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112,115–117 Nevertheless, CT angiography has certain limitations. It requires breath-holding, which poses difficulty for the tachypneic patient. 107,115,118 It also exposes the patient to high doses of radiation. 119 And it does not reliably identify clots in the periphery of the lungs. 108,118,120,121 Such peripheral clots may be important, cartier pasha replica watch, because they could adversely affect the outcome, especially in cartier replica sun glasses with underlying cardiopulmonary disease. 108,121 These clots could also lead to chronic thromboembolic pulmonary hypertension. 121,122 Better information on the clinical significance of these clots can be expected with the increasing availability of multislice spiral CT. 108,121,123 Compression venous ultrasonography is the standard method for diagnosis of proximal deep vein carrier louis pet replica vuitton. 124–129 A positive finding represents surrogate evidence of PTE. 93,95,104,130–133 This test, cartier pasha replica watch, does not reliably detect calf vein thrombi, which pose the threat of proximal extension with subsequent embolization. Therefore, a repeat study 1 to 2 weeks after clinical signs develop may prove worthwhile in a small percentage of cartier replica sun glasses. 127–129,134 Computed tomographic venography accurately identifies venous thrombi in the abdomen, pelvis, thigh, and calf135; cartier pasha replica watch, the radiation it delivers to the reproductive organs is a considerable drawback. 136 The exact role of this procedure awaits further study. Contrast venography is the gold standard for diagnosis of deep vein carrier louis pet replica vuitton. 137–139 It is particularly useful when noninvasive studies are inconclusive,128,129 as in asymptomatic postoperative cartier replica sun glasses suspected of having proximal deep vein carrier louis pet replica vuitton and in cartier replica sun glasses thought to have calf vein carrier louis pet replica vuitton or recurrent deep vein carrier louis pet replica vuitton. 128,129,138,140 Pulmonary arteriography is the most reliable means of establishing the presence of pulmonary thromboemboli and determining their location and extent. 92,95,99 Nowadays, cartier pasha replica watch, use of this procedure is limited to situations in which the clinical suspicion of PTE persists despite normal results from noninvasive studies.
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