Management of Pulmonary Embolism (1)

I wanted to tell about the mistake I made while solving a question about pulmonary embolism but yet I want to mention the important investigations to be made:

A case presenting with SUDDEN onset of chest pain tachypnea and tachycardia should carry the suspicion that he developed PE, it would be reasonable to start with an ABG (resp. alkalosis), and CXR usually is normal but you may expect the following signs :

1 westermark sign : an area of hypertranslucency due to blockade of pulmonary artery

2 Hampton hump: a wedge shape area usually above the diaphragm , yet a normal CXR doesn’t Exclude a Pulmonary embolism

ECG may show RV strain due to acute pulmonary HTN, in the form of large S wave in lead I, deep Q and inverted T in lead III

Positive D dimer / FDPs test, and YES ! a Negative D- Dimer RULES OUT ! pulmonary embolism

Specific  tests:

1-      Spiral CT always start with it best i9nitial test not only it would diagnose a PE but would rule out any associated lung conditions in DD like COPD or pneumonia

2-      Ventilation perfusion scan : classified as low probability moderate and high probability

3-      Pulmonary angiography is the most sensitive test and best choice yet it’s a LOW risk invasive procedure, used if V/P scan didn’t rule it out

My struggle in answering this topic related questions is in the choice between V/P scan and angio.

A Question about a pregnant female who is suspected to develop a pulmonary embolism, and she has done D-dimer Positive and spiral ct scan , the question asks what should be doing next a VP scan Vs Angio , I went for the Angio ,, I thought that both of them is carrying extreme hazards VP scan may be teratogenic ?? correct me if I’m wrong and Angio would carry a risk for Renal failure ,, the answer was V/p scan , yes I know it’s in normal conditions but I wasn’t sure about it  was the case also in pregnancy

Yet not to forget to mention always do a duplex on lower limb veins to exclude DVTs which you may usually add,

Also never use WARFARIN in pregnant females , we use LMWH throughout the course of pregnancy , management should continue 3 months after delivery

Please if there is a specialist I was lucky enough to read this post correct it and serve Medicine : ))