E1183. A-Z of PE: Everything PERTinent to the Pulmonary Embolism Response Team
Authors
Ariel Lewis;
Jacobi Medical Center
Linda Haramati;
Montefiore Medical Center
Jonathan Alis;
Jacobi Medical Center
Background
Acute pulmonary embolism (PE) is the third leading cause of cardiovascular-related death and causes more than 250,000 hospitalizations in the United States annually. To organize and improve the efficiency of PE care, a new paradigm for the evaluation and treatment of patients with acute PE was created: the Pulmonary Embolism Response Team (PERT). The PERT model involves rapid consultation and treatment by a multidisciplinary team of specialists. At the forefront of this multistep process is rapid accurate diagnosis and risk stratification. With this in mind, this exhibit presents a comprehensive range of topics that are relevant to both radiologists and nonradiologist members of the PERT, who are crucial in acquiring, accurately diagnosing, and risk-stratifying patients with PE.
Educational Goals / Teaching Points
This presentation is aimed at educating all members of the multidisciplinary PERT with a broad range of topics, ranging from technical factors related to acquisition of a diagnostic CT to nuanced interpretation of a CT for PE. Fundamental technical aspects of obtaining a diagnostic study that are frequently overlooked will be discussed, such as contrast administration, timing methods, optimal contrast opacification, and minimal thresholds needed to confidently detect both acute and chronic PE. Familiarity with common mimickers of PE and artifacts, including understanding the mechanism of flow related artifacts. CT risk stratification parameters, such as clot obstruction scores, right ventricular dysfunction, and dual-energy CT perfusion maps will be discussed. This includes a brief review of their literature, limitations, and importance of interpreting them in conjunction with knowledge of the patients other comorbidities and in comparison to priors.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit covers acute and chronic PE, risk stratification using clot burden and right heart dysfunction, and awareness of common mimickers. The focus will be on CT and dual-energy CT.
Conclusion
This exhibit provides a comprehensive review of the core knowledge required for acquiring and interpreting CT pulmonary angiogram for all PERT members. Accurate and prompt diagnosis of PE requires familiarity with fundamental anatomy as well as common mimickers, pitfalls, and artifacts. In addition, CT risk-stratification parameters including clot burden scores, right heart dysfunction, and perfusion maps are discussed, which will help triage high-risk patients.
