Chronic Blood Clots Can Be Missed!

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    Chronic Thromboembolic Pulmonary Hypertension 

    In this video, Roger Seheult, MD of MedCram discusses chronic thromboembolic pulmonary hypertension. He discusses a letter to the editor from the study in ERJ which shows that there is an association between COVID-19 and venous thromboembolism.  He notes that a small subset of patients with venous thromboembolism (blood clots in the body) will go on to develop CTEPH or chronic thromboembolic pulmonary hypertension. It was noted that with COVID-19 there was an increase in the numbers of venous thromboembolism in the form of pulmonary embolism (blood clot to the lungs).  However, the letter notes that despite a rise in the numbers of pulmonary embolisms, there was a reduction in the number of referrals to a large center for CTEPH in the UK.  The reason for this was not clear. 

    Treatment for CTEPH

    Treatment for CTEPH can be complicated. Individuals who have developed this have already been on blood thinners and it failed to prevent further clots.  Next step treatments may include open-heart surgery and pulling out the clots individually. 

    Best diagnostic test of choice for CTEPH

    If a person is concerned that someone may have this, the diagnostic test of choice is not a CT pulmonary angiogram but ventilation-perfusion scintigraphy (VQ scan). This study shows that a VQ scan is much more sensitive than a CT pulmonary angiogram. The CT pulmonary angiogram however is easier to perform in an emergency room setting but can miss the chronic findings of CTEPH. 



    Rising COVID-19 related acute pulmonary emboli but falling national chronic thromboembolic pulmonary hypertension referrals from a large national dataset (ERJ) |…

    Ventilation-perfusion scintigraphy is more sensitive than multidetector CTPA in detecting chronic thromboembolic pulmonary disease as a treatable cause of pulmonary hypertension (Journal of Nuclear Medicine) |…

    MedCram: Pulmonary Embolism explained clearly

    PEA specimen (Wikipedia) |…

    Medicine Explained Clearly (MedCram) |


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