Acute pulmonary thromboembolism in emergency room: gray-scale versus color doppler ultrasound evaluation.

Abstract

BACKGROUND:

Pulmonary thromboembolism (PTE) remains under-diagnosed fatal disease at emergency units suggesting the need for alternative, easy, and noninvasive bedside diagnostic approaches.

OBJECTIVES:

To determine the diagnostic role of gray-scale and color Doppler transthoracic ultrasonography (TUS) in patients with PTE.

PATIENTS AND METHODS:

Blinded to 64 multi-detectors CT pulmonary angiography (MDCTPA) examination as a gold standard, 60 patients with clinically suspected PTE underwent gray-scale and then color Doppler TUS examination. Results were compared and diagnostic accuracy of TUS was assessed.

RESULTS:

Forty patients proved to have PTE by MDCTPA. TUS showed typical lesions in 33 patients with the mean of 2 lesions per patient. Most lesions were hypoechoic, wedge- shaped, and pleural- based and the majority (80%) was located in the lower lobes. Consolidation with little perfusion was detected by Color Doppler ultrasound in 97% of lesions. Isolated central PTE was significantly higher in TUS negative patients. For gray -scale TUS, sensitivity, specificity, positive and negative predictive values and accuracy were 82%, 90%, 94%, 72%, and 85%. Meanwhile the sensitivity, specificity, positive and negative predictive values and accuracy of color Doppler TUS were 80%, 95%, 97%, 70% and 87%, respectively.

CONCLUSION:

TUS is a reliable diagnostic bedside test for PTE in critically ill and immobile patients. Adding color Doppler to gray-scale TUS increases the specificity and accuracy and consequently the confidence in the diagnosis of peripheral pulmonary infarctions and differentiates them from other pulmonary lesions that allow initiation of anticoagulants.

• Authors: Maha Kamel Ghanem, Hoda Ahmed Makhlouf, Ali Abdel-Azeem Hasan, Ahmed Atef Alkarn
• Journal: The clinical respiratory journal (Clin Respir J) Vol. 12 Issue 2 Pg. 474-482 (Feb 2018) ISSN: 1752-699X [Electronic] England
• PMID: 27608416 (Publication Type: Comparative Study, Journal Article)
• Copyright: © 2016 John Wiley & Sons Ltd.

Topics

• Acute Disease
• Adult
• Aged
• Computed Tomography Angiography (methods)
• Critical Illness
• Cross-Sectional Studies
• Diagnosis, Differential
• Emergency Service, Hospital
• Female
• Humans
• Lung (blood supply, diagnostic imaging, pathology)
• Male
• Middle Aged
• Pleura (diagnostic imaging, pathology)
• Pleural Effusion (diagnostic imaging, pathology)
• Point-of-Care Testing (statistics & numerical data)
• Predictive Value of Tests
• Prospective Studies
• Pulmonary Embolism (diagnostic imaging, pathology)
• Sensitivity and Specificity
• Ultrasonography, Doppler, Color (methods)