Noseda A, Krzemien M
Clinique de Pneumologie, Département de Médecine, C.H.U. Brugmann, U.L.B.
Rev Med Brux. 1999 Jun;20(3):147-52.
A good knowledge of clinical presentation and of risk factors for pulmonary embolism is mandatory to improve adequate clinical suspicion. Some recent improvements in diagnostic strategy have to be emphasized. A low D-dimer level has a good negative predictive value to rule out pulmonary embolism. Ventilation-perfusion lung scan is the most often used imaging technique. In case of non diagnostic scan, serial non invasive search for deep vein thrombosis in the limbs is recommended by some experts at least in patients with good cardio-respiratory reserve, pulmonary angiography being recommended otherwise. Spiral CT allows direct demonstration of clots, being hardly less sensitive than pulmonary angiography except for subsegmental emboli. Future perspectives include the use of spiral CT as first choice procedure, as well as magnetic resonance imaging.
熟知肺栓塞的临床表现和危险因素对于提高临床怀疑度至关重要。必须强调诊断策略方面的一些近期进展。D - 二聚体水平低对于排除肺栓塞具有良好的阴性预测价值。通气 - 灌注肺扫描是最常用的成像技术。若扫描结果无法确诊，一些专家建议至少对心肺储备良好的患者进行肢体深静脉血栓的系列无创检查，否则建议进行肺血管造影。螺旋CT可直接显示血栓，除亚段栓塞外，其敏感性与肺血管造影相近。未来的发展方向包括将螺旋CT作为首选检查方法，以及应用磁共振成像。
