慢性 CT 特征在伴有合并症的 PE 患者中。

Chronic CT features in PE patients with co-existing DVT.

机构信息

Departments of Pulmonary Diseases, Kirikkale University Faculty of Medicine, Kirikkale, Turkey.

出版信息

Am J Emerg Med. 2021 Aug;46:126-131. doi: 10.1016/j.ajem.2021.03.031. Epub 2021 Mar 14.

DOI:10.1016/j.ajem.2021.03.031

PMID:33744749

Abstract

OBJECTIVE

Clinical features may be different in patients with PE without co-existing DVT compared to those with PE with co-existing DVT. This prospective study aims to investigate the different clinical features between patients with isolated pulmonary embolism (PE) and those with PE associated with deep venous thrombosis.

METHOD

This is a prospective study conducted in 107 consecutive patients diagnosed with acute PE in the emergency department or other departments of Kırıkkale University Hospital. The diagnosis of PE was confirmed by computed tomography pulmonary angiography (CTPA), which was ordered on the basis of symptoms and findings. Bilateral lower extremity compression ultrasound with standard 7.5 MHz linear array probe was applied to all patients. According to compression ultrasound results, the patients were divided into two classes as with and without deep venous thrombosis. Embolism in the main or lobar pulmonary arteries were classified as central, and those found only in segmental or subsegmental arteries were classified as peripheral. Laboratory parameters and Oxygen saturation were assessed on admission.

RESULTS

67 of 107 (62.6%) patients with PE were isolated pulmonary embolism, and 40 (37.4%) were PE + DVT. Patients with PE with co-existing DVT have wider pulmonary artery, higher d-dimer and pro BNP level, and lower saturation than those with isolated pulmonary embolism. Central pulmonary embolism is more common in patients with deep vein thrombus than those without it. (87.5% (35/40) vs 32.8% (22/67),p = 0.001). 38.6% of central pulmonary embolism occur without deep vein thrombosis of the lower extremities. Patients with PE with co-existing DVT have 42.5% mosaic perfusion pattern,70% chronic infarct appearance such as linear band, pleural nodüle, %15.0 thickened, small arteries and, %12.5 shrunken complete artery occlusion, suggesting the chronic background.

CONCLUSION

PE patients with co-existing DVT are clinically more serious than those who do not have a DVT. An acute picture may be present in the chronic background in a significant proportion of patients with PE with co-existing DVT. In the presence of deep vein thrombosis, pulmonary embolism is usually central, but more than one-third of central pulmonary emboli occur without lower extremity deep vein thrombosis.

摘要

目的

与同时存在深静脉血栓形成（DVT）的肺栓塞（PE）患者相比，无 DVT 的 PE 患者的临床特征可能不同。本前瞻性研究旨在探讨单纯性肺栓塞（PE）患者与 PE 合并 DVT 患者之间的不同临床特征。

方法

这是一项在基里卡大学医院急诊科或其他科室连续诊断为急性 PE 的 107 例患者中进行的前瞻性研究。通过计算机断层肺动脉造影（CTPA）确诊 PE，该检查基于症状和检查结果进行。对所有患者应用双侧下肢压缩超声检查，使用标准 7.5MHz 线性阵列探头。根据压缩超声结果，患者分为有和无深静脉血栓形成两组。主或叶肺动脉中的栓塞分为中央型，仅在段或亚段动脉中发现的栓塞分为外周型。入院时评估实验室参数和氧饱和度。

结果

107 例 PE 患者中，67 例（62.6%）为单纯性肺栓塞，40 例（37.4%）为 PE+DVT。与单纯性肺栓塞相比，合并 DVT 的 PE 患者的肺动脉更宽，D-二聚体和前 BNP 水平更高，饱和度更低。合并深静脉血栓形成的患者中中央型肺栓塞更为常见，而无深静脉血栓形成的患者中则较少见（87.5%（35/40）比 32.8%（22/67），p=0.001）。38.6%的中央型肺栓塞发生在无下肢深静脉血栓形成的情况下。合并 DVT 的 PE 患者中，42.5%存在马赛克灌注模式，70%存在线性条带、胸膜结节等慢性梗死表现，15.0%存在增厚，小动脉和 12.5%存在完全动脉闭塞缩小，提示存在慢性背景。