Acute pulmonary embolism in patients with HIV disease

Objectives: To determine the incidence, mode of presentation, and outcome o f pulmonary embolism (PE) in patients with HIV infection. Methods: Retrospective review of clinical case records, imaging department database, and necropsy reports of patients admitted to the specialist HIV/A IDS unit at UCL hospitals from April 1993 to August 1997 in order to identi fy those with a diagnosis of PE. Results: During the study period there were 3792 admissions of whom 10 (0.2 6%) had PE. All patients with PE presented with fever, seven were dyspnoeic , and seven had cough: all were thought initially to have respiratory infec tion. Only five patients had pleural pain. All 10 patients had abnormal bas eline chest radiographs. The diagnosis in six was made by computed tomograp h (CT) pulmonary angiography, in two was made by ventilation perfusion (V/Q ) scanning, in one by both techniques, and in one at necropsy. CT angiograp hy in addition to identifying thrombus also showed concomitant lung parench ymal abnormalities in all but one patient. Nine patients with PE had one or more risk factors for venous thromboembolism as did 34/40 case matched con trols (odds ratio = 1.67; 95% confidence interval = 0.18-15.5). All patient s diagnosed in life were anticoagulated and five survived. Conclusions: PE was uncommon in this HIV infected population. The diagnosis should be considered in patients with respiratory infection which does not respond to antibiotics. Identifiable risk factors for venous thromboemboli sm appear to be unhelpful in increasing clinical index of suspicion for PE. As baseline chest radiographs are frequently abnormal, the diagnostic util ity of V/Q scanning may be reduced and CT pulmonary angiography is the imag ing modality of first choice.