Rubboli A, Leonardi G, de Castro U, Bracchetti D
Section of Cardiology, Maggiore Hospital, Bologna.
G Ital Cardiol. 1998 Feb;28(2):123-30.
Several approaches have been proposed for the diagnosis of acute pulmonary embolism (PE), but little is known about the strategies effectively used in daily clinical practice.
Retrospective evaluation of the diagnostic strategy used in our institution in the patients (pts) discharged between January 1st 1995 and December 31st 1996 with diagnostic code 415.1, corresponding to acute PE in the International Classification of Disease.
One-hundred-twenty-seven patients (49 M; 78 F; mean age: 71.5 +/- 15 years; range: 25-95) were identified. Electrocardiogram, chest X-ray, blood gas analysis and plasma D-dimer measurement were performed in 122 (96%), 121 (95%), 114 (90%) and 86 (68%) pts, respectively. Out of the 102 pts surviving the initial phase (early mortality: 20%), 83 (81%) underwent lung scintigraphy, 10 (10%) spiral CT scanning and 2 (2%) pulmonary angiography, while 7 (7%) were treated directly. Thirty of the 83 pts undergoing lung scintigraphy had non-diagnostic results, but only 8 of them underwent further investigation (with spiral CT in 6 cases and pulmonary angiography in 2 cases). Transthoracic echocardiography and ultrasonography of the lower limbs were used in 49 (48%) and 74 (73%) pts respectively, for diagnostic confirmation and to search for the embolic source.
At our institution, where multiple and modern diagnostic facilities are available, ventilation/perfusion lung scanning still represents the most frequently used imaging technique. Spiral CT is employed quite often as an alternative to either lung scintigraphy or pulmonary angiography which, in turn, is used very seldom. Ultrasonography of the lower-limbs is widely utilized (although not in a serial manner and only as a second-line test), while the role of echocardiography appears to be marginal. Spiral CT, pulmonary angiography and lower-limb ultrasonography showed high diagnostic accuracy, while the accuracy of lung scintigraphy and echocardiography was confirmed as being suboptimal. However, due to the retrospective design of our study and the characteristics of our population, these results cannot be extrapolated to pts referred for suspected acute PE, in whom further investigations are thus warranted in order to identify the most cost-effective diagnostic approach.
已经提出了几种用于诊断急性肺栓塞（PE）的方法，但对于日常临床实践中有效使用的策略知之甚少。
回顾性评估我们机构在1995年1月1日至1996年12月31日期间出院的患者中使用的诊断策略，这些患者的诊断代码为415.1，对应于国际疾病分类中的急性PE。
共识别出127例患者（男性49例；女性78例；平均年龄：71.5±15岁；范围：25 - 95岁）。分别有122例（96%）、121例（95%）、114例（90%）和86例（68%）患者进行了心电图、胸部X线、血气分析和血浆D - 二聚体测量。在最初阶段存活的102例患者（早期死亡率：20%）中，83例（81%）接受了肺闪烁扫描，10例（10%）接受了螺旋CT扫描，2例（2%）接受了肺血管造影，7例（7%）直接接受了治疗。83例接受肺闪烁扫描的患者中有30例结果未明确诊断，但其中只有8例进行了进一步检查（6例进行螺旋CT检查，2例进行肺血管造影检查）。分别有49例（48%）和74例（73%）患者使用经胸超声心动图和下肢超声检查来确诊和寻找栓子来源。
在我们拥有多种现代诊断设备的机构中，通气/灌注肺扫描仍然是最常用的成像技术。螺旋CT经常被用作肺闪烁扫描或肺血管造影的替代方法，而肺血管造影则很少使用。下肢超声检查被广泛应用（尽管不是连续使用且仅作为二线检查），而超声心动图的作用似乎很有限。螺旋CT、肺血管造影和下肢超声检查显示出较高的诊断准确性，而肺闪烁扫描和超声心动图的准确性被证实欠佳。然而，由于我们研究的回顾性设计以及我们研究人群的特点，这些结果不能外推至疑似急性PE的患者，因此有必要进行进一步研究以确定最具成本效益的诊断方法。
