PURPOSE: The diagnosis of pulmonary embolism(PE) is still a problem especially at the emergency units. The aim of this study was to determine the diagnostic accuracy of thoracic ultrasonography(TUS) in patients with pulmonary emboli.
METHODS: In this prospective study, 37 patients with suspected PE were evaluated in the Pulmonary Disease Department of a Training and Reasearch Hospital between January 2010 and December 2010. At the begining,TUS was performed by a pulmonolog, subsequently for definitive diagnosis CT pulmonary angiography were performed in all cases as a referance method.Other diagnostic procedures included estimation of d-dimer levels,echocardiography and venous doppler ultrasonography of the legs.Both the pulmonolog and radiolog were blinded to the results of the other diagnostic method.The diagnosis of PE was suggested if at least one or more typical pleural-based/subpleural hypoechoic lesion with or without pleural effusion were reported by TUS.In the presence of pure pleural effusion or normal sonografic findings,the diagnosis of PE was ruled out.
RESULTS: PE was diagnosed in 24 patients.It was shown that TUS was true-positive in 22 patients,false positive in 5,true negative in 8 and false negative in 2.The sensitivity, specificity,positive predictive value, negative predictive value and diagnostic accuracy of TUS in diagnosis of PE for clinically suspected patients were 91.7%,61.5%,81.4%,80.0% and 81.1%,respectively.
CONCLUSIONS: TUS with a high sensitivity and diagnostic accuracy, is a noninvasive,widely available,cost-effective method which can be rapidly performed.A negative TUS study cannot rule out PE with certainty but it may prove a valuable tool in the diagnosis of PE at bedside especially at emergency setting, facilitating immediate treatment decision.
CLINICAL IMPLICATIONS: TUS may be useful in the diagnosis of PE especially for critcally ill and immobile patients, it is also important for the rapid dicision of treatment.
DISCLOSURE: The following authors have nothing to disclose: Sevda Comert, Benan Caglayan, Ulku Akturk, Ali Fidan, Nesrin Kiral, Elif Torun, Banu Salepci
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