angio-TAC) de tórax en el diagnóstico de exclusión de la tromboembolia pulmonar (TEP) y comprobar la observancia de los protocolos diagnósticos de enfermedad tromboembólica.</p> <span class="elsevierStyleSectionTitle">Pacientes y métodos</span><p class="elsevierStyleSimplePara elsevierViewall">Realizamos un estudio retrospectivo de los pacientes a quienes se realizó una angio-TAC de tórax por sospecha de TEP durante el año 2004. Se realizó un seguimiento de 3 meses en todos ellos. Se determinó el porcentaje de pacientes diagnosticados de un episodio tromboembólico por un método objetivo durante el período de seguimiento. Se analizó el porcentaje de pacientes con angio-TAC negativa a quienes se realizó alguna prueba diagnóstica adicional (ecografía de miembros inferiores y/o gammagrafía de ventilación-perfusión pulmonar).</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Durante el año 2004 se realizaron 165 angio-TAC de tórax por sospecha de TEP. Se excluyó a 4 pacientes con indicación de anticoagulación crónica y a otros 2 con pronóstico de vida inferior a 3 meses. De los 159 pacientes restantes, en 60 la angio-TAC se interpretó como de alta probabilidad para TEP (prevalencia del 38%). Entre los 99 pacientes con angio-TAC negativa, se produjo un episodio tromboembólico objetivamente confirmado en 35 de ellos (sensibilidad del 63%; intervalo de confianza del 95%, 53–73%). En el 46% de los pacientes no se realizó ninguna prueba diagnóstica adicional.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">En nuestro medio la angio-TAC helicoidal no multidetectora negativa es insuficiente para el diagnóstico de exclusión de la TEP. La observancia de los protocolos diagnósticos internacionalmente aceptados dista de ser óptima.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:29 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The evaluation of suspected pulmonary embolism" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Fedullo PF" 1 => "Tapson VF" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMcp035442" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2003" "volumen" => "349" "paginaInicial" => "1247" "paginaFinal" => "1256" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14507950" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ 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Year/Month | Html | Total | |
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2024 November | 5 | 6 | 11 |
2024 October | 31 | 19 | 50 |
2024 September | 25 | 12 | 37 |
2024 August | 46 | 50 | 96 |
2024 July | 25 | 23 | 48 |
2024 June | 29 | 23 | 52 |
2024 May | 41 | 26 | 67 |
2024 April | 19 | 27 | 46 |
2024 March | 23 | 18 | 41 |
2024 February | 21 | 21 | 42 |
2023 March | 3 | 2 | 5 |
2023 February | 27 | 28 | 55 |
2023 January | 17 | 23 | 40 |
2022 December | 22 | 24 | 46 |
2022 November | 34 | 25 | 59 |
2022 October | 24 | 37 | 61 |
2022 September | 21 | 28 | 49 |
2022 August | 24 | 40 | 64 |
2022 July | 20 | 46 | 66 |
2022 June | 24 | 32 | 56 |
2022 May | 20 | 41 | 61 |
2022 April | 24 | 30 | 54 |
2022 March | 20 | 38 | 58 |
2022 February | 17 | 32 | 49 |
2022 January | 20 | 46 | 66 |
2021 December | 19 | 56 | 75 |
2021 November | 21 | 49 | 70 |
2021 October | 33 | 70 | 103 |
2021 September | 17 | 62 | 79 |
2021 August | 15 | 38 | 53 |
2021 July | 13 | 30 | 43 |
2021 June | 29 | 61 | 90 |
2021 May | 21 | 48 | 69 |
2021 April | 36 | 113 | 149 |
2021 March | 22 | 26 | 48 |
2021 February | 11 | 29 | 40 |
2021 January | 13 | 36 | 49 |
2020 December | 20 | 38 | 58 |
2020 November | 14 | 21 | 35 |
2020 October | 13 | 17 | 30 |
2020 September | 9 | 19 | 28 |
2020 August | 21 | 19 | 40 |
2020 July | 23 | 29 | 52 |
2020 June | 9 | 15 | 24 |
2020 May | 19 | 23 | 42 |
2020 April | 22 | 24 | 46 |
2020 March | 16 | 26 | 42 |
2020 February | 10 | 33 | 43 |
2020 January | 18 | 31 | 49 |
2019 December | 24 | 26 | 50 |
2019 November | 12 | 25 | 37 |
2019 October | 15 | 27 | 42 |
2019 September | 3 | 27 | 30 |
2019 August | 12 | 13 | 25 |
2019 July | 21 | 20 | 41 |
2019 June | 4 | 21 | 25 |
2019 May | 13 | 19 | 32 |
2019 April | 15 | 13 | 28 |
2019 March | 12 | 16 | 28 |
2019 February | 10 | 18 | 28 |
2019 January | 17 | 21 | 38 |
2018 December | 14 | 17 | 31 |
2018 November | 31 | 27 | 58 |
2018 October | 23 | 26 | 49 |
2018 September | 6 | 11 | 17 |
2018 May | 3 | 1 | 4 |
2018 April | 9 | 3 | 12 |
2018 March | 6 | 2 | 8 |
2018 February | 4 | 6 | 10 |
2018 January | 3 | 8 | 11 |
2017 December | 3 | 6 | 9 |
2017 November | 2 | 5 | 7 |
2017 October | 6 | 7 | 13 |
2017 September | 3 | 12 | 15 |
2017 August | 7 | 31 | 38 |
2017 July | 7 | 14 | 21 |
2017 June | 7 | 26 | 33 |
2017 May | 12 | 34 | 46 |
2017 April | 12 | 6 | 18 |
2017 March | 1 | 2 | 3 |
2017 February | 2 | 6 | 8 |
2017 January | 2 | 1 | 3 |
2016 December | 9 | 5 | 14 |
2016 November | 9 | 12 | 21 |
2016 October | 15 | 13 | 28 |
2016 September | 14 | 8 | 22 |
2016 August | 6 | 1 | 7 |
2016 July | 5 | 3 | 8 |
2016 March | 2 | 0 | 2 |
2015 December | 3 | 0 | 3 |
2015 October | 41 | 7 | 48 |
2015 September | 30 | 2 | 32 |
2015 August | 47 | 8 | 55 |
2015 July | 39 | 5 | 44 |
2015 June | 30 | 7 | 37 |
2015 May | 43 | 6 | 49 |
2015 April | 36 | 10 | 46 |
2015 March | 32 | 8 | 40 |
2015 February | 26 | 2 | 28 |
2015 January | 41 | 5 | 46 |
2014 December | 33 | 4 | 37 |
2014 November | 37 | 3 | 40 |
2014 October | 51 | 10 | 61 |
2014 September | 46 | 9 | 55 |
2014 August | 43 | 10 | 53 |
2014 July | 39 | 11 | 50 |
2014 June | 48 | 11 | 59 |
2014 May | 52 | 8 | 60 |
2014 April | 57 | 5 | 62 |
2014 March | 59 | 5 | 64 |
2014 February | 34 | 7 | 41 |
2014 January | 39 | 7 | 46 |
2013 December | 37 | 4 | 41 |
2013 November | 40 | 8 | 48 |
2013 October | 47 | 6 | 53 |
2013 September | 43 | 8 | 51 |
2013 August | 43 | 12 | 55 |
2013 July | 44 | 14 | 58 |
2013 June | 44 | 11 | 55 |
2013 May | 32 | 5 | 37 |
2013 April | 30 | 6 | 36 |
2013 March | 13 | 3 | 16 |