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J Korean Soc Emerg Med > Volume 23(2); 2012 > Article
Journal of The Korean Society of Emergency Medicine 2012;23(2): 229-234.
Clinical Outcome Related to Diagnosis of Saddle Pulmonary Embolism using Computed Tomographic Angiography in an Emergency Department
Hoi Won Kim, Won Young Kim, Chang Hwan Sohn, Dong Woo Seo, Jae Ho Lee, Won Kim, Kyoung Soo Lim
Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. wonpia@yahoo.co.kr
Saddle embolism (SE) is defined as a thromboembolus located at the bifurcation of the main pulmonary artery. The aim of this study was to determine the prognostic significance of SE as diagnosed by computed tomographic (CT) angiography in patients with submassive pulmonary embolism (PE).
Between July 2006 and June 2010, 223 consecutive patients diagnosed with submassive PE using contrast enhanced CT angiography in an emergency department were assessed. One experienced radiologist evaluated the CT results, searching for any presence of SE. The clinical information including echocardiographic findings and outcomes for all patients was reviewed. The presence of SE was determined in order to assess its predictive power for major adverse events (MAE) within 1 month (shock, intubation, mortality, thrombolysis and thrombectomy).
Sixteen out of 223 patients (7.2%) were found to have a SE. Overall mortality at 1 month was 13.5% with no difference between SE and non-SE patients (12.6% vs. 25.0%, p=0.16). SE patients had a significantly higher rate of MAE (27.5% vs. 62.5%, p=0.01). The presence of SE and the observation of a D-shaped left ventricle by echocardiography were associated with an odds ratio of the occurrence of MAE of 3.75 (95% Confidence Interval: 1.22-11.31, p=0.02), 2.94 (95% Confidence Interval: 1.39-6.22, p<0.01).
SE, as diagnosed by CT angiography, was associated with submassive PE related shock, intubation, mortality, thrombolysis and thrombectomy within 1 month of observation.
Key words: Pulmonary embolism, Computed tomography, Outcome
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