Cardiovascular Journal of Africa: Vol 28 No 4 (July/August 2017)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 4, July/August 2017

AFRICA

227

(partially occlusive thrombus) in the right middle lobe of the

lung (

0.045). We have no specific reasons to account for this

difference.

In our study, the severity of PE was quantified using the

Qanadli score and two cardiovascular parameters, namely the

ratios of RV:LV diameter and PA:AO, all of which can be used to

indicate right ventricular dysfunction. Right ventricular dilatation

is important in the risk stratification of patients, especially in the

suspected high-risk PE patient. The presence of right ventricular

overload guides the clinician to immediate PE-specific treatment,

such as thrombolysis, surgical embolectomy or catheter-directed

treatment where available.

In addition, right ventricular dysfunction is used to identify

patients with a high likelihood of fatal pulmonary embolism.

In the study by Qanadli

et al

. in 2001, a CT obstruction of

40% and greater predicted and identified more than 90% of

their patients with right ventricular dilatation.

The degree of

obstruction in their study was considered the most important

factor in determining right ventricular response to PE. In our

study we found no statistically significant differences between

HIV-positive and -negative groups in terms of severity of the

Qanadli score or with regard to the RV:LV and PA:AO ratios.

The most common CTPA-detectable parenchymal and pleural

complications reported in association with PE are as follows:

atelectasis in from 55

to 71%

of patients,consolidation in 39%,

wedge-shaped opacity in 31%,

ground-glass opacity 43%,

and

pleural effusion in more than 50% of patients.

In comparison,

our data showed a higher frequency of consolidation, atelectasis

and ground-glass opacification (atelectasis 52%, consolidation

61%, wedge-shaped opacity 15%, ground-glass opacity 48%

and pleural effusion 42%). In the HIV-infected patients, the

frequency of consolidation (68%), wedge-shaped opacity (18%),

and pleural effusion (45%) was higher when compared with

HIV-uninfected patients but there were no statistically significant

associations between HIV status of the patient and the presence

of any of the complications.

Limitations

The data were collected from patients attending a regional

hospital in the Western Cape, which has a high incidence of

both TB and HIV.

The sample was dominated by HIV-infected

patients (68% in the proportion tested). A large number of

patients were excluded (103) because of missing information,

and a further 45 patients could not be considered for comparing

HIV-infected and uninfected patients because testing had not

been done. This resulted in a sample size that was statistically

small and may have accounted for the low/poor correlations of

prevalence across the various groups of TB and HIV-infected

and non-infected patients.

In addition, the reading of the scans by a single radiologist is

a limitation, and did not allow for evaluation of inter-observer

error in this study. The shortage of radiologist consultants at the

public institutions and the workload on the existing consultants

restricts the availability of senior staff for research purposes.

Conclusion

This study provides a foundation for additional studies to be

performed regarding thromboembolism in HIV, particularly in

Africa, as this information is extremely limited. The high number

of patients presenting for CTPAwho were HIV infected (and also

infected with TB) highlights that PE evaluation should include

severity/extent of the disease, as these patients may have more

severe disease in specific lobes. The use of a validated scoring

system such as the Qanadli score when reporting PE may have

a profound effect on patient risk stratification, management,

and prognosis and would also provide a system for collecting

larger volumes of data for analysis. Larger, local studies should

be performed prospectively to evaluate associations between PE,

TB and HIV

The authors acknowledge the contributions of the Statistical Consulting

Service (SCS), Department of Statistical Sciences, University of Cape Town

(consultants: Reshma Kassanjee and Katya Mauff).

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