Promisloff Robert A
Respiratory Associates, Ltd, Wynnewood, PA 19096-3902, USA.
J Am Osteopath Assoc. 2002 Oct;102(10):558-60.
This report describes a case in which a patient had a Greenfield filter placed at the time of diagnosis of deep vein thrombosis (DVT) when he was asymptomatic for pulmonary embolism. Later in the patient's hospital course, a typical clincal picture of pulmonary embolism developed. The issues examined in this report include: (1) the incidence of asymptomatic pulmonary embolism; (2) the value of the baseline ventilation perfusion (VQ) lung scan for the diagnosis of DVT; and (3) the value of an echocardiogram in diagnosing pulmonary embolism. It appears reasonable that patients in whom DVT is diagnosed undergo baseline VQ scanning. This procedure would prevent the misdiagnosis of a new pulmonary embolism while the patient is on anticoagulation therapy and possibly avoid unnecessary invasive diagnostic procedures. The case described demonstrates the usefulness of the echocardiogram and a transthoracic echo in the diagnosis of pulmonary embolism. It also points out the surprisingly high incidence of silent pulmonary embolism in patients in whom DVT is diagnosed.
本报告描述了一例患者，其在诊断为深静脉血栓形成（DVT）时无症状性肺栓塞，当时放置了格林菲尔德滤器。在患者住院过程中，随后出现了典型的肺栓塞临床症状。本报告探讨的问题包括：（1）无症状性肺栓塞的发生率；（2）基线通气灌注（VQ）肺扫描对DVT诊断的价值；（3）超声心动图在诊断肺栓塞中的价值。对诊断为DVT的患者进行基线VQ扫描似乎是合理的。这一程序可防止患者在接受抗凝治疗时对新发肺栓塞的误诊，并可能避免不必要的侵入性诊断程序。所描述的病例证明了超声心动图和经胸超声心动图在诊断肺栓塞中的有用性。它还指出，在诊断为DVT的患者中，无症状性肺栓塞的发生率高得出奇。
