Editing Chest standard texts (section)

== CTPA ==

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||''Text to copy and insert, optimised for Sectra standard report texts.&nbsp;''
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'''Auto-inserted clinical details:'''<br />
<RequestCaseHistory><br />
<RequestReason><br />

'''Report:'''<br />
Scan quality: [Good/Adequate/Poor/Non-diagnostic.].<br />
Pulmonary emboli? [Yes/No.]<br />
Location: [Saddle/Main left/Main right/Segmental left/Segmental right/Subsegmental left/Subsegmental right/Multiple/Right heart]<br />
Features of right heart strain/raised pulmonary artery pressure: [Straightening/reverse bowing of interventricular septum/Pulmonary artery enlargement/Reflux of contrast into hepatic veins]<br />
Right ventricular/Left ventricular diameter ratio: []<br />
Lymphadenopathy: [Axillary/Hilar/Mediastinal]<br />
Lung parenchyma: [] <br />
Pleural disease: [] <br /> 
Pulmonary nodules: [] <br /> 
Upper abdominal organs: [] <br /> 
Bones: [] <br /> 
Vasculature including coronary arteries: [] <br /> 
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{| class="wikitable mw-collapsible <!--mw-collapsed-->"
|colspan="3"| Explanatory notes&nbsp;
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!Heading
!Options
!Reason
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||Pulmonary emboli? ||Yes/No. ||
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||Location ||Saddle/Main left/Main right/Segmental left/Segmental right/Subsegmental left/Subsegmental right/Multiple/Right heart ||High clot burden may correlate with prognosis (not all studies find this to be so) and the PE index (Wu et al) may predict outcome, but the most significant factor is whether there is haemodynamic compromise/shock. Right heart clot is associated with increased mortality.
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||Features of right heart strain/raised pulmonary artery pressure ||Straightening/reverse bowing of interventricular septum/Pulmonary artery enlargement/Reflux of contrast into hepatic veins ||Classification of PE into massive, submassive and nonmassive (high, intermediate and low risk) does not rely on CT and relies on the patient's clincal status specifically blood pressure and other signs of shock. However, various combinations of CT and clinical signs have been studied and shown to predict mortality - Jaff et al provide a good summary. 
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||Right ventricular/Left ventricular diameter ratio: || ||Originally assessed on the 4 chamber view, but you may not need to reformat - measurements on axial images (not necessarily the same images) have been shown to give equivalent results. > 0.9 is significant, although not across all studies - reformatting into a 4 chamber view is quick and easy. Again various combinations of this ratio and other factors may help stratify patients e.g. Kyoung Kang et al. Give measurements and ratio e.g. RV/LV = 45 mm/40 mm = 1.125
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||Lymphadenopathy: ||Axillary/Hilar/Mediastinal 
|rowspan="4"|Many other features are likely to contribute to prognosis including acute infection and cancer.
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||Lung parenchyma: || 

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||Pleural disease: ||  
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||Pulmonary nodules: || 
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||Upper abdominal organs: || ||
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||Bones || ||
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||Vasculature including coronary arteries || ||High pitch CTPAs will often demonstrate some detail relating to the coronary arteries.
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''References:''
1. <br />
2. T Lu, Michael & Demehri, Shadpour & Cai, Tianxi & Parast, Layla & Hunsaker, Andetta & Goldhaber, Samuel & J Rybicki, Frank. (2012). Axial and Reformatted Four-Chamber Right Ventricle-to-Left Ventricle Diameter Ratios on Pulmonary CT Angiography as Predictors of Death After Acute Pulmonary Embolism. AJR. American journal of roentgenology. 198. 1353-60. 10.2214/AJR.11.7439. <br />
3. Prognostic Factors for Pulmonary Embolism The PREP Study, A Prospective Multicenter Cohort Study Sanchez, Trinquart L, Caille V, Couturaud F, Pacouret G, Meneveau N, Verschuren F, Roy PM, Parent F, Righini M, Perrier A, Lorut C, Tardy B, Benoit MO, Chatellier G, Meyer G. American Journal of Respiratory and Critical Care Medicine https://www.atsjournals.org/doi/full/10.1164/rccm.200906-0970OC <br />
4. Moroni, Chiara & Bartolucci, Maurizio & Vanni, Simone & Nazerian, Peiman & Bartolini, Marco & Miele, Vittorio. (2017). Prognostic value of CT pulmonary angiography (CTPA) parameters in acute pulmonary embolism (APE). 10.1594/ecr2017/C-3066. <br />
5. Wu AS, Pezzullo JA, Cronan JJ, Hou DD, Mayo-Smith WW. CT Pulmonary Angiography: Quantification of Pulmonary Embolus as a Predictor of Patient Outcome—Initial Experience Radiology https://pubs.rsna.org/doi/10.1148/radiol.2303030083?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed
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6. Int J Cardiovasc Imaging. 2016 Jul;32(7):1153-61. doi: 10.1007/s10554-016-0887-z. Epub 2016 Apr 13. Normal ventricular diameter ratio on CT provides adequate assessment for critical right ventricular strain among patients with acute pulmonary embolism. Kumamaru KK, George E, Ghosh N, Quesada CG, Wake N, Gerhard-Herman M, Rybicki FJ<br />
7. Doo KyoungKangMD ChristianThiloMD U. JosephSchoepfMD J. MichaelBarrazaJrBS John W.NanceJrMD GorkaBastarrikaMD, PhD Joseph A.AbroMA James G.RavenelMD†PhilipCostelloMD Samuel Z.GoldhaberMD JACC: Cardiovascular Imaging Volume 4, Issue 8, August 2011, Pages 841-849 CT Signs of Right Ventricular Dysfunction: Prognostic Role in Acute Pulmonary Embolism https://doi.org/10.1016/j.jcmg.2011.04.013
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8. Michael R. Jaff , M. Sean McMurtry , Stephen L. Archer , Mary Cushman , Neil Goldenberg , Samuel Z. Goldhaber , J. Stephen Jenkins , Jeffrey A. Kline , Andrew D. Michaels , Patricia Thistlethwaite , Suresh Vedantham , R. James White , Brenda K. Zierler Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension Circulation https://www.ahajournals.org/doi/full/10.1161/CIR.0b013e318214914f?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed
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9. Masotti L, Righini M, Vuilleumier N, et al. Prognostic stratification of acute pulmonary embolism: focus on clinical aspects, imaging, and biomarkers. Vasc Health Risk Manag. 2009;5(4):567-75. <br />