Matthews S
Radiology Department, Northern General Hospital, Herries Road, Sheffield, South Yorkshire S5 7AU, UK.
Br J Radiol. 2006 May;79(941):441-4. doi: 10.1259/bjr/15144573.
Pulmonary embolism is the leading cause of death in pregnancy. Despite the difficulties in clinical diagnosis and the concerns regarding radiation of the fetus, the British Thoracic Society guidelines for imaging pulmonary embolism do not specifically address the issue of imaging for pulmonary embolism in this group. This communication discusses the difficulties of diagnosis and imaging pulmonary embolism in pregnancy and proposes a suitable imaging protocol. Clinical exclusion of patients from further imaging is recommended if the patient has a low pre-test probability of pulmonary embolism and a normal d-dimer. It is advised that all remaining patients undergo bilateral leg Doppler assessment. If this test is positive, the patient should be treated for pulmonary embolism; if negative, all patients should be referred for CT pulmonary angiography. Ideally, informed consent should be obtained prior to CT scanning. All neonates exposed to iodinated contrast in utero should have their thyroid function tested in the first week of life due to the theoretical risk of contrast induced hypothyroidism.
肺栓塞是妊娠期死亡的主要原因。尽管临床诊断存在困难且对胎儿辐射存在担忧，但英国胸科学会关于肺栓塞成像的指南并未特别涉及该群体肺栓塞成像的问题。本文讨论了妊娠期诊断和成像肺栓塞的困难，并提出了合适的成像方案。如果患者肺栓塞的预测试概率较低且D-二聚体正常，建议临床排除患者进一步成像检查。建议对所有其余患者进行双侧腿部多普勒评估。如果该检查呈阳性，患者应接受肺栓塞治疗；如果为阴性，所有患者均应转诊进行CT肺动脉造影。理想情况下，CT扫描前应获得知情同意。由于存在造影剂诱发甲状腺功能减退的理论风险，所有在子宫内接触过碘化造影剂的新生儿应在出生后第一周进行甲状腺功能检测。
