Michael Kemal Atalay MD, PhD, Presenter: Nothing to Disclose

Nicholas L Walle MD, Abstract Co-Author: Nothing to Disclose

Thomas K. Egglin MD, Abstract Co-Author: Nothing to Disclose

CT pulmonary angiography (CTPA) can accurately diagnosis pulmonary embolism (PE) and several other potentially relevant conditions. This study aimed to determine the prevalence and nature of important missed findings at CTPA in an emergency department (ED) setting.

Two experienced attending radiologists reviewed 335 consecutive CTPA studies performed in our adult ED over a 2-month period (60% women; age: 56 ± 18 y). This ED is part of an urban teaching hospital, and is a busy level 1 trauma center that averages more than 100,000 adult visits per year. It is staffed by 1 of 17 board certified radiologists, all with ED radiology experience. All of the reviewed studies were performed on 16- or 64-detector row scanners using an imaging protocol optimized for PE detection and a scan length extending from the thoracic inlet to the lowest costophrenic angle. All important findings were noted. Those findings not described in the original report were considered missed. Findings were ‘pertinent’ if they could explain the patient’s symptoms (n=16), and ‘incidental’ otherwise (n=16).

We found 374 pertinent findings in 192 patients, 122 (33%) of which were missed. Commonly missed pertinent findings included pulmonary hypertension (8/12, 67%), esophageal disorders (23/44, 52%), coronary artery calcification (53/103, 52%), COPD (17/41, 42%), and CHF (4/10, 40%). Two of 28 (7%) cases of PE were missed. There were 230 incidental findings in 165 patients, of which 48 (21%) were missed. Frequently missed incidental findings included aortic aneurysm (3/7, 43%), cardiomegaly (21/56, 38%), thyroid nodules (5/21, 24%), and lung nodules ≤ 5mm (6/28, 21%).

We found that 33% of pertinent findings and 21% of incidental findings are missed at CTPA in a busy ED setting. The clinical significance of these findings and whether they were previously known remains unclear.

Potentially important findings are commonly not reported in patients undergoing CTPA in the emergency department.

Atalay, M, Walle, N, Egglin, T, The Prevalence and Nature of Missed Findings at CT Pulmonary Angiogram in a Busy Emergency Department.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11004462.html