An official American Thoracic Society/Society of Thoracic Radiology clinical practice guideline: Evaluation of suspected pulmonary embolism in pregnancy

American Journal of Respiratory and Critical Care Medicine

Volumn 184, Issue 10, 2011, Pages 1200-1208

  Leung, Ann N ^a   Bull, Todd M ^a   Jaeschke, Roman ^a   Lockwood, Charles J ^a   Boiselle, Phillip M ^a   Hurwitz, Lynne M ^a   James, Andra H ^a   McCullough, Laurence B ^a   Menda, Yusuf ^a   Paidas, Michael J ^a   Royal, Henry D ^a   Tapson, Victor F ^a   Winer Muram, Helen T ^a   Chervenak, Frank A ^a   Cody, Dianna D ^a   McNitt Gray, Michael F ^a   Stave, Christopher D ^a   Tuttle, Brandi D ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

ANTICOAGULANT AGENT; D DIMER; GADOLINIUM; IODINATED CONTRAST MEDIUM;

ANTICOAGULANT THERAPY; ARTICLE; COMPRESSION ULTRASOUND; COMPUTED TOMOGRAPHIC ANGIOGRAPHY; COMPUTED TOMOGRAPHIC PULMONARY ANGIOGRAPHY; COST EFFECTIVENESS ANALYSIS; DEEP VEIN THROMBOSIS; DIAGNOSTIC ACCURACY; DIAGNOSTIC VALUE; DIGITAL SUBTRACTION ANGIOGRAPHY; ECHOGRAPHY; FETOTOXICITY; HEALTH CARE COST; HUMAN; LUNG ANGIOGRAPHY; LUNG EMBOLISM; LUNG SCINTISCANNING; MAGNETIC RESONANCE ANGIOGRAPHY; PRACTICE GUIDELINE; PREDICTIVE VALUE; PREGNANCY DISORDER; PREGNANT WOMAN; PRIORITY JOURNAL; RADIATION DOSE; SENSITIVITY AND SPECIFICITY; THORAX RADIOGRAPHY;

CONTRAST MEDIA; FEMALE; FIBRIN FIBRINOGEN DEGRADATION PRODUCTS; HUMANS; LEG; LUNG; MAGNETIC RESONANCE IMAGING; PREGNANCY; PREGNANCY COMPLICATIONS, CARDIOVASCULAR; PULMONARY EMBOLISM; RADIATION DOSAGE; RADIOGRAPHY, THORACIC;

EID: 81455155711     PISSN: 1073449X     EISSN: 15354970     Source Type: Journal    
DOI: 10.1164/rccm.201108-1575ST     Document Type: Article

References (71)

1. Centers for Disease Control and Prevention. Pregnancy-related mortality surveillance - United States, 1991-1999. MMWR Morb Mortal Wkly Rep 2003;52:1-8.
2. Marik PE, Plante LA. Venous thromboembolic disease and pregnancy. N Engl J Med 2008;359:2025-2033.
3. Royal College of Obstetricians and Gynaecologists. Green-top Guideline No. 28: Thromboembolic Disease in Pregnancy and the Puerperium: Acute Management. 2007 [accessed Oct. 4, 2011]. Available from: www.rcog.org.uk/ guidelines
4. Stein PD, Woodard PK, Weg JG, Wakefield TW, Tapson VF, Sostman HD, Sos TA, Quinn DA, Leeper KV Jr, Hull RD, et al. Diagnostic pathways in acute pulmonary embolism: recommendations of the PIOPED II Investigators. Radiology 2007;242:15-21. (Pubitemid 44956005)
5. Schuster ME, Fishman JE, Copeland JF, Hatabu H, Boiselle PM. Pulmonary embolism in pregnant patients: a survey of practices and policies for CT pulmonary angiography. AJR Am J Roentgenol 2003;181:1495-1498. (Pubitemid 37466521)
6. Bourjeily G, Paidas M, Khalil H, Rosene-Montella K, Rodger M. Pulmonary embolism in pregnancy. Lancet 2010;375:500-512.
7. Schunemann HJ, Jaeschke R, Cook DJ, Bria WF, El-Solh AA, Ernst A, Fahy BF, Gould MK, Horan KL, Krishnan JA, et al. An official ATS statement: grading the quality of evidence and strength of recommendations in ATS guidelines and recommendations. Am J Respir Crit Care Med 2006;174:605-614. (Pubitemid 44330555)
8. Chan WS, Ray JG, Murray S, Coady GE, Coates G, Ginsberg JS. Suspected pulmonary embolism in pregnancy: clinical presentation, results of lung scanning, and subsequent maternal and pediatric outcomes. Arch Intern Med 2002;162:1170-1175. (Pubitemid 34522406)
9. Cahill AG, Stout MJ, Macones GA, Bhalla S. Diagnosing pulmonary embolism in pregnancy using computed-tomographic angiography or ventilation-perfusion. Obstet Gynecol 2009;114:124-129.
10. Gherman RB, Goodwin TM, Leung B, Byrne JD, Hethumumi R, Montoro M. Incidence, clinical characteristics, and timing of objectively diagnosed venous thromboembolism during pregnancy. Obstet Gynecol 1999;94:730-734. (Pubitemid 29484440)
11. Powrie RO, Larson L, Rosene-Montella K, Abarca M, Barbour L, Trujillo N. Alveolar-arterial oxygen gradient in acute pulmonary embolism in pregnancy. Am J Obstet Gynecol 1998;178:394-396. (Pubitemid 28124146)
12. Heit JA, Kobbervig CE, James AH, Petterson TM, Bailey KR, Melton LJ III. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med 2005;143:697-706.
13. Damodaram M, Kaladindi M, Luckit J, Yoong W. D-dimers as a screening test for venous thromboembolism in pregnancy: is it of any use? J Obstet Gynaecol 2009;29:101-103.
14. Levy MS, Spencer F, Ginsberg JS, Anderson JA. Reading between the (Guidelines). Management of submassive pulmonary embolism in the first trimester of pregnancy. Thromb Res 2008;121:705-707. (Pubitemid 351308145)
15. To MS, Hunt BJ, Nelson-Piercy C. A negative D-dimer does not exclude venous thromboembolism (VTE) in pregnancy. J Obstet Gynaecol 2008;28:222-223. (Pubitemid 351507703)
16. Chan WS, Lee A, Spencer FA, Chunilal S, Crowther M, Wu W, Johnston M, Rodger M, Ginsberg JS. D-dimer testing in pregnant patients: towards determining the next 'level' in the diagnosis of deep vein thrombosis. J Thromb Haemost 2010;8:1004-1011.
17. Kovac M, Mikovic Z, Rakicevic L, Srzentic S, Mandic V, Djordjevic V, Radojkovic D, Elezovic I. The use of D-dimer with new cutoff can be useful in diagnosis of venous thromboembolism in pregnancy. Eur J Obstet Gynecol Reprod Biol 2010;148:27-30.
18. Chan WS, Chunilal S, Lee A, Crowther M, Rodger M, Ginsberg JS. A red blood cell agglutination D-dimer test to exclude deep venous thrombosis in pregnancy. Ann Intern Med 2007;147:165-170. (Pubitemid 351664596)
19. Ahmad A, Jamjute P, Ghosh T, Klazinga D. D-dimer negative deep vein thrombosis in puerperium. Eur Clin Obstet Gynaecol 2008;3:131-134.
20. International Commission of Radiological Protection. Pregnancy and medical radiation: Publication 84. Ann ICRP 2000;30:1-44.
21. McCollough CH, Schueler BA, Atwell TD, Braun NN, Regner DM, Brown DL, LeRoy AJ. Radiation exposure and pregnancy: when should we be concerned? Radiographics 2007;27:909-917; discussion 917-908.
22. Linet MS, Kim KP, Rajaraman P. Children's exposure to diagnostic medical radiation and cancer risk: epidemiologic and dosimetric considerations. Pediatr Radiol 2009;39:S4-S26.
23. Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation NRC. Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2. National Academies Press; 2006.
24. Bourjeily G, Chalhoub M, Phornphutkul C, Alleyne TC, Woodfield CA, Chen KK. Neonatal thyroid function: effect of a single exposure to iodinated contrast medium in utero. Radiology 2010;256:744-750.
25. Food and Drug Administration. Content and Format of Labeling for Human Prescription Drug and Biological Products; Requirements for Pregnancy and Lactation Labeling. Fed Regist 2008;29:30831-30868.
26. Lin SP, Brown JJ. MR contrast agents: physical and pharmacologic basics. J Magn Reson Imaging 2007;25:884-899.
27. Webb JA, Thomsen HS, Morcos SK. The use of iodinated and gadolinium contrast media during pregnancy and lactation. Eur Radiol 2005;15:1234-1240. (Pubitemid 40778748)
28. Worsley DF, Alavi A, Aronchick JM, Chen JT, Greenspan RH, Ravin CE. Chest radiographic findings in patients with acute pulmonary embolism: observations from the PIOPED Study. Radiology 1993;189:133-136. (Pubitemid 23292935)
29. Greenspan RH, Ravin CE, Polansky SM, McLoud TC. Accuracy of the chest radiograph in diagnosis of pulmonary embolism. Invest Radiol 1982;17:539-543. (Pubitemid 13211533)
30. Gottschalk A, Stein PD, Goodman LR, Sostman HD. Overview of Prospective Investigation of Pulmonary Embolism Diagnosis II. Semin Nucl Med 2002;32:173-182. (Pubitemid 34803590)
31. Daftary A, Gregory M, Seibyl JP, Saluja S. Chest radiograph as a triage tool in the imaging-based diagnosis of pulmonary embolism. AJR Am J Roentgenol 2005;185:132-134.
32. Forbes KP, Reid JH, Murchison JT. Do preliminary chest X-ray findings define the optimum role of pulmonary scintigraphy in suspected pulmonary embolism? Clin Radiol 2001;56:397-400. (Pubitemid 35023753)
33. Scarsbrook AF, Bradley KM, Gleeson FV. Perfusion scintigraphy: diagnostic utility in pregnant women with suspected pulmonary embolic disease. Eur Radiol 2007;17:2554-2560.
34. Ridge CA, McDermott S, Freyne BJ, Brennan DJ, Collins CD, Skehan SJ. Pulmonary embolism in pregnancy: comparison of pulmonary CT angiography and lung scintigraphy. AJR Am J Roentgenol 2009;193:1223-1227.
35. Righini M, Le Gal G, Aujesky D, Roy PM, Sanchez O, Verschuren F, Rutschmann O, Nonent M, Cornuz J, Thys F, et al. Diagnosis of pulmonary embolism by multidetector CT alone or combined with venous ultrasonography of the leg: a randomised non-inferiority trial. Lancet 2008;371:1343-1352. (Pubitemid 351522315)
36. van Rossum AB, van Houwelingen HC, Kieft GJ, Pattynama PM. Prevalence of deep vein thrombosis in suspected and proven pulmonary embolism: a meta-analysis. Br J Radiol 1998;71:1260-1265.
37. Chan WS, Lee A, Spencer FA, Crowther M, Rodger M, Ramsay T, Ginsberg JS. Predicting deep venous thrombosis in pregnancy: out in "LEFt" field? Ann Intern Med 2009;151:85-92.
38. Parker JA, Coleman RE, Siegel BA, Sostman HD, McKusick KA, Royal HD. Procedure guideline for lung scintigraphy: 1.0. Society of Nuclear Medicine. J Nucl Med 1996;37:1906-1910. (Pubitemid 26378387)
39. Shahir K, Goodman LR, Tali A, Thorsen KM, Hellman RS. Pulmonary embolism in pregnancy: CT pulmonary angiography versus perfusion scanning. AJR Am J Roentgenol 2010;195:W214-220.
40. Revel MP, Cohen S, Sanchez O, Collignon MA, Thiam R, Redheuil A, Meyer G, Frija G. Pulmonary embolism during pregnancy: diagnosis with lung scintigraphy or CT angiography? Radiology 2011;258:590-598.
41. King U, Im JM, Freeman SJ, Boylan T, Cheow HK. Quality of CT pulmonary angiography for suspected pulmonary embolus in pregnancy. Eur Radiol 2008;18:2709-2715.
42. Litmanovich D, Boiselle PM, Bankier AA, Kataoka ML, Pianykh O, Raptopoulos V. Dose reduction in computed tomographic angiography of pregnant patients with suspected acute pulmonary embolism. J Comput Assist Tomogr 2009;33:961-966.
43. Kluge A, Luboldt W, Bachmann G. Acute pulmonary embolism to the subsegmental level: diagnostic accuracy of three MRI techniques compared with 16-MDCT. AJR Am J Roentgenol 2006;187:W7-14.
44. Chen MM, Coakley FV, Kaimal A, Laros RK Jr. Guidelines for computed tomography and magnetic resonance imaging use during pregnancy and lactation. Obstet Gynecol 2008;112:333-340.
45. Meaney JF, Weg JG, Chenevert TL, Stafford-Johnson D, Hamilton BH, Prince MR. Diagnosis of pulmonary embolism with magnetic resonance angiography. N Engl J Med 1997;336:1422-1427. (Pubitemid 27208601)
46. Gupta A, Frazer CK, Ferguson JM, Kumar AB, Davis SJ, Fallon MJ, Morris IT, Drury PJ, Cala LA. Acute pulmonary embolism: diagnosis with MR angiography. Radiology 1999;210:353-359. (Pubitemid 29055300)
47. Oudkerk M, van Beek EJ, Wielopolski P, van Ooijen PM, Brouwers-Kuyper EM, Bongaerts AH, Berghout A. Comparison of contrastenhanced magnetic resonance angiography and conventional pulmonary angiography for the diagnosis of pulmonary embolism: a prospective study. Lancet 2002;359:1643-1647. (Pubitemid 34518523)
48. Ohno Y, Higashino T, Takenaka D, Sugimoto K, Yoshikawa T, Kawai H, Fujii M, Hatabu H, Sugimura K. MR angiography with sensitivity encoding (SENSE) for suspected pulmonary embolism: comparison with MDCT and ventilation-perfusion scintigraphy. AJR Am J Roentgenol 2004;183:91-98. (Pubitemid 38789017)
49. Pleszewski B, Chartrand-Lefebvre C, Qanadli SD, Dery R, Perreault P, Oliva VL, Prenovault J, Belblidia A, Soulez G. Gadolinium-enhanced pulmonary magnetic resonance angiography in the diagnosis of acute pulmonary embolism: a prospective study on 48 patients. Clin Imaging 2006;30:166-172.
50. Stein PD, Chenevert TL, Fowler SE, Goodman LR, Gottschalk A, Hales CA, Hull RD, Jablonski KA, Leeper KV Jr., DP Naidich, et al. Gadolinium-enhanced magnetic resonance angiography for pulmonary embolism: a multicenter prospective study (PIOPED III). Ann Intern Med 2010;152:434-443.
51. van Rooij WJ, den Heeten GJ, Sluzewski M. Pulmonary embolism: diagnosis in 211 patients with use of selective pulmonary digital subtraction angiography with a flow-directed catheter. Radiology 1995;195:793-797.
52. Forauer AR, McLean GK, Wallace LP. Clinical follow-up of patients after a negative digital subtraction pulmonary arteriogram in the evaluation of pulmonary embolism. J Vasc Interv Radiol 1998;9:903-908. (Pubitemid 28530362)
53. Henry JW, Relyea B, Stein PD. Continuing risk of thromboemboli among patients with normal pulmonary angiograms. Chest 1995;107:1375-1378.
54. Wittram C, Waltman AC, Shepard JA, Halpern E, Goodman LR. Discordance between CT and angiography in the PIOPED II study. Radiology 2007;244:883-889. (Pubitemid 47292101)
55. Hurwitz LM, Yoshizumi T, Reiman RE, Goodman PC, Paulson EK, Frush DP, Toncheva G, Nguyen G, Barnes L. Radiation dose to the fetus from body MDCT during early gestation. AJR Am J Roentgenol 2006;186:871-876. (Pubitemid 46100280)
56. Winer-Muram HT, Boone JM, Brown HL, Jennings SG, Mabie WC, Lombardo GT. Pulmonary embolism in pregnant patients: fetal radiation dose with helical CT. Radiology 2002;224:487-492. (Pubitemid 34809132)
57. Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation NRC. Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII - Phase 2. National Academy of Sciences; 2006.
58. Parker MS, Hui FK, Camacho MA, Chung JK, Broga DW, Sethi NN. Female breast radiation exposure during CT pulmonary angiography. AJR Am J Roentgenol 2005;185:1228-1233.
59. Cook JV, Kyriou J. Radiation from CT and perfusion scanning in pregnancy. BMJ 2005;331:350.
60. Hurwitz LM, Yoshizumi TT, Reiman RE, Paulson EK, Frush DP, Nguyen GT, Toncheva GI, Goodman PC. Radiation dose to the female breast from 16-MDCT body protocols. AJR Am J Roentgenol 2006;186:1718-1722. (Pubitemid 46115730)
61. International Commission on Radiological Protection. Radiation dose to patients from radiopharmaceuticals: Publication 53. Ann ICRP 1987;18:1-377.
62. International Commission on Radiological Protection. Radiation Dose to Patients from Radiopharmaceuticals: Publication 80 (addendum 2 to ICRP publication 53). Ann ICRP 1998;28:1-126.
63. Hurwitz LM, Reiman RE, Yoshizumi TT, Goodman PC, Toncheva G, Nguyen G, Lowry C. Radiation dose from contemporary cardiothoracic multidetector CT protocols with an anthropomorphic female phantom: implications for cancer induction. Radiology 2007;245:742-750. (Pubitemid 350127344)
64. Brenner DJ, Doll R, Goodhead DT, Hall EJ, Land CE, Little JB, Lubin JH, Preston DL, Preston RJ, Puskin JS, et al. Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. Proc Natl Acad Sci USA 2003;100:13761-13766. (Pubitemid 37499140)
65. McCullough LB, Chervenak FA. Ethics in obstetrics and gynecology. New York: Oxford University Press; 1994.
66. Schaefer-Prokop C, Prokop M. CTPA for the diagnosis of acute pulmonary embolism during pregnancy. Eur Radiol 2008;18:2705-2708.
67. Kearon C, Kahn SR, Agnelli G, Goldhaber S, Raskob GE, Comerota AJ. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008;133:454S-545S. (Pubitemid 351892971)
68. Kline JA, Hernandez-Nino J, Jones AE, Rose GA, Norton HJ, Camargo CA Jr. Prospective study of the clinical features and outcomes of emergency department patients with delayed diagnosis of pulmonary embolism. Acad Emerg Med 2007;14:592-598. (Pubitemid 46929085)
69. Smith SB, Geske JB, Maguire JM, Zane NA, Carter RE, Morgenthaler TI. Early anticoagulation is associated with reduced mortality for acute pulmonary embolism. Chest 2010;137:1382-1390.
70. Sostman HD, Coleman RE, DeLong DM, Newman GE, Paine S. Evaluation of revised criteria for ventilation-perfusion scintigraphy in patients with suspected pulmonary embolism. Radiology 1994;193:103-107. (Pubitemid 24298007)
71. Sostman HD, Miniati M, Gottschalk A, Matta F, Stein PD, Pistolesi M. Sensitivity and specificity of perfusion scintigraphy combined with chest radiography for acute pulmonary embolism in PIOPED II. J Nucl Med 2008;49:1741-1748.