Clinical outcome after a negative spiral CT pulmonary angiographic finding in an inpatient population from cardiology and pneumology wards

Chest. 2003 Feb;123(2):359-65. doi: 10.1378/chest.123.2.359.


Study objectives: The purpose of this study was to assess the clinical follow-up of a negative spiral CT (SCT) angiographic finding after a suspicion of acute pulmonary embolism (PE) in a population of inpatients with cardiac and/or respiratory disease. In this high-risk population, clinical findings suggestive of PE are frequently misleading.

Design: One hundred seventy-five consecutive patients hospitalized in cardiac and pneumology wards underwent SCT angiography for suspected PE over a 30-month period. Angiographic findings were positive in one third. For the 117 patients with negative SCT angiographic findings, a clinical follow-up during a minimum of 6 months was assessed, particularly in relation to recurrent thromboembolism, mortality, and cause of death.

Results: The mean +/- SD follow-up was 21 +/- 11.5 months, and five patients were unavailable for follow-up. Of the 117 patients with negative findings, 81 patients did not receive anticoagulant therapy and 46 patients received anticoagulation for cardiac disease or deep venous thrombosis. Twenty-two patients died during the follow-up period, 3 of them during the first 3 months following the initial event from an undetermined cause. In patients still alive, a new PE occurred in two cases. Patients with a poor cardiopulmonary reserve did not present any recurrent events. In this population, tests other than imaging (d-dimers, cardiac echocardiography, or venous ultrasound) contributed little to eliminate the diagnosis of PE.

Conclusions: Whether or not early deaths are considered or not to be related to a recurrent PE, the rate of recurrence after a negative SCT angiographic finding varied between 1.8% and 4.9%. SCT angiography can be used confidently to rule out significant PE, and may prevent further investigations and unnecessary treatment in an inpatient population with cardiac and/or respiratory diseases.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Angiography*
  • Cardiology Service, Hospital
  • Female
  • France
  • Heart Diseases / diagnostic imaging*
  • Heart Diseases / mortality
  • Hospital Departments
  • Humans
  • Lung Diseases / diagnostic imaging*
  • Lung Diseases / mortality
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Pulmonary Embolism / diagnostic imaging*
  • Pulmonary Embolism / mortality
  • Recurrence
  • Survival Rate
  • Tomography, Spiral Computed*