All Journals from Richard Bodington
The case:
A 58 year old man was brought to the emergency department with acute confusion after being found unconscious on his floor at home. He had a background of alcohol misuse with alcoholic liver disease. He was not taking any regular medications. On examination he smelt of alcohol and was tachycardic at 96 bpm with BP 110/70. The patient’s Glasgow Coma Score was 14, being drowsy but responsive with bilateral lower zone crepitations on auscultation of the chest. Neurological examination revealed generalized reduced muscle bulk but no focal deficits.
This T2 weighted MRI scan demonstrates a hyperintense trident shaped lesion extending from the pontomedullary junction to the midbrain with peripheral sparing (figure 2 – abnormality indicated by white arrows).
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Abstract
Aims: In this retrospective study we assess the diagnostic yield of computed tomography pulmonary angiogram (CTPA) and the incidence of alterative and incidental diagnoses.
Methods: The results of all CTPA scans performed in our trust over a period of 18 months were reviewed and all diagnoses noted. Data collected was descriptively analysed.
Results: A total of 1138 scans were performed (56.5% men, mean age 59 years). A diagnosis of pulmonary embolism (PE) was made in 20.2%, an alternative aetiology for presenting symptoms in 26.4% and incidental findings in 19.5%. The commonest alternative diagnosis was pneumonia (9.5%).
Conclusions: Significant numbers of CTPA yield unexpected findings, which may provide an explanation for the clinical presentation. Furthermore substantial numbers of incidental pathologies are also diagnosed which may lead to inappropriate resource utilization and increased patient anxiety.
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