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 postprocessing, in addition to the savings in cost, time, and contrast media, support its use in the angiographic diagnosis of PE.