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New In Coagulation
Thursday, July 10, 2008
Ask the Experts about Emergency Medicine Management Pregnancy and Pulmonary Embolism- Which Imaging Study Should Be Used?
Robert D. Glatter, MD, FAAEM
Medscape Emergency Medicine. 2008; ©2008 Medscape
Posted 06/09/2008
http://www.medscape.com/viewarticle/558090
Pulmonary embolism (PE) is a leading cause of maternal mortality during pregnancy and up to 6 weeks postpartum.[1] Compared with nonpregnant women, women who are pregnant have a 5-fold increased risk for venous thromboembolism (VTE).[2]
An evaluation to rule out PE during pregnancy is especially challenging due to concerns regarding fetal radiation exposure. Clinical examinations are unreliable, and imaging the patient is essential. In these cases, ventilation-perfusion scans (V/Q) and helical computed axial tomographic pulmonary angiography (HCTPA) are the 2 most common imaging modalities available.
The greater accuracy of HCTPA, along with findings that the average fetal radiation dose is consistently lower than V/Q scanning for all 3 trimesters, illustrates that HCTPA is more appropriate for evaluating a pregnant patient in whom you suspect acute PE.
The issue of increased radiation exposure to breast tissue from HCTPA should be discussed with each patient. If there is still a concern regarding radiation risk, a half-dose perfusion scan[10] or MRI (if available) may be suitable alternatives.
Donna Castellone
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