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Immediately from the ACCP Pulmonary drugs Board overview 2009 direction, this article covers each subject in a concise, easy-to-use layout. Use as a self-study source to arrange for the pulmonary drugs subspecialty board exam.
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Diagnosis of PE Clinical Suspicion: The clinical suspicion of PE is often arrived at using an unstructured approach based on a combination of factors, including the presence or absence of identifiable risk factors (eg, surgery in the past, obesity, or previous VTE); symptoms (eg, dyspnea, pleuritic chest pain, and hemoptysis); physical examination findings (eg, tachypnea); the results of basic laboratory studies (eg, hypoxemia); and the likely presence of alternative diagnoses (eg, asthma, pneumonia, or congestive heart failure).
However, its use in detecting small peripheral PEs is unproven (6% of cases in the PIOPED study). Such small clots may not be important physiologically, but their detection may be important markers for future VTE. Several analyses have suggested that CT scanning may be a more cost-effective . initial test for suspected PE compared with the V/Q lung scan because of its greater sensitivity for PE and its ability to identify alternative diagnoses to PE. In addition, the use of CT scanning for the estimation of clot burden and right ventricular function is emerging as a useful prognostic measure in patients with documented acute PE.
Chest 2007; 131:1917−1928 33 This article is an update to the one before it, taking into account the rapidly evolving field of therapeutic trials in PAH. The authors give a nice review of the current evidence for each potential agent and a suggested algorithm for their use in patients with PAH. Budhiraja R, Hassoun PM. Portopulmonary hypertension: a tale of two circulations. Chest 2003; 123:562−576 Pulmonary involvement is common in patients with portal hypertension and can manifest in diverse ways.