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Original Research: Pulmonary Procedures |

Accuracy of Point-of-Care Multiorgan Ultrasonography for the Diagnosis of Pulmonary EmbolismUltrasonography in Pulmonary Embolism Diagnosis

Peiman Nazerian, MD; Simone Vanni, MD, PhD; Giovanni Volpicelli, MD, FCCP; Chiara Gigli, MD; Maurizio Zanobetti, MD; Maurizio Bartolucci, MD; Antonio Ciavattone, MD; Alessandro Lamorte, MD; Andrea Veltri, MD; Andrea Fabbri, MD; Stefano Grifoni, MD
Author and Funding Information

From the Department of Emergency Medicine (Drs Nazerian, Vanni, Gigli, Zanobetti, and Grifoni), Careggi University Hospital, Firenze; Department of Emergency Medicine (Drs Volpicelli and Lamorte), San Luigi Gonzaga University Hospital, Torino; Radiology Department (Dr Bartolucci), Careggi University Hospital, Firenze; Department of Emergency Medicine (Drs Ciavattone and Fabbri), Pierantoni Morgagni Hospital, Forlì; and Radiology Department (Dr Veltri), San Luigi Gonzaga University Hospital, Torino, Italy.

Correspondence to: Peiman Nazerian, MD, Department of Emergency Medicine, Careggi University Hospital, Largo Brambilla 3, 50134 Firenze, Italy; e-mail: pnazerian@hotmail.com


For editorial comment see page 931

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(5):950-957. doi:10.1378/chest.13-1087
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Background:  Presenting signs and symptoms of pulmonary embolism (PE) are nonspecific, favoring a large use of second-line diagnostic tests such as multidetector CT pulmonary angiography (MCTPA), thus exposing patients to high-dose radiation and to potential serious complications. We investigated the diagnostic performance of multiorgan ultrasonography (lung, heart, and leg vein ultrasonography) and whether multiorgan ultrasonography combined to Wells score and D-dimer could safely reduce MCTPA tests.

Methods:  Consecutive adult patients suspected of PE and with a Wells score > 4 or a positive D-dimer result were prospectively enrolled in three EDs. Final diagnosis was obtained with MCTPA. Multiorgan ultrasonography was performed before MCTPA and considered diagnostic for PE if one or more subpleural infarcts, right ventricular dilatation, or DVT was detected. If multiorgan ultrasonography was negative for PE, an alternative ultrasonography diagnosis was sought. Accuracies of each single-organ and multiorgan ultrasonography were calculated.

Results:  PE was diagnosed in 110 of 357 enrolled patients (30.8%). Multiorgan ultrasonography yielded a sensitivity of 90% and a specificity of 86.2%, lung ultrasonography 60.9% and 95.9%, heart ultrasonography 32.7% and 90.9%, and vein ultrasonography 52.7% and 97.6%, respectively. Among the 132 patients (37%) with multiorgan ultrasonography negative for PE plus an alternative ultrasonographic diagnosis or plus a negative D-dimer result, no patients received PE as a final diagnosis.

Conclusions:  Multiorgan ultrasonography is more sensitive than single-organ ultrasonography, increases the accuracy of clinical pretest probability estimation in patients with suspected PE, and may safely reduce the MCTPA burden.

Trial registry:  ClinicalTrials.gov; No.: NCT01635257; URL: www.clinicaltrials.gov

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