Pulmonary Embolism

Question 1

Modified Wells Score

Answer 1

Modified Wells Scoring System:
Clinical signs or symptoms of a deep vein thrombosis: +3
Alternative diagnosis less likely than pulmonary embolism: +3
Previous pulmonary embolism or deep vein thrombosis: +1.5
Pulse >100/min: +1.5
Recent surgery/immobile patient: +1.5
Hemoptysis: +1
Cancer (treated in last 6 months, palliative or receiving treatment): +1

Question 2

Modified Wells score interpretation

Answer 2

A Wells score of 0-1, 2-6, and >6 corresponds to a low, moderate, and high probability of pulmonary embolism, respectively.

Question 3

Further testing, based on Wells score

Answer 3

Patients with a low or moderate pretest probability of pulmonary embolism should receive a D-dimer blood test. Patients with a Wells score of >4 should receive a computed tomography scan with contrast. A VQ lung scan may be utilized in cases where CT scanning is unavailable or if there are contraindications to contrast such as chronic renal failure. VQ scans utilize inhaled radioisotopes and a scintillation camera to visualize perfusion deficits

Question 4

McConnell sign

Answer 4

McConnell sign is right ventricular dysfunction which may be seen on 2D Echo in patients with pulmonary embolism.

Question 5

McConnell sign, definition

Answer 5

McConnell sign is a distinct echocardiography finding described in patients with acute PE. There is a distinct regional pattern of right ventricular dysfunction, with akinesia of the mid free wall but normal motion at the apex.

Question 6

D-dimer

Answer 6

D-dimer blood test
A D-dimer is a fibrin degradation product. The test is very sensitive but not specific for a pulmonary embolism. Hence, a D-dimer blood test is preferred in cases where the likelihood of a pulmonary embolism is low.