Nauffal Dolores, Chacón Liliana, Domènech Rosalía
Servicio de Neumología, Hospital Universitario La Fe, Valencia, España.
Med Clin (Barc). 2008 Nov;131 Suppl 2:48-53. doi: 10.1016/s0025-7753(08)76449-2.
There are common, specific noninvasive and invasive tests for the diagnosis of pulmonary embolism (PE). Arterial blood gases, lung radiography and electrocardiography belong to the first group and should be performed in patients with suspected PE. Among the second group, D-dimer determination is essential. Ventilation-perfusion scintigraphy was formerly the most frequently used test but has been relegated to a second-line position by the development of multislice computed tomography (CT) angiography, which provides the possibility of simultaneously studying the lower limbs to detect deep venous thrombosis (DVT). SPECT and magnetic resonance imaging can be used as an alternative to multislice CT angiography, but there is less experience with these techniques. Transthoracic echocardiography has, above all, predictive value and lower limb ultrasonography is the most common non-invasive method to detect DVT. Invasive tests, the gold standard, are often unavailable and their use is therefore limited to selected patients. In conclusion, noninvasive management (clinical probability, D-dimer and multislice CT) is feasible in most patients with suspected PE.
对于肺栓塞(PE)的诊断,有常见的、特定的非侵入性和侵入性检查。动脉血气分析、胸部X线检查和心电图属于第一组检查,应在疑似PE的患者中进行。在第二组检查中,D-二聚体测定至关重要。通气-灌注闪烁扫描术以前是最常用的检查,但随着多层计算机断层扫描(CT)血管造影术的发展,它已退居二线,多层CT血管造影术提供了同时研究下肢以检测深静脉血栓形成(DVT)的可能性。单光子发射计算机断层扫描(SPECT)和磁共振成像可作为多层CT血管造影术的替代方法,但这些技术的经验较少。经胸超声心动图主要具有预测价值,下肢超声检查是检测DVT最常用的非侵入性方法。侵入性检查作为金标准,往往难以进行,因此其应用仅限于特定患者。总之,对于大多数疑似PE的患者,非侵入性管理(临床概率、D-二聚体和多层CT)是可行的。