Antakly-Hanon Y, Vieillard-Baron A, Qanadli S D, Fourme T, Léwy P, Jondeau G, Lacombe P, Jardin F, Bourdarias J P, Dubourg O
Service de cardiologie, hôpital Ambroise-Pare, Boulogne.
Arch Mal Coeur Vaiss. 1998 Jul;91(7):843-8.
Transoesophageal echocardiography is a method of visualising intracardiac thrombi and could therefore be useful for the diagnosis of pulmonary embolism, but its diagnostic value is unknown. The authors carried out a prospective study with this diagnostic tool in massive pulmonary embolism. The study protocol was to perform transthoracic echocardiography in patients with suspected acute pulmonary embolism and then to perform transoesophageal echocardiography when there were signs of acute cor pulmonale. The results of both echocardiographic investigations were compared with two reference radiological techniques: the spiral CT scan and/or pulmonary angiography. Fifty-six patients underwent transthoracic echocardiography. In the 34 patients with transthoracic echocardiographic signs of acute cor pulmonale, the positive predictive value of the investigation for pulmonary embolism was 91% and the negative predictive value was 54%. Twenty of these 34 patients underwent transoesophageal echocardiography. The sensitivity and specificity for the diagnosis of proximal embolism were 85% and 86% respectively. The limitations of the method were poor visualisation of the left pulmonary artery in which only one thrombus was detected, compared with 6 by spiral CT scan, and the absence of visualisation of lobar arteries. Consequently, the real sensitivity of transoesophageal echocardiography for visualisation of all thrombi in the pulmonary arteries in acute cor pulmonale was only 55%. In acute cor pulmonale, the diagnostic value of transoesophageal echocardiography is poor because the sensitivity for visualisation of intra-pulmonary arterial thrombi is low compared with other radiological techniques. However, in patients with proximal emboli in the right or main pulmonary artery, the diagnosis may be established in a few minutes without the need of other more invasive techniques. Nevertheless, normal transoesophageal echocardiography does not rule out the presence of proximal in the left pulmonary artery or distal emboli in the lobar arteries.
经食管超声心动图是一种观察心内血栓的方法，因此可能对肺栓塞的诊断有用，但其诊断价值尚不清楚。作者使用这一诊断工具对大面积肺栓塞进行了一项前瞻性研究。研究方案是对疑似急性肺栓塞患者进行经胸超声心动图检查，然后在出现急性肺心病体征时进行经食管超声心动图检查。将两种超声心动图检查结果与两种参考放射学技术：螺旋CT扫描和/或肺血管造影进行比较。56例患者接受了经胸超声心动图检查。在34例有经胸超声心动图急性肺心病体征的患者中，该检查对肺栓塞的阳性预测值为91%，阴性预测值为54%。这34例患者中有20例接受了经食管超声心动图检查。对近端栓塞诊断的敏感性和特异性分别为85%和86%。该方法的局限性在于左肺动脉显示不佳，仅检测到1个血栓，而螺旋CT扫描检测到6个，且叶动脉未显示。因此，经食管超声心动图对急性肺心病患者肺动脉内所有血栓的实际敏感性仅为55%。在急性肺心病中，经食管超声心动图的诊断价值较差，因为与其他放射学技术相比，其对肺动脉内血栓的显示敏感性较低。然而，对于右或主肺动脉近端有栓子的患者，无需其他更具侵入性的技术，几分钟内即可确诊。尽管如此，经食管超声心动图正常并不能排除左肺动脉近端或叶动脉远端存在栓子。
