Assessment of the prevalence of pulmonary embolism in patients with severe pulmonary tuberculosis

Abstract

Background Tuberculosis (TB) is an infectious disease of public health concern. Many reports pointed to the association between TB and thromboembolic diseases. The aim of the present study is to assess the prevalence of pulmonary embolism in patients with severe pulmonary TB. Patients and methods The study was done on 50 (35 males and 15 females) patients with severe pulmonary TB, and all patients were proved to have pulmonary TB by sputum or BAL examination and culture. In all patients, causes of hypercoagulability state were excluded, and computed tomography (CT) pulmonary angiography was done to search for evidence of pulmonary embolism. Results Eight of 50 (16%) patients had evidence of pulmonary embolism, six (12%) patients had pulmonary embolism on the segmental and subsegmental level, and two (4%) patients had pulmonary embolism in the main pulmonary artery branches. The diagnosis of pulmonary embolism was done only by CT pulmonary angiography, as clinical and chest radiography signs were masked by those for pulmonary TB. Patients with evidence of pulmonary embolism were more hypoxic and had higher levels of D-dimer, but the difference was not statistically significant. Conclusion Pulmonary embolism should be searched for in patients with severe pulmonary TB. CT pulmonary angiography is the standard method for diagnosis and can be performed in those patients who are more hypoxemic. Prophylactic anticoagulation management can be justified in these patients. Larger studies are needed to define the risk factors in patients with severe pulmonary TB who are at an increased risk of developing pulmonary embolism.

Keywords

• computed tomography pulmonary angiography
• pulmonary embolism
• pulmonary tuberculosis