Original Research

CT pulmonary angiography findings in HIV-infected patients referred for suspected pulmonary thrombo-embolic disease

Diane Wiese, Leisha Rajkumar, Susan Lucas, David Clopton, Jacob Benfield, Jason DeBerry
South African Journal of Radiology | Vol 26, No 1 | a2273 | DOI: https://doi.org/10.4102/sajr.v26i1.2273 | © 2022 Diane Wiese, Leisha Rajkumar, Susan Lucas, David Clopton, Jacob Benfield, Jason DeBerry | This work is licensed under CC Attribution 4.0
Submitted: 16 August 2021 | Published: 31 January 2022

About the author(s)

Diane Wiese, Department of Radiology, Faculty of Medicine, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa
Leisha Rajkumar, Department of Radiology, Faculty of Medicine, Helen Joseph Hospital, University of the Witwatersrand, Johannesburg, South Africa
Susan Lucas, Department of Radiology, Faculty of Medicine, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa
David Clopton, Department of Radiology, Faculty of Medicine, James H. Quillien VA Healthcare System, East Tennessee State University, Johnson City, Tennessee, United States of America
Jacob Benfield, Department of Radiology, Faculty of Medicine, James H. Quillien VA Healthcare System, East Tennessee State University, Johnson City, Tennessee, United States of America
Jason DeBerry, Department of Radiology, Faculty of Medicine, Elizabeth and Claire LaPlante Foundation, West Virginia University, Morgantown, West Virginia, United States of America


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Abstract

Background: South Africa bares a significant burden of HIV and imaging is commonly performed as part of the workup for respiratory distress.

Objectives: The aim of this study was to document the prevalence of pulmonary thrombo-embolic disease (PTED) and other findings in HIV-infected patients referred for CT pulmonary angiography (CTPA) for suspected PTED.

Method: Forty CTPA studies of documented HIV-infected individuals investigated for suspected PTED during a 1-year period were retrieved, anonymised and interpreted by three consultant radiologists. Inter-reader reliability was calculated using Free Marginal multi-rater Kappa.

Results: Fourteen of the forty cases (35%) were positive for PTED. In the pulmonary embolism (PE)-positive group, 57.14% had peripheral disease and 42.86% had both peripheral and central disease. Associated findings in the PE-positive cases were pulmonary infarcts (17.5%), mosaic attenuation (17.5%) and linear atelectasis (7.5%). The most common incidental findings were solid pulmonary nodules (52.5%), non-wedge-shaped consolidation (45%), cardiomegaly (52.5%) and enlarged intra-thoracic lymph nodes (52.5%). Thirty per cent of the study population had findings related directly to the presence of PTED, whilst most cases in the study (77.5%) had pulmonary findings unrelated to PTED. In the PE-negative cases, 55% reported emergent findings that warranted immediate or urgent medical attention.

Conclusion: Computed tomography pulmonary angiography imaging is critical for diagnosing PE. However, further investigation into the judicious application of CTPA in HIV-infected patients with suspected PTED is required, as CTPA findings in most of the cases in this study were unrelated to PE.


Keywords

CTPA; HIV; pulmonary embolism; imaging findings; radiological; prevalence

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