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Differentiation of pulmonary embolism from high altitude pulmonary edema
Dilshad Ahmed Khan1, Rizwan Hashim, Tariq Mahmud Mirza
1Department of Pathology, Combined Millitary Hospital, Skardu. dilshad56@yahoo.com
Objective:
To differentiate the high altitude pulmonary edema (HAPE) from pulmonary embolism (PE) by clinical probability model of PE, lactate dehydrogenase (LDH), aspartate transaminase (AST) and D-dimer assays at high altitude.
Design:
A prospective study.
Place And Duration Of Study:
The study was carried out at CMH, Skardu, from October 2001 to December 2002.
Subjects And Methods:
Consecutive 40 patients evacuated from height > 3000 meters with symptoms of PE or HAPE were included. Clinical pretest probabilities scores of PE, Minutex D-dimer assay (Biopool international) and cardiac enzymes estimation by IFCC approved methods, were used for diagnosis. Mann-Whitney U test was applied by using SPSS and level of significance was taken at (p<0.05).
Results:
Out of 40 subjects, 31 HAPE and 9 patients of PE were initially diagnosed on the basis of clinical features, D-dimer assay and V-Q scanning. Out of 9 patients of PE; 3 had plasma D-dimer between 250-500 ng/ml and 6 > 500 ng/ml. Plasma D-dimer of 500 ng/ml was considered as cut-off value; 6 (66.7%) patients of PE could be diagnosed and 30 (96.7%) cases of HAPE excluded indicating very good negative predictive value. Serum LDH, AST and CK were raised above the reference ranges in 8 (89%), 7 (78 %) and 3 (33 %) patients of PE as compared to 11 (35%), 6 (19%) and 9 (29 %) of HAPE respectively.
Conclusion:
Clinical assessment in combination with D-dimer assay, LDH and AST can be used for timely differentiation of PE from HAPE at high altitude where diagnostic imaging procedures are not available.