Clinical follow-up of patients after a negative digital subtraction pulmonary arteriogram in the evaluation of pulmonary embolism.

PURPOSE: This study was designed to examine the clinical course of patients following digital subtraction pulmonary arteriography (DSPA) interpreted as negative for pulmonary emboli (PE).

MATERIALS AND METHODS: Sixty-three patients underwent DSPA interpreted as negative for PE over a 27-month period. Follow-up data were collected by means of medical and diagnostic radiology record review, interviews of referring physicians, and patient telephone interviews.

RESULTS: Of 63 patients, two were excluded and seven were lost to follow-up, leaving a study population of 54 patients. Mean follow-up was 12.1 months (range, 0-28.5 months). Thirty-one reported no symptoms of PE. Of 13 patients reporting intermittent chest pain and/or dyspnea during their mean follow-up of 13.6 months, 10 had a history of cardiac, nonthrombotic pulmonary, or gastroesophageal reflux disease. There were no subsequent positive angiograms or ventilation/perfusion scans. Comorbid conditions in the 10 patients who died included cardiac events (n = 4), advanced cancer (n = 2), sepsis/pneumonia (n = 2), sarcoidosis (n = 1), and cerebrovascular accident (n = 1). No documented PE was identified.

CONCLUSION: The technique of DSPA is sufficiently sensitive to exclude clinically significant PE. The advantages of image post-processing, in addition to the savings in cost, time, and contrast media, support its use in the angiographic diagnosis of PE.