Patel Harish, Sun Haozhe, Hussain Ali N, Vakde Trupti
Department of Medicine, BronxCare Hospital Center a Clinical Affiliate of Mt Sinai Health Systems and Academic affiliate of Icahn School of Medicine, Bronx, NY 10457, USA.
Division of the Pulmonary and Critical Care, BronxCare Hospital Center a Clinical Affiliate of Mt Sinai Health Systems and Academic Affiliate of Icahn School of Medicine, Bronx, NY 10457, USA.
Diagnostics (Basel). 2020 Jun 2;10(6):365. doi: 10.3390/diagnostics10060365.
The incidence of venous thromboembolism (VTE), including lower extremity deep vein thrombosis (DVT) and pulmonary embolism (PE) is increasing. The increase in suspicion for VTE has lowered the threshold for performing imaging studies to confirm diagnosis of VTE. However, only 20% of suspected cases have a confirmed diagnosis of VTE. Development of pulmonary embolism rule-out criteria (PERC) and update in pre-test probability have changed the paradigm of ruling-out patient with low index of suspicion. The D-dimer test in conjunction to the pre-test probability has been utilized in VTE diagnosis. The age appropriate D-dimer cutoff and inclusion of YEARS algorithm (signs of the DVT, hemoptysis and whether PE is the likely diagnosis) for the D-dimer cutoff have been recent updates in the evaluation of suspected PE. Multi-detector computed tomography pulmonary angiography (CTPA) and compression ultrasound (CUS) are the preferred imaging modality to diagnose PE and DVT respectively. The VTE diagnostic algorithm do differ in pregnant individuals. The prerequisite of avoiding excessive radiation has recruited planar ventilation-perfusion (V/Q) scan as preferred in pregnant patients to evaluate for PE. The modification of CUS protocol with addition of the Valsalva maneuver should be performed while evaluating DVT in pregnant individual.
静脉血栓栓塞症（VTE）的发病率在上升，其中包括下肢深静脉血栓形成（DVT）和肺栓塞（PE）。对VTE怀疑指数的增加降低了进行影像学检查以确诊VTE的阈值。然而，只有20%的疑似病例被确诊为VTE。肺栓塞排除标准（PERC）的制定以及检测前概率的更新改变了对低怀疑指数患者进行排除的模式。D-二聚体检测结合检测前概率已被用于VTE诊断。适用于各年龄段的D-二聚体临界值以及将YEARS算法（DVT的体征、咯血以及PE是否为可能的诊断）纳入D-二聚体临界值的考量是近期对疑似PE评估的更新内容。多排螺旋CT肺动脉造影（CTPA）和加压超声（CUS）分别是诊断PE和DVT的首选影像学检查方法。VTE诊断算法在孕妇中确实有所不同。避免过度辐射这一前提使得平面通气-灌注（V/Q）扫描成为评估孕妇PE的首选方法。在评估孕妇DVT时，应采用添加瓦氏动作的CUS方案。
