Intermediate probability lung scans (IPLS): retrospective review of 82 cases

Area of Science:

• Medical Imaging
• Pulmonary Medicine
• Diagnostic Accuracy

Background:

• Pulmonary embolism (PE) diagnosis can be challenging, particularly in cases with intermediate probability lung scans (IPLS).
• Previous studies, like PIOPED, reported high PE prevalence in IPLS, necessitating further investigation into management strategies.

Purpose of the Study:

• To determine the frequency of documented PE in patients with IPLS.
• To analyze the management strategies, including further imaging and anticoagulation.
• To assess follow-up outcomes in patients with IPLS.

Main Methods:

• Retrospective review of 82 patients with intermediate probability ventilation-perfusion (V/Q) lung scans.
• Analysis of diagnostic imaging (venous sonography, CTA) and anticoagulation therapy.
• Evaluation of clinical outcomes and mortality during follow-up.

Main Results:

• 14.1% of V/Q scans were classified as intermediate probability for PE.
• 72% of IPLS patients underwent further imaging, with 39% showing evidence of thromboembolic disease.
• Anticoagulation was administered to patients with confirmed disease and some based on clinical judgment; no mortality occurred in untreated cases.

Conclusions:

• Over one-third of patients with IPLS, after further imaging, are diagnosed with thromboembolic disease.
• Approximately half of IPLS cases receive anticoagulation therapy.
• No mortality or PE was observed in follow-up of untreated IPLS patients, suggesting potential for selective treatment.