International angiology : a journal of the International Union of Angiology
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Pulmonary angiography is the gold standard for segmental pulmonary embolism (PE) but no longer for its subsegmental PE, because the inter-observer agreement for angiographically documented subsegmental PE is only 60%. Two non-invasive tools exclude PE with a negative predictive value of > 99%: a normal perfusion lung scan and a normal rapid ELISA VIDAS D-dimer test. The positive predictive value of a high probability ventilation-perfusion lung scan (VP-scan) is only 85% to 87%. ⋯ Single-slice helical CT as the primary diagnostic test in patients with suspected PE in retrospective outcome studies and in prospective multicenter management studies indicate that the negative predictive value of a negative spiral CT preceded or followed by a negative compression ultrasonography (CUS) is > 99%. Therefore, a helical spiral CT can replace both the VP-scan and pulmonary angiography to safely rule in and out PE. A negative rapid ELISA VIDAS D-dimer test result will reduce the need for helical spiral CT by 25% to 35%.
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Raynaud's phenomenon and digital necrosis of the fingers are rare complications of hypereosinophilia. We report a case of a smoking male who developed Raynaud's phenomenon and digital necrosis of the fingers associated with idiopathic hypereosinophilia with angiographically documented occlusion of small and medium arteries of the extremities. The eosinophils may play a thrombotic role in vascular pathology and eosinophil blood count should be checked when investigating patients with digital gangrene.