Pavan D, Nicolosi G L, Antonini-Canterin F, Zanuttini D
Dipartimento di Cardiologia, Associazione per la Ricerca in Cardiologia, Pordenone, Italy.
Int J Cardiol. 1998 May 29;65 Suppl 1:S87-90. doi: 10.1016/s0167-5273(98)00071-0.
Pulmonary embolism is a very common disease often misdiagnosed, because of variable and nonspecific clinical manifestations. Therefore it has a burden of high mortality, particularly in nonrecognized cases. Pulmonary angiography, which is usually considered the gold standard, and ventilation/perfusion pulmonary scan have shown good results in this field, but the first is costly and invasive, and both are not easily and rapidly available in all centers. Echocardiography can be helpful in the diagnosis of pulmonary embolism; transthoracic echo in particular is able to recognize indirect signs of the disease, due to acute pressure right overload; it is also possible to evaluate pulmonary artery systolic pressure by continuous wave Doppler. Transthoracic echocardiography can be negative in cases of small pulmonary embolism, in which the pressure overload and therefore haemodynamic impairment is trivial. The sensitivity and specificity of transthoracic echo is low, but its role in the diagnosis and management of pulmonary embolism may be important, because it can easily and rapidly show the presence and degree of right ventricular pressure overload and therefore it can help in addressing therapy and prognosis. Transesophageal echo may directly demonstrate thrombotic masses in the main pulmonary arteries or, less often, floating intracavitary thrombi. In this field it is showing promising results.
肺栓塞是一种常见疾病，常因临床表现多样且不具特异性而被误诊。因此，其死亡率很高，尤其是在未被识别的病例中。通常被视为金标准的肺血管造影和通气/灌注肺扫描在该领域已显示出良好效果，但前者成本高且具有侵入性，而且并非所有中心都能轻易快速地进行这两项检查。超声心动图有助于肺栓塞的诊断；尤其是经胸超声能够识别由于右心急性压力超负荷导致的该病间接征象；还可以通过连续波多普勒评估肺动脉收缩压。对于小的肺栓塞病例，经胸超声心动图可能呈阴性，因为此类病例压力超负荷及血流动力学损害较轻。经胸超声的敏感性和特异性较低，但其在肺栓塞的诊断和管理中的作用可能很重要，因为它能够轻松快速地显示右心室压力超负荷的存在及程度，从而有助于指导治疗和判断预后。经食管超声可直接显示主肺动脉内的血栓块，较少情况下可显示心腔内漂浮血栓。在这一领域，经食管超声正显示出有前景的结果。
