Krempf M, Joffre F, Jover A, Migueres J
Poumon Coeur. 1979;35(2):81-5.
The diagnosis of mislaying forms of pulmonary embolism, where even angiography was not pathognomonic, induced the use of a phlebography on lower limbs in patients where this diagnosis was suspected. The revelation of a distal thrombo-phlebitis and even more so an iliocaval one, becomes a major value when the clinical and paraclinical data remained arguable. The comparative study of diagnostic usual clinical and paraclinical elements (radiographies, E.C.G., gasometries and scintigraphies) confirmed, in 22 patients, the value of phlebography. On a pneumological background, it is useful to perform this examination, most of the time : a) on patients over 55, when a cardiorespiratory decompensation remained unexplained in a patient with chronic respiratory insufficiency, or even an unproved hemoptysis; b) but mostly before 55, in case of painful pneumopathy above all if it is bilateral and recurring, or in case of paroxysmal bronchospasm without atopic ground, when a belated asthma could be thought of. Finally vascular tests induced the fitting in situ of a clamp or "umbrella" in the vena cava in 7 patients out of 22.
对于一些难以确诊的肺栓塞类型,即使血管造影也无特征性表现,因此对于疑似此类诊断的患者,会采用下肢静脉造影。当临床和辅助检查数据存在争议时,发现远端血栓性静脉炎,尤其是髂股静脉血栓性静脉炎,具有重要意义。对22例患者进行的常规临床和辅助检查诊断要素(X光片、心电图、血气分析和闪烁扫描)的对比研究,证实了静脉造影的价值。在肺部疾病背景下,大多数情况下进行此项检查是有用的:a)对于55岁以上的患者,当慢性呼吸功能不全患者出现无法解释的心肺失代偿,甚至是原因不明的咯血时;b)但主要是对于55岁以下的患者,在出现疼痛性肺病时,尤其是双侧且反复发作的情况,或者在无特应性基础的阵发性支气管痉挛时,此时可能会考虑迟发性哮喘。最后,在22例患者中,有7例通过血管检查在腔静脉原位植入了夹子或“伞”。