Key result
Esophageal wall thickening on CTPA is linked to a ~57% lower rate of pulmonary embolism.
Why the study?
Does evaluation of esophageal wall thickness on CT pulmonary angiography help explain symptoms in emergency patients evaluated for pulmonary embolism?
Cross-Sectional (n=434)
Does evaluation of esophageal wall thickness on CT pulmonary angiography help explain symptoms in emergency patients evaluated for pulmonary embolism?
Evaluating esophageal wall thickness on CT pulmonary angiography can identify alternative gastrointestinal causes for acute chest symptoms in emergency patients, especially when pulmonary embolism is excluded.
Answers are grounded in this paper and cite their sources.
May suggest alternative diagnoses when PE excluded; leaves open clinical utility of esophageal thickness on CTPA.
Background: A significant proportion of patients with chest discomfort suffer from esophageal pathology and other conditions unrelated to pulmonary embolism. Objectives: To determine the proportion of emergency patients undergoing CT pulmonary angiography, where esophageal pathology suspected from CT and other secondary findings would contribute to the explanation of their symptoms. Patients and Methods: CT scans of 434 patients who were referred from the emergency department for CT pulmonary angiography were evaluated for esophageal wall thickness and distention, the presence of pulmonary embolism and other findings that might explain acute symptoms. Esophageal pathology was considered when the distal esophageal wall was at least 5 mm thick, as previously reported. Results: Pulmonary embolism was confirmed in 27% patients. The distal esophageal wall was thickened in 87 (20%) patients. In this group, pulmonary embolism was present in 11 patients (13%) compared to 104 (30%) in patients without esophageal wall thickening (P = 0.007). From 76 patients with excluded pulmonary embolism, in 43 (56%), a suspected esophageal pathology was consistent with their symptoms. Gastroscopy confirmed CT findings in 34 of 42 patients (P = 0.0001). Conclusion: Esophageal wall thickening is common in emergency patients with excluded pulmonary embolism and this finding may help to direct the patients appropriately.
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Grusová et al. (2017) conducted a cross-sectional in Chest discomfort suspected of pulmonary embolism (n=434). Esophageal wall thickening (≥5 mm) vs. No esophageal wall thickening was evaluated on Presence of pulmonary embolism (p=0.007). Esophageal wall thickening (≥5 mm) was associated with a lower rate of pulmonary embolism compared to patients without thickening (13% vs 30%, P=0.007) during CT pulmonary angiography.
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